Neurocognitive, Psychosocial, and Quality of Life Outcomes After Multisystem Inflammatory Syndrome in Children Admitted to the PICU

• Published in: Pediatric critical care medicine Vol. 24; no. 4; p. 289
• Main Authors: Otten, Marieke H, Buysse, Corinne M P, Buddingh, Emmeline P, Terheggen-Lagro, Suzanne W J, von Asmuth, Erik G J, de Sonnaville, Eleonore S V, Ketharanathan, Naomi, Bunker-Wiersma, Heleen E, Haverman, Lotte, Hogenbirk, Karin, de Hoog, Matthijs, Humblet, Martien, Joosten, Koen F M, Kneyber, Martin C J, Krabben, Geanne, Lemson, Joris, Maas, Nienke M, Maebe, Sofie, Roeleveld, Peter P, van Schooneveld, Monique, Timmers-Raaijmaakers, Brigitte, van Waardenburg, Dick, Walker, Jennifer C, Wassenberg, Renske, van Woensel, Job B M, de Wit, Esther, Wolthuis, Diana W, van Zwol, Annelies, Oostrom, Kim J, Knoester, Hennie, Dulfer, Karolijn
• Format: Journal Article
• Language: English
• Published: United States 01.04.2023
• Subjects: Child; COVID-19 - epidemiology; Humans; Intensive Care Units, Pediatric; Prospective Studies; Quality of Life
• ISSN: 1529-7535; 1947-3893
• DOI: 10.1097/PCC.0000000000003180

To investigate neurocognitive, psychosocial, and quality of life (QoL) outcomes in children with Multisystem Inflammatory Syndrome in Children (MIS-C) seen 3-6 months after PICU admission. National prospective cohort study March 2020 to November 2021. Seven PICUs in the Netherlands. Children with MIS-C (0-17 yr) admitted to a PICU. None. Children and/or parents were seen median (interquartile range [IQR] 4 mo [3-5 mo]) after PICU admission. Testing included assessment of neurocognitive, psychosocial, and QoL outcomes with reference to Dutch pre-COVID-19 general population norms. Effect sizes (Hedges' g ) were used to indicate the strengths and clinical relevance of differences: 0.2 small, 0.5 medium, and 0.8 and above large. Of 69 children with MIS-C, 49 (median age 11.6 yr [IQR 9.3-15.6 yr]) attended follow-up. General intelligence and verbal memory scores were normal compared with population norms. Twenty-nine of the 49 followed-up (59%) underwent extensive testing with worse function in domains such as visual memory, g = 1.0 (95% CI, 0.6-1.4), sustained attention, g = 2.0 (95% CI 1.4-2.4), and planning, g = 0.5 (95% CI, 0.1-0.9). The children also had more emotional and behavioral problems, g = 0.4 (95% CI 0.1-0.7), and had lower QoL scores in domains such as physical functioning g = 1.3 (95% CI 0.9-1.6), school functioning g = 1.1 (95% CI 0.7-1.4), and increased fatigue g = 0.5 (95% CI 0.1-0.9) compared with population norms. Elevated risk for posttraumatic stress disorder (PTSD) was seen in 10 of 30 children (33%) with MIS-C. Last, in the 32 parents, no elevated risk for PTSD was found. Children with MIS-C requiring PICU admission had normal overall intelligence 4 months after PICU discharge. Nevertheless, these children reported more emotional and behavioral problems, more PTSD, and worse QoL compared with general population norms. In a subset undergoing more extensive testing, we also identified irregularities in neurocognitive functions. Whether these impairments are caused by the viral or inflammatory response, the PICU admission, or COVID-19 restrictions remains to be investigated.