Specialty follow -up care after hospital discharge of patients with multisystem inflammatory syndrome in children associated with COVID-19 from a rural tertiary-care hospital.

BACKGROUND: The clinical features of Multisystem Inflammatory Syndrome in Children (MIS-C) have been well documented, but there is limited data regarding the short term and longitudinal outcomes of children living in rural areas. We report the demographic and clinical features, as well as the multi-specialty follow-up of patients with MIS-C served by a large tertiary care rural health system. METHODS: Patients that met the Centers for Disease Control (CDC) case definition of MIS-C admitted between March 1, 2020, and March 31, 2021, were included in this case series. Manual chart review was used to report demographic characteristics, clinical, laboratory and radiologic features during acute hospitalization and multispecialty follow-up, and adherence to follow-up 6-10 weeks after hospital discharge. RESULTS: Twenty-one patients with MIS-C were admitted at our center during the review period. Ninety percent of the cohort required intensive care during hospitalization. Of 19 patients with measured ejection fractions, 52 % had some degree of left ventricular dysfunction on admission; nine patients had electrocardiogram changes on admission. The majority of patients had elevated inflammatory markers during hospitalization. Most patients had resolution of symptoms, improvement in inflammatory markers, and normal cardiac function at the time of discharge. Follow-up with pediatric cardiology, hematology-oncology and infectious disease was indicated for most patients at discharge. Of these, 100 % of patients kept initial follow-up appointments with pediatric cardiology and infectious disease, while 94 % kept initial follow-up appointments with pediatric hematology-oncology. CONCLUSION: Though most patients were critically ill during hospitalization, the majority had resolution of cardiac abnormalities and inflammatory markers at discharge and timely follow-up with multiple subspecialists after admission with MIS-C.

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital.

OBJECTIVE: To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. METHODS: We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children's hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. RESULTS: Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission (P = .020) and prolonged length of stay (P = .004) were associated with decreased likelihood of completing recommended follow-up. CONCLUSIONS: Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

Microcephaly, Hypotonia, and Intracranial Calcifications in an 11-Week-Old Boy.

An 11-week-old unvaccinated, term Amish boy initially presented with poor feeding, microcephaly, failure to thrive, and developmental delays. His physical examination was significant for both weight and head circumference being less than the third percentile, and he was noted to have micrognathia, truncal hypotonia, and head lag. He was admitted to the pediatric hospital medicine service for further diagnostic evaluation. Laboratory studies assessing for endocrinological and metabolic etiologies yielded negative results, and imaging studies (including a chest radiograph, echocardiogram, and abdominal ultrasound) were normal. However, intracranial calcifications were noted on a head ultrasound. The etiology of his constellation of symptoms was initially thought to be infectious, but the ultimate diagnosis was not made until after discharge from the pediatric hospital medicine service.