Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2 Infection: A Multi-institutional Study from New York City

Kaushik, Shubhi; Aydin, Scott I.; Derespina, Kim R.; Bansal, Prerna B.; Kowalsky, Shanna; Trachtman, Rebecca; Gillen, Jennifer K.; Perez, Michelle M.; Soshnick, Sara H.; Conway, Edward E.; Bercow, Asher; Seiden, Howard S.; Pass, Robert H.; Ushay, Henry M.; Ofori-Amanfo, George; Medar, Shivanand S.

OBJECTIVE: To assess clinical characteristics and outcomes of SARS-CoV-2 associated multisystem inflammatory syndrome in children (MIS-C). STUDY DESIGN: Children with MIS-C admitted to pediatric intensive care units (PICU) in New York City between April 23 and May 23, 2020 were included. Demographic and clinical data were collected. RESULTS: Of 33 children with MIS-C, the median age was 10 years; 61% were male; 45% were Hispanic/Latino; 39% were black. Comorbidities were present in 45%. Fever (93%) and vomiting (69%) were the most common presenting symptoms. Depressed left ventricular ejection fraction (LVEF) was found in 63% of patients with median EF of 46.6% (IQR 39.5, 52.8). C-reactive protein, procalcitonin, D-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. For treatment, intravenous immunoglobulin was used in 18 (54%), corticosteroids in 17 (51%), tocilizumab in 12 (36%), remdesivir in 7 (21%), vasopressors in 17 (51%), mechanical ventilation in 5 (15%), extracorporeal membrane oxygenation (ECMO) in 1 (3%), and intra-aortic balloon pump in 1 (3%). The LVEF normalized in 95% of those with depressed EF. All patients were discharged home with median duration of PICU stay of 4.7 (4, 8) days and hospital stay of 7.8 (6, 10.1) days. One (3%) patient died after withdrawal of care secondary to stroke while on ECMO. CONCLUSIONS: Critically ill children with COVID-19 associated MIS-C have a spectrum of severity broader than described previously but still require careful supportive intensive care. Rapid, complete clinical and myocardial recovery was almost universal.