Clinical Profile and Short-Term Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome (MIS-C) Treated With Pulse Methylprednisolone

• Published in: Indian pediatrics Vol. 58; no. 8; pp. 718 - 722
• Main Authors: Sugunan, Sheeja, Bindusha, S., Geetha, S., Niyas, H. R., Kumar, A. Santhosh
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.08.2021
• Subjects: Maternal and Child Health; Medicine; Medicine & Public Health; Pediatric Surgery; Pediatrics; Research Paper; COVID-19; IVIG; Kawasaki disease; Coronary artery
• ISSN: 0019-6061; 0974-7559
• DOI: 10.1007/s13312-021-2277-4

Objective To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and/or intravenous immunoglobulin (IVIG). Method This prospective observational study included children satisfying CDC MIS-C criteria admitted from September to November, 2020. Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks. Results Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5–9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respec-tively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group ( P =0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group. Conclusion In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.