Multidimensional 1-Year Outcomes After Intensive Care Admission for Multisystem Inflammatory Syndrome in Children.

Abstract

Objectives: The COVID-19 pandemic gave rise to uncertainty concerning potential sequelae related to a severe acute respiratory syndrome coronavirus 2 infection. This landscape is currently unfolding with studies reporting sequelae on various domains (physical, cognitive, and psychosocial), although most studies focus on adults or only one domain. We sought to investigate concurrent sequelae on multiple domains 1 year after PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C).

Design: Prospective cohort study.

Setting: Two academic, tertiary referral hospitals in The Netherlands and Belgium.

Patients: Patients (< 18 yr, n = 58) seen in-person 1-year after PICU admission for MIS-C.

Interventions: None.

Measurements and main results: Seventy MIS-C patients (62% male; median age, 10.0 [interquartile range, 7.4-13.0]) were admitted to the PICU, mostly (86%) due to (imminent) circulatory failure. The majority received IV immunoglobulins (95%), steroids (83%), and vasopressors and/or inotropes (72%). Invasive respiratory support and extracorporeal membrane oxygenation were necessary in 7% and 2%, respectively. All patients survived. Fifty-eight patients (83%) attended 1-year follow-up. Although most patients had normal functional performance scores (Pediatric Cerebral Performance Category, Pediatric Overall Performance Category, and Functional Status Score), 62% still experienced physical sequelae: fatigue (40%), headaches (27%), and decreased exercise tolerance (19%). Cognitive, behavioral, and psychological problems were reported in 14%, 13%, and 23%, respectively. This resulted in 22% requiring ongoing healthcare utilization, 9% not being able to return to full-time school attendance and cessation of hobbies in 7%.

Conclusions: This is the first 1-year outcome study of MIS-C PICU patients to include both physical and psychosocial characteristics. One year after PICU admission, most children had normalized functional performance as measured by three validated performance scores. However, many still reported a variety of multidimensional sequelae at 1-year follow-up impacting daily life. This emphasizes the importance of continued investigative efforts and multidisciplinary follow-up programs to better understand pathophysiology and contributing factors to the MIS-C disease trajectory and initiate patient-specific interventions to improve outcome and social participation.