Citations 3
Postdischarge Glucocorticoid Use and Clinical Outcomes of Multisystem Inflammatory Syndrome in Children
Berbert, Laura , Dallas, Johnathan, Newhams, Margaret M. , Chen, Sabrina , Ardoin, Stacy P. , Basiaga, Matthew L. , Crandall, Hillary , Dhakal, Sanjeev, Sagcal‐Gironella, Anna Carmela P. , Huie, Livie , Jones, Madelyn, Kim, Susan , Lionetti, Geraldina, Mannion, Melissa L. , Muscal, Eyal , Tejtel, S. Kristen Sexson , Villacis-Nunez, D. Sofia , Wu, Eveline Y. , Zambrano, Laura D. , Campbell, Angela P. , Patel, Manish M. , Randolph, Adrienne G. , Investigators, Overcoming COVID-19, Kong, Michele , Tarquinio, Keiko M. , Kücükak, Suden, FitzGerald, Madyson M., Worden, Julie, Levy, Emily R. , Martin, Lora , Malloch, Lacy , Clouser, Katharine N. , Walker, Tracie C. , Hall, Mark W., Staat, Mary Allen , Loftis, Laura L. , Smith, Lincoln , Feldstein, Leora R. , Jackson, Ashley , Levy, Emily R , Randolph, Adrienne G , Kong, Michele , Mannion, Melissa L , Staat, Mary A , Son, Mary Beth F. , Young, Cameron C. , Canny, Susan , Dhanrajani, Anita D. , Hobbs, Charlotte V. , James, Karen, Prahalad, Sampath , Schulert, Grant S , Investigators, Overcoming COVID-19, Cvijanovich, Natalie Z , Zinter, Matt S. , Schwartz, Stephanie P. , Hall, Mark W. , McGuire, John K. , Tenforde, Mark W.
JAMA Network Open | November 11, 2022 | Volume: 5 | Issue: 11 | Pages: e2241622
10.1001/jamanetworkopen.2022.41622
ImportanceMinimal data are available regarding the postdischarge treatment of multisystem inflammatory syndrome in children (MIS-C).ObjectivesTo evaluate clinical characteristics associated with duration of postdischarge glucocorticoid use and assess postdischarge clinical course, laboratory test result trajectories, and adverse events in a multicenter cohort with MIS-C.Design, Setting, and ParticipantsThis retrospective cohort study included patients with MIS-C hospitalized with severe illness and followed up for 3 months in an ambulatory setting. Patients younger than 21 years who were admitted between May 15, 2020, and May 31, 2021, at 13 US hospitals were included. Inclusion criteria were inpatient treatment comprising intravenous immunoglobulin, diagnosis of cardiovascular dysfunction (vasopressor requirement or left ventricular ejection fraction ≤55%), and availability of complete outpatient data for 3 months.ExposuresGlucocorticoid treatment.Main Outcomes and MeasuresMain outcomes were patient characteristics associated with postdischarge glucocorticoid treatment, laboratory test result trajectories, and adverse events. Multivariable regression was used to evaluate factors associated with postdischarge weight gain (≥2 kg in 3 months) and hyperglycemia during illness.ResultsAmong 186 patients, the median age was 10.4 years (IQR, 6.7-14.2 years); most were male (107 [57.5%]), Black non-Hispanic (60 [32.3%]), and Hispanic or Latino (59 [31.7%]). Most children were critically ill (intensive care unit admission, 163 [87.6%]; vasopressor receipt, 134 [72.0%]) and received inpatient glucocorticoid treatment (178 [95.7%]). Most were discharged with continued glucocorticoid treatment (173 [93.0%]); median discharge dose was 42 mg/d (IQR, 30-60 mg/d) or 1.1 mg/kg/d (IQR, 0.7-1.7 mg/kg/d). Inpatient severity of illness was not associated with duration of postdischarge glucocorticoid treatment. Outpatient treatment duration varied (median, 23 days; IQR, 15-32 days). Time to normalization of C-reactive protein and ferritin levels was similar for glucocorticoid duration of less than 3 weeks vs 3 or more weeks. Readmission occurred in 7 patients (3.8%); none was for cardiovascular dysfunction. Hyperglycemia developed in 14 patients (8.1%). Seventy-five patients (43%) gained 2 kg or more after discharge (median 4.1 kg; IQR, 3.0-6.0 kg). Inpatient high-dose intravenous and oral glucocorticoid therapy was associated with postdischarge weight gain (adjusted odds ratio, 6.91; 95% CI, 1.92-24.91).Conclusions and RelevanceIn this multicenter cohort of patients with MIS-C and cardiovascular dysfunction, postdischarge glucocorticoid treatment was often prolonged, but clinical outcomes were similar in patients prescribed shorter courses. Outpatient weight gain was common. Readmission was infrequent, with none for cardiovascular dysfunction. These findings suggest that strategies are needed to optimize postdischarge glucocorticoid courses for patients with MIS-C.
BNT162b2 mRNA Vaccination Against Coronavirus Disease 2019 is Associated With a Decreased Likelihood of Multisystem Inflammatory Syndrome in Children Aged 5–18 Years—United States, July 2021 – April 2022
Zambrano, Laura D. , Newhams, Margaret M. , Olson, Samantha M. , Halasa, Natasha , Price, Ashley M. , Orzel, Amber, Boom, Julie A. , Bline, Katherine , Kamidani, Satoshi , Tarquinio, Keiko M. , Schuster, Jennifer E. , Cullimore, Melissa L. , Heidemann, Sabrina M. , Nofziger, Ryan A. , Cameron, Melissa A. , Walker, Tracie C. , Michelson, Kelly N, Coates, Bria M. , Flori, Heidi R. , Mack, Elizabeth H. , Smallcomb, Laura , Gertz, Shira J. , Bhumbra, Samina S. , Bradford, Tamara T. , Levy, Emily R. , Kong, Michele , Irby, Katherine, Zinter, Matt S. , Bowens, Cindy, Crandall, Hillary , Hume, Janet R. , Patel, Manish M, Campbell, Angela P. , Randolph, Adrienne G. , Investigators, for the Overcoming COVID-19, Murdock, Meghan, Gaspers, Mary Glas , Kelley, Connor P. , Irby, Katherine, Sanders, Ronald C., Yates, Masson, Smith, Chelsea , Crane, Katheryn, Lionetti, Geraldina, Murcia-Montoya, Juliana, Villarreal-Chico, Denise, Skura, Adam L., Hakimi, Daniel , Peralta, Harvey, Sea, Yea Ji, Mrotek, Kennis-Grace, Lockwood, Justin M. , Port, Emily, Carson, Imogene A., Chatani, Brandon , Kamidani, Satoshi, Hussaini, Laila, Baida, Nadine, Michelson, Kelly N, Rhodes, Simone T., Khan, Hassan A, Rowan, Courtney M. , Stumpf, Mary, Johnston, Marla , Newhams, Margaret M, Kücükak, Suden, Orzel, Amber O, Chen, Sabrina R., Boutselis, Benjamin J., McCadden, Timothy P. , Stewart, Kasey R, Weller, Edie, Berbert, Laura , He, Jie , Bruno, Ellen R., Goertzen, Lexie A., Drapeau, Noelle M., Martin, Lora , Malloch, Lacy , Harrison, Virginia A., Sanders, Cameron , Patterson, Kayla , Chikere, Chidinma A, Kietzman, Abigail , Sullivan, Melissa, Rinehart, Valerie H., Hoody, Lauren A., Bennett, Paris C., Twinem, Nicole A., Tomcany, Merry, Staat, Mary Allen , Rohlfs, Chelsea C., Wolfe, Amber, Chiotos, Kathleen, Douglas, Rebecca L. , Phengchomphet, Kathlyn, Bickford, Megan M., Wakefield, Lauren E., Hayek, Haya , Romero, Yesenia, Boom, Julie A, Oates, Jennifer N., Maamari, Mia , Bowens, Cindy, Olson, Mady, Zambrano, Laura D, Patel, Manish M, Kamidani, Satoshi , Levy, Emily R , Randolph, Adrienne G , Kong, Michele , Hume, Janet R , Zambrano, Laura D , Staat, Mary A , Gertz, Shira J , Bline, Katherine E , Young, Cameron C. , Sahni, Leila C , Maddux, Aline B. , Chiotos, Kathleen , Hobbs, Charlotte V. , Pannaraj, Pia S. , Schwartz, Stephanie P. , Michelson, Kelly N, Irby, Katherine, Cvijanovich, Natalie Z , Bowens, Cindy, Patel, Manish M, Investigators, for the Overcoming COVID-19, Typpo, Katri , Irby, Katherine, Kamidani, Satoshi, Michelson, Kelly N, Newhams, Margaret M, Orzel, Amber O, Moran, Patrick, Behl, Supriya , Chiotos, Kathleen, Boom, Julie A, Bowens, Cindy, Olson, M, Zambrano, Laura D, Patel, Manish M
Clinical Infectious Diseases | August 4, 2022 | Volume: 76 | Issue: 3 | Pages: e90-e100
Abstract Background Multisystem inflammatory syndrome in children (MIS-C), linked to antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is associated with considerable morbidity. Prevention of SARS-CoV-2 infection or coronavirus disease 2019 (COVID-19) by vaccination might also decrease MIS-C likelihood. Methods In a multicenter, case-control, public health investigation of children ages 5–18 years hospitalized from 1 July 2021 to 7 April 2022, we compared the odds of being fully vaccinated (2 doses of BNT162b2 vaccine ≥28 days before hospital admission) between MIS-C case-patients and hospital-based controls who tested negative for SARS-CoV-2. These associations were examined by age group, timing of vaccination, and periods of Delta and Omicron variant predominance using multivariable logistic regression. Results We compared 304 MIS-C case-patients (280 [92%] unvaccinated) with 502 controls (346 [69%] unvaccinated). MIS-C was associated with decreased likelihood of vaccination (adjusted OR [aOR]: .16; 95% CI: .10–.26), including among children ages 5–11 years (aOR: .22; 95% CI: .10–.52), ages 12–18 years (aOR: .10; 95% CI: .05–.19), and during the Delta (aOR: .06; 95% CI: .02–.15) and Omicron (aOR: .22; 95% CI: .11–.42) variant-predominant periods. This association persisted beyond 120 days after the second dose (aOR: .08; 95% CI: .03–.22) in 12–18-year-olds. Among all MIS-C case-patients, 187 (62%) required intensive care unit admission and 280 (92%) vaccine-eligible case-patients were unvaccinated. Conclusions Vaccination with 2 doses of BNT162b2 is associated with reduced likelihood of MIS-C in children ages 5–18 years. Most vaccine-eligible hospitalized patients with MIS-C were unvaccinated.
Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C
Berbert, Laura , Young, Cameron C. , Feldstein, Leora R. , Zambrano, Laura D. , Kücükak, Suden, Newhams, Margaret M. , Miller, Kristen , FitzGerald, Madyson M., He, Jie , Halasa, Natasha , Loftis, Laura L. , Walker, Tracie C. , Gertz, Shira J. , Tarquinio, Keiko M. , Fitzgerald, Julie C. , Kong, Michele , Schuster, Jennifer E. , Mack, Elizabeth H. , Rowan, Courtney M. , Staat, Mary Allen , Zinter, Matt S. , Irby, Katherine , Crandall, Hillary , Flori, Heidi R. , Cullimore, Melissa L. , Nofziger, Ryan A. , Gaspers, Mary Glas , Hume, Janet R. , Levy, Emily R. , Chen, Sabrina , Patel, Manish M. , Weller, Edie, Campbell, Angela P. , Randolph, Adrienne G. , Investigators, for the Overcoming COVID-19, Martin, Lora , Malloch, Lacy , Levy, Emily R , Young, Cameron C , Randolph, Adrienne G , Kong, Michele , Hume, Janet R , Staat, Mary A , Gertz, Shira J , Maddux, Aline B. , Miller, Kristen R. , Cvijanovich, Natalie Z , Schwartz, Stephanie P. , Hobbs, Charlotte V. , Shein, Steven L. , Tenforde, Mark W. , Investigators, for the Overcoming COVID-19
Pediatrics | June 29, 2022 | Volume: 150 | Issue: 3 | Pages: No page available
OBJECTIVES To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C). METHODS Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04–1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06–1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55–6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35–4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C). CONCLUSIONS Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.