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. 2023 Apr 1;24(4):289-300.
doi: 10.1097/PCC.0000000000003180. Epub 2023 Jan 23.

Neurocognitive, Psychosocial, and Quality of Life Outcomes After Multisystem Inflammatory Syndrome in Children Admitted to the PICU

Marieke H Otten  1 , Corinne M P Buysse  2 , Emmeline P Buddingh  3 , Suzanne W J Terheggen-Lagro  4 , Erik G J von Asmuth  5 , Eleonore S V de Sonnaville  6 , Naomi Ketharanathan  2 , Heleen E Bunker-Wiersma  7 , Lotte Haverman  8 , Karin Hogenbirk  7 , Matthijs de Hoog  2 , Martien Humblet  9 , Koen F M Joosten  2 , Martin C J Kneyber  10 , Geanne Krabben  10 , Joris Lemson  11 , Nienke M Maas  12 , Sofie Maebe  9 , Peter P Roeleveld  7 , Monique van Schooneveld  13 , Brigitte Timmers-Raaijmaakers  14 , Dick van Waardenburg  9 , Jennifer C Walker  14 , Renske Wassenberg  15 , Job B M van Woensel  1 , Esther de Wit  14 , Diana W Wolthuis  10 , Annelies van Zwol  11 , Kim J Oostrom  16 , Hennie Knoester  1 , Karolijn Dulfer  2
Affiliations

Neurocognitive, Psychosocial, and Quality of Life Outcomes After Multisystem Inflammatory Syndrome in Children Admitted to the PICU

Marieke H Otten et al. Pediatr Crit Care Med. .

Abstract

Objectives: To investigate neurocognitive, psychosocial, and quality of life (QoL) outcomes in children with Multisystem Inflammatory Syndrome in Children (MIS-C) seen 3-6 months after PICU admission.

Design: National prospective cohort study March 2020 to November 2021.

Setting: Seven PICUs in the Netherlands.

Patients: Children with MIS-C (0-17 yr) admitted to a PICU.

Interventions: None.

Measurements and main results: Children and/or parents were seen median (interquartile range [IQR] 4 mo [3-5 mo]) after PICU admission. Testing included assessment of neurocognitive, psychosocial, and QoL outcomes with reference to Dutch pre-COVID-19 general population norms. Effect sizes (Hedges' g ) were used to indicate the strengths and clinical relevance of differences: 0.2 small, 0.5 medium, and 0.8 and above large. Of 69 children with MIS-C, 49 (median age 11.6 yr [IQR 9.3-15.6 yr]) attended follow-up. General intelligence and verbal memory scores were normal compared with population norms. Twenty-nine of the 49 followed-up (59%) underwent extensive testing with worse function in domains such as visual memory, g = 1.0 (95% CI, 0.6-1.4), sustained attention, g = 2.0 (95% CI 1.4-2.4), and planning, g = 0.5 (95% CI, 0.1-0.9). The children also had more emotional and behavioral problems, g = 0.4 (95% CI 0.1-0.7), and had lower QoL scores in domains such as physical functioning g = 1.3 (95% CI 0.9-1.6), school functioning g = 1.1 (95% CI 0.7-1.4), and increased fatigue g = 0.5 (95% CI 0.1-0.9) compared with population norms. Elevated risk for posttraumatic stress disorder (PTSD) was seen in 10 of 30 children (33%) with MIS-C. Last, in the 32 parents, no elevated risk for PTSD was found.

Conclusions: Children with MIS-C requiring PICU admission had normal overall intelligence 4 months after PICU discharge. Nevertheless, these children reported more emotional and behavioral problems, more PTSD, and worse QoL compared with general population norms. In a subset undergoing more extensive testing, we also identified irregularities in neurocognitive functions. Whether these impairments are caused by the viral or inflammatory response, the PICU admission, or COVID-19 restrictions remains to be investigated.

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Conflict of interest statement

Dr. Buddingh’s institution received funding from Leids Universitair Fonds/ Bontiusstichting and ZonMw. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Patient flow. MIS-C = Multisystem Inflammatory Syndrome in Children.
See this image and copyright information in PMC

Comment in

References

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Supplementary concepts