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Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection (MIS-C): A Multi-institutional Study from New York City

  • Author Footnotes
    ∗ Contributed equally.
    Shubhi Kaushik
    Footnotes
    ∗ Contributed equally.
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Author Footnotes
    ∗ Contributed equally.
    Scott I. Aydin
    Footnotes
    ∗ Contributed equally.
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY

    Department of Pediatrics, Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Kim R. Derespina
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
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  • Prerna B. Bansal
    Affiliations
    Department of Pediatrics, Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Shanna Kowalsky
    Affiliations
    Department of Pediatrics, Division of Infectious Diseases, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Rebecca Trachtman
    Affiliations
    Department of Pediatrics, Division of Clinical Immunology and Pediatric Rheumatology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Jennifer K. Gillen
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Michelle M. Perez
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
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  • Sara H. Soshnick
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
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  • Edward E. Conway Jr.
    Affiliations
    Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY
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  • Asher Bercow
    Affiliations
    Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY
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  • Howard S. Seiden
    Affiliations
    Department of Pediatrics, Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Robert H. Pass
    Affiliations
    Department of Pediatrics, Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Henry M. Ushay
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
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  • George Ofori-Amanfo
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY

    Department of Pediatrics, Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Shivanand S. Medar
    Correspondence
    Reprint requests: Shivanand S. Medar, MD, Assistant Professor of Pediatrics, Attending Physician, Division of Pediatric Critical Care Medicine and Pediatric Cardiology, Albert Einstein College of Medicine, Children's Hospital at Montefiore, 3411 Wayne Ave, Suite 808B, Bronx, NY 10467
    Affiliations
    Department of Pediatrics, Division of Pediatric Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY

    Department of Pediatrics, Division of Pediatric Cardiology, Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY
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  • Author Footnotes
    ∗ Contributed equally.

      Objective

      To assess clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome in children (MIS-C).

      Study design

      Children with MIS-C admitted to pediatric intensive care units 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; and 39% were black. Comorbidities were present in 45%. Fever (93%) and vomiting (69%) were the most common presenting symptoms. Depressed left ventricular ejection fraction was found in 63% of patients with median ejection fraction 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 in 1 (3%), and intra-aortic balloon pump in 1 (3%). The left ventricular ejection fraction normalized in 95% of those with a depressed ejection fraction. All patients were discharged home with median duration of pediatric intensive care unit stay of 4.7 days (IQR, 4-8 days) and a hospital stay of 7.8 days (IQR, 6.0-10.1 days). One patient (3%) died after withdrawal of care secondary to stroke while on extracorporeal membrane oxygenation.

      Conclusions

      Critically ill children with coronavirus disease-2019-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.

      Abbreviations:

      COVID-19 (Coronavirus disease-2019), ECMO (Extracorporeal membrane oxygenation), IL (Interleukin), IVIG (Intravenous immunoglobulin), LV (Left ventricular), MIS-C (Multisystem inflammatory syndrome in children), PICU (Pediatric intensive care unit), RT-PCR (Reverse transcription polymerase chain reaction), SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2)
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