Pediatric COVID-19 MIS: delayed onset, cardiovascular symptoms dominate

  • Feldstein LR & al.
  • N Engl J Med
  • 29 Jun 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • SARS-CoV-2 multisystem inflammatory syndrome (MIS) in children (MIS-C) is associated with delayed onset, multi-organ system damage in previously healthy children and adolescents.
  • Related study and editorial: MIS-C is distinct from Kawasaki’s disease.
  • MIS-C is linked to older age, more intense inflammation and myocardial injury, and different racial/ethnic predominance.

Why this matters

Key results

  • 186 patients, 26 US states.
  • Median age, 8.3 (interquartile range, 3.3-12.5) years.
  • 70% tested positive for SARS-CoV-2.
  • 7% had symptoms before MIS-C onset (median interval, 25 days).
  • 73% were previously healthy.
  • 2% (4 patients) died.
  • 71% (132) had >4 organ systems involved, including:
    • 92% gastrointestinal.
    • 80% cardiovascular.
    • 76% hematologic.
    • 74% mucocutaneous.
    • 70% respiratory.
  • Median (interquartile range) hospital duration:
    • 7 days (4-10) among those discharged alive. 
    • 5 days (2-5) for those who died.
  • Treatment: 98%-100% intravenous Ig, ~49% glucocorticoids, 8% IL-6 inhibitors, 13% IL-1Ra inhibitor.
  • 48% with cardiovascular involvement received vasoactive support.
  • 73% (94/128) had elevated B-type natriuretic peptide, 50% (77/153) elevated troponin.
  • Coronary artery aneurysm z score >2.5 in left artery in 8% and right artery in 9%.
  • 59% had respiratory insufficiency/failure.
  • 78% had no underlying respiratory conditions.

Study design

  • Targeted epidemiological surveillance study characterizing MIS-C epidemiology, clinical characteristics.
  • Funding: CDC.

Limitations

  • Underestimated cases.
  • Limited generalizability.