Heart Troubles Ease Over Time in Kids With MIS-C
Here's some reassuring news for parents: Most heart problems in children with a rare inflammatory condition triggered by COVID-19 infection resolve within a few months, a new study finds.
Multisystem inflammatory syndrome in children (MIS-C) causes inflammation throughout the body, and many patients develop a range of non-respiratory symptoms such as abdominal pain, skin rashes, heart abnormalities and, in some cases, extremely low blood pressure.
The study included 45 children, median age 9 years, with MIS-C who were treated at NewYork-Presbyterian Morgan Stanley Children's Hospital, in New York City. When first admitted, the children were critically ill and required intensive care.
Nearly 80% had some type of heart problem, and almost half had moderate to severe heart abnormalities, including decreased ability of the heart to pump, coronary artery dilation, and leaking heart valves.
Two-thirds of the children had a temporary decrease in the number of white blood cells, the majority had an increase in inflammatory markers, and more than half had elevated markers of heart injury.
The children were given steroids to ease inflammation, and most received intravenous immunoglobulin and immunomodulators to normalize the immune system. One-third received respiratory support, though none required external life support. More than half received treatment to increase and maintain blood pressure.
"These kids were quite sick, but at our hospital, where we began using steroids and other treatments routinely for MIS-C, most of the patients responded rapidly and were discharged by about five days," said study first author Dr. Kanwal Farooqi. She is an assistant professor of pediatrics at Columbia University College of Physicians and Surgeons and a pediatric cardiologist at NewYork-Presbyterian Morgan Stanley Children's Hospital.
"It was both challenging and scary, because we didn't know how these patients would do long term, especially in terms of cardiac and immunologic abnormalities, which were the most prominent issues at the time," Farooqi said in a university news release.
The researchers found that immunologic abnormalities and markers for heart injury returned to normal within a few weeks after the children left the hospital, and most of the heart abnormalities, including all of the coronary artery abnormalities, had resolved by four months.
Most of the children continued to do well several months after being hospitalized, according to the study published online July 15 in the journal Pediatrics.
"Nevertheless, given the absence of long-term data, we are recommending that children who had more than mild dysfunction on cardiac ultrasound should get a cardiac MRI at six months and see a pediatrician before being cleared for competitive sports," Farooqi said.
While there's been a steep decline in cases of MIS-C, "it's reasonable [for parents] to have children evaluated by a pediatrician or a cardiologist if they complain of nonspecific cardiac symptoms like chest pain or palpitations," Farooqi said. "They can then be screened so that the need for further testing can be better assessed."
The U.S. Centers for Disease Control and Prevention has more on MIS-C.
SOURCE: Columbia University Irving Medical Center, news release, July 15, 2021
Infections: Misc.