Patients With MIS-C Need to Be Closely Monitored Following Hospital Discharge

Patients with multisystem inflammatory syndrome in children (MIS-C) had more abnormal neurologic examinations, worse working memory scores, more somatization and depression symptoms, and lower quality of life 6 to 12 months after hospital discharge, according to JAMA Network Open.¹

Improved monitoring may be reasonable for early identification and treatment of neurological and psychological symptoms in this population, the study authors wrote; although findings need to be confirmed.

Acute neurological involvement happens in some patients with MIS-C, but there are few data on neurological and psychological sequelae. Currently, care is offered for adults who experience neurological symptoms post COVID-19, where symptomology that significantly affects patients’ daily lives is seen.²

No studies contain direct evaluations of cognitive function 6 to 12 months following discharge.

a child is lying in bed awake

The study authors aimed to characterize neurological, psychological, and quality of life sequelae regarding MIS-C.

MIS-C is a serious complication of SARS-CoV-2 infection. The illness is characterized by fever, inflammation, multisystem organ involvement, and serious illness necessitating hospitalization.

This was a cross-sectional cohort study that was conducted in the United States and Canada. Participants consisted of children with MIS-C diagnosed from November 2020 through November 2021, 6 to 12 months following hospital discharge. Their sibling or community controls were used as comparisons. Data analysis was completed from August 2022 to May 2023.

A central study location remotely administered a single neurological examination and in-depth neuropsychological assessment including measures of cognition, behavior, quality of life, and daily function.

A total of 64 patients with MIS-C (mean [SD] age, 11.5 [3.9] years; n = 20 girls) and 44 control participants (mean age, 12.6 [3.7] years; 20 girls) were enrolled in the study. The MIS-C group presented abnormalities on neurological examination more often than controls (n = 15 of 61 children vs 3 of 43 children; OR, 4.7; 95% CI, 1.3-16.7). Even though the 2 groups performed similarly on most cognitive evaluations, the MIS-C group scored lower on the National Institutes of Health Cognition Toolbox List Sort Working Memory Test, a measure of executive functioning (mean scores, 96.1 [14.3] vs 103.1 [10.5]).

Parents described worse psychological outcomes in cases compared with controls, especially greater scores for depression symptoms (mean scores, 52.6 [13.1] vs 47.8 [9.4]) and somatization (mean scores, 55.5 [15.5] vs 47.0 [7.6]). Self-reported (mean scores, 79.6 [13.1] vs 85.5 [12.3]) and parent-reported (mean scores, 80.3 [15.5] vs 88.6 [13.0]) quality of life scores were also lower in cases than controls.

The lower rate of neurological abnormalities in this study compared with earlier studies might mirror that there are fewer neurological sequelae associated with more recent SARS-CoV-2 variants, earlier detection of MIS-C, easing of restrictions, or MIS-C treatment advancements.

The present study observed that multiple hospitalization-related variables (eg, length of stay, shock, cardiopulmonary resuscitation, inflammation) were not linked with neurobehavioral outcomes. However, intensive care unit admission and lower left ventricular ejection fraction were each significantly associated with worse executive functioning, possibly reflecting the effect of the hyperinflammatory process on the brain and heart, but larger studies are needed.

The present study observed that 30% of children with MIS-C scored in the at-risk range for daily life executive functions and symptom internalization. These findings recognize children who might have self-regulatory and organizational difficulties or increased risk for mood or anxiety disorders, and who should be clinically evaluated.

Some limitations are present in this study. Children experiencing neurological or psychological symptoms (before or following MIS-C) might have been more likely to partake, creating selection bias. The study design also couldn’t differentiate hospitalization effects from those of MIS-C.

“Until larger studies validate findings and assess longer-term neurobehavioral outcomes, enhanced neurodevelopmental monitoring after hospitalization for MIS-C may be warranted for early identification and treatment of neurological and psychological symptoms,” the study authors concluded.

References

1. Rollins CK, Calderon J, Wypij D, et al. Neurological and psychological sequelae associated with multisystem inflammatory syndrome in children. JAMA Netw Open. 2023;6(7):e2324369. doi:10.1001/jamanetworkopen.2023.24369

2. Petrullo J. Dr Shruti Agnihotri highlights the importance of value-based neurologic care for post–COVID-19 patients. Am J Manag Care. April 25, 2023. Accessed July 25, 2023. https://www.ajmc.com/view/dr-shruti-agnihotri-highlights-the-importance-of-value-based-neurologic-care-for-post-covid-19-patients