COVID-19: Children Above 5 Years at Higher Risk of MIS-C

Children who are above 5 years and those with high blood markers for inflammation (ferritin) were found to be at a higher risk of developing severe Covid-related multisystem inflammatory syndrome.

The research is published in CMAJ (Canadian Medical Association Journal).

The international study included 232 children younger than 18 admitted to 1 of 15 centers - 13 in Canada, 1 in Costa Rica and 1 in Iran - for suspected MIS-C between March 1, 2020, and March 7, 2021.

‘In children, COVID-19 is usually mild. However, in rare cases, children can be severely affected, and present symptoms similar to Kawasaki disease (KD) or toxic shock syndrome.’

The patients met the World Health Organization's definition for MIS-C, which includes fever persisting for at least 3 days; elevated C-reactive protein, which indicates inflammation; illness involving 2 or more systems with no obvious microbial cause of inflammation; and positivity for COVID-19 or suspected contact with a positive case.

Most patients (89%) had gastrointestinal symptoms such as pain and dermatological problems like rashes and swelling (85%).

Cardiac involvement was common (59%), as were abnormalities in blood coagulation (90%).

Of the 232 children, 73 (31.5%) were admitted to ICU, and 47 (64%) of them needed treatment for very low blood pressure.

The risk of admission to the ICU was higher in children aged 6-12 years (44%) and 13-17 years (46%) than in children aged 0-5 years (18%). As well, children admitted to the hospital later in the pandemic (between November 2020 and March 2021) were more likely to be admitted to the ICU (50 of 112, 45%) than those hospitalized earlier (23 of 120, 19%).

The authors note challenges in diagnosing MIS-C.

"Multisystem inflammatory syndrome in children is a new diagnosis, with differing diagnostic criteria that have not been validated," writes Dr. Joan Robinson, a pediatrician at the University of Alberta, Edmonton, Alberta, with coauthors.

"Most of these children lacked a history of contact with a person with proven SARS-CoV-2 infection. Identifying exposure can be difficult as infected contacts may be asymptomatic or may never have been tested."

The authors call for international consensus on MIS-C diagnostic criteria to enhance clinical care and research.



Source: Eurekalert