OA02 A cohort of 79 children with Paediatric multisystem inflammatory syndrome associated with COVID-19
Authors: Bohm Marek , Amin Tania , Deri Antigoni , Gargh Kapil , Wood Mark 
Published: April 2022

Abstract

Background/Aims
COVID-19 can manifest as a significant lung inflammation in adults. Although the course of disease is usually mild in children, it occasionally results in Paediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS). We present a cohort of 79 children treated for PIMS-TS in Yorkshire, UK between May 2020 and September 2021.

Methods
This retrospective multicentre cohort study includes children fulfilling the case definition of PIMS-TS according to Royal College of Paediatrics and Child Health criteria. The collected data include demographics, clinical symptoms, laboratory results, echocardiographic findings, treatment and outcomes.

Results
Out of 79 PIMS-TS cases, 50 were male, 29 female. Ages were between 3 months and 16 years (median 7 years). 45 children were within the normal weight range for age, 4 underweight, 30 overweight. 41 children were Caucasian, 34 Asian, 2 African and 2 Afro-Caribbean origin. The median duration of admission was 7 days with range 0-21 days. All children had fever. In 51 cardiac involvement was detected (impaired cardiac function, pericardial effusion or changes on coronary arteries by echocardiographic examination). In 51 children a skin rash was observed (usually macular blanching confluent non-pruritic), 48 children had gastrointestinal symptoms such as abdominal pains, vomiting or diarrhoea, 39 children had non-purulent conjunctivitis, 13 children enlarged cervical lymph nodes. All patients initially received antibiotics and all but two were treated with an anti-platelet dose of aspirin, a small number early on with an anti-inflammatory dose of aspirin, 31 were treated with 3 consecutive infusions of intravenous methylprednisolone (IVMP) 10 mg/kg daily followed by a weaning dose of oral prednisolone, 35 by IVMP and intravenous immunoglobulins (IVIG), 9 by IVIG only. The duration of treatment by oral prednisolone was 3-35 days with median 15 days. Inotropic support for hypotension was needed in 18 cases and oxygen therapy in 11 cases. All children had a good outcome and are being followed-up in our Paediatric Rheumatology / Cardiology clinics at 1-2 weeks, 6 weeks, 6 months and 12 months. To date, follow-up at 12 months has shown resolution of cardiac abnormalities including initial mild dilatation of coronary arteries; most of our patients have fully recovered within 6 weeks. No patients had any thromboembolic event identified. After discharge from hospital self-limiting musculoskeletal pains, lethargy, peeling of palms and/or headaches were common. 3 patients received psychology support.

Conclusion
We report 100% survival in our cohort of patients with PIMS-TS. None of the patients represented with flare of the symptoms. The majority were treated by corticosteroids alone, or in combination with IVIG. We believe that advance knowledge of PIMS-TS (from colleagues in other regions in the UK, affected earlier), prompt treatment and structured follow-up approach by multi-disciplinary team contributed to the good outcomes so far.

Disclosure
M. Bohm: None. T. Amin: None. A. Deri: None. K. Gargh: None. M. Wood: None.