Short-, mid-, and long-term complications after multisystem inflammatory syndrome in children over a 24-month follow-up period in a hospital in Lima-Peru, 2020-2022

Giancarlo Alvarado-Gamarra; Matilde Estupiñan-Vigil; Raquel Garcés-Ghilardi; Jesús Domínguez-Rojas; Olguita Del Águila; Katherine Alcalá-Marcos; Rafael Márquez Llanos; Lucie Ecker; Carlos R Celis; Carlos Alva-Diaz; Claudio F Lanata

doi:10.3389/fped.2023.1232522

Short-, mid-, and long-term complications after multisystem inflammatory syndrome in children over a 24-month follow-up period in a hospital in Lima-Peru, 2020-2022

Front Pediatr. 2023 Nov 24:11:1232522. doi: 10.3389/fped.2023.1232522. eCollection 2023.

Authors

Affiliations

¹ Department of Pediatrics, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.
² Instituto de Investigación Nutricional, Lima, Peru.
³ Red de Eficacia Clínica y Sanitaria, REDECS, Lima, Peru.
⁴ Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo"-INCOR, Lima, Peru.
⁵ Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú.
⁶ Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru.
⁷ Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN, United States.
⁸ Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Abstract

Objective: To determine the short-, mid-, and long-term complications after multisystem inflammatory syndrome in children (MIS-C) over a 24-month follow-up period in a hospital in Lima, Peru, 2020-2022, and to explore differences according to the immunomodulatory treatment received and type of SARS-CoV-2 virus circulating.

Methods: Ambispective 24-month follow-up study in children <14 years of age diagnosed with MIS-C at the Hospital Nacional Edgardo Rebagliati Martins (HNERM).

Results: A total of 62 children were admitted with MIS-C. The most common short-term complications and serious events were intensive care unit (ICU) admission, invasive mechanical ventilation (IMV) due to respiratory failure, and shock; predominantly during the second pandemic wave (lambda predominance) and in children that received intravenous immunoglobulin (IVIG) plus a corticosteroid. Two patients died during the first wave due to MIS-C. During prospective follow-up (median of 24 months; IQR: 16.7-24), only 46.7% of patients were followed for >18-24 months. Of the total, seven (11.3%) patients were identified with some sequelae on discharge. Among the 43 remaining children, sequelae persisted in five (11.6%) cases (neurological, hematological, and skin problems). Six patients (13.9%) presented with new onset disease (hematologic, respiratory, neurological, and psychiatric disorders). One patient died due to acute leukemia during the follow-up period. None of them were admitted to the ICU or presented with MIS-C reactivation. Two patients presented persistence of coronary aneurysm until 8- and 24-month post-discharge.

Conclusion: In our hospital, children with MIS-C frequently developed short-term complications and serious events during the acute phase, with less frequent complications in the mid- and long-term. More studies are required to confirm these findings.

Keywords: COVID-19; Peru; death; hospitalization; long-term effect; multisystem inflammatory syndrome in children; pediatric multisystem inflammatory disease.

Grants and funding

GA was supported by the Kaelin Award in Health Sciences-protocols 2021 grant from the “Instituto de Evaluación e Investigación de Tecnologías en Salud” (IETSI), EsSalud, Peru. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.