Multisystem Inflammatory Syndrome Associated with Sars-Cov-2 in Children- a Comparative Study between First and Second Wave

ABSTRACT

BACKGROUND AND AIM: The clinical spectrum and management of Multi-system Inflammatory Syndrome in Children (MIS-C) is evolving with each wave of COVID-19. This study aims to compare the clinical spectrum and immunomodulatory management of children with MIS-C between first and second wave in a tertiary care hospital in south India. METHOD(S) This prospective observational comparative study included children satisfying CDC MIS-C criteria admitted during 1st and 2nd wave of COVID 19 (total period from September 2019 to January 2022). We compared the clinical presentation, severity of illness, inflammatory biomarker profile, immunomodulatory therapy, need for inotropic support, duration of stay and outcome. RESULT(S) Study population included 27 during 1st wave and 75 during 2nd wave. Median age (IQR) of patients was 4.4years (3.15, 7.95) and 5.6 years (3.25, 8.8) during 1st and 2nd wave respectively. Males preponderance was seen in both waves (69% VS 65%). Clinical presentation was similar in both waves. 37% patients presented with shock during 1st wave while 36% in 2nd wave. Gastrointestinal symptoms were predominant (78% VS 82%) followed by cardiac manifestations (44% VS 45%), while a higher incidence of coronary artery dilatation was seen in 2nd wave (35% VS 26%). Comparison of immunomodulatory therapy is depicted in table 1. IVIG and pulse Methylprednisolone requirement was more during 2nd wave. 3 patients during 2nd wave needed additional immunomodulatory therapy with Anakinra (table 1). No patient required 2nd dose of IVIG. There was no mortality. CONCLUSION(S) Clinical presentation was similar in both waves. Requirement of immunomodulatory therapy was more during 2nd wave.