Intensive care needs and short-term outcome of Multisystem Inflammatory Syndrome in Children (MIS-C): Experience from North India

Angurana, Suresh Kumar; Awasthi, Puspraj; Thakur, Ajay; Randhawa, Manjinder Singh; Nallasamy, Karthi; Kumar, Manoj Rohit; Naganur, Sanjeev; Kumar, Mahendra; Goyal, Kapil; Ghosh, Arnab; Bansal, Arun; Jayashree, Muralidharan

OBJECTIVES: To describe the intensive care needs and outcome of Multisystem Inflammatory Syndrome in Children (MIS-C). METHODOLOGY: This retrospective study was conducted in the Pediatric Emergency and Intensive Care Units and COVID-19 hospital of a tertiary care teaching and referral hospital in North India over a period of 5 months (September 2020-January 2021). Clinical details, laboratory investigations, intensive care needs, treatment, and short-term outcome were recorded. RESULTS: Forty children with median (IQR) age of 7 (5-10) years were enrolled. The common clinical features were fever (97.5%), mucocutaneous involvement (80%), abdominal (72.5%) and respiratory (50%) symptoms. Shock was noted in 80% children. Most cases (85%) required PICU admission where they received nasal prong oxygen (40%), non-invasive (22.5%) and invasive (22.5%) ventilation, and vasoactive drug support (72.5%). The confirmation of SARS-CoV-2 exposure was noted in the form of positive serology (66.7%), RT PCR (10%), and contact with SARS-CoV-2 positive case (12.5%). The common echocardiographic findings included myocardial dysfunction (ejection fraction <55%) (72.5%), and coronary artery dilatation or aneurysm (22.5%). The immunomodulatory treatment included IVIG (2 gm/kg) (100%) and steroids (methylprednisolone 10-30 mg/kg/day for 3-5 days) (85%). Aspirin was used in 80% and heparin (low molecular weight) in 7.5% cases. Two children died (5%) and median duration of PICU and hospital stay in survivors were 5 (2-8) and 7 (4-9) days, respectively. Children with shock showed higher total leucocyte count and higher rates of myocardial dysfunction. CONCLUSION: Cardiovascular involvement and shock are predominant features in severe disease. Early diagnosis may be challenging given the overlapping features with other diagnoses. A high index of suspicion is warranted in children with constellation of fever, mucocutaneous, GI and cardiovascular involvement alongwith evidence of systemic inflammation and recent or concurrent SARS-CoV-2 infection. The short-term outcome is good with appropriate organ support therapies and immunomodulation.