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

Abstract 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.