Treatment response and short-term outcomes in children admitted as multisystem inflammatory syndrome in children

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a postviral complication that has been described among children after 2–6 weeks of exposure to the COVID-19 virus from various parts of the world. Published literature regarding MIS-C in children is limited. The aim of this study was to investigate the disease management and clinical outcomes of a larger group of children from North India presenting with features of MIS-C. Materials and Methods: This is an observational study of children with MIS-C, admitted to the pediatric intensive care unit (PICU) between March 1, 2021, and August 31, 2021, during the second wave of SARS-CoV-2 infection in India. Results: Out of the 37 children presenting with MIS-C, 62% of patients were male and 37% were female patients. Vasoactive medications were required in 14 patients. Eighteen patients required respiratory support, of which 17 received noninvasive ventilation and only one patient required invasive mechanical ventilation. Methylprednisolone and intravenous immunoglobulin (IVIG) were used in the majority of patients. No patient required remdesivir. Thirty-six patients were discharged home with a median duration of 4 days in PICU and a hospital stay of 10 days, only 1 (2.7%) patient died during the treatment. Thirty-five (94.5%) patients received IVIG alone, and five patients (13.5%) received IVIG along with methylprednisolone. Patients who received a combination of steroids and IVIG had greater severity of illness, deranged laboratory parameters, highly raised inflammatory markers, requiring higher inotropes, respiratory support, PICU requirement, and length of stay in hospital. Conclusions: The decision to treat MIS-C patients with IVIG plus methylprednisolone or IVIG alone must be reviewed on an individual basis. IVIG in conjunction with methylprednisolone should be considered for patients with severe MIS-C and hypotension who have been admitted to the PICU.