A large nationwide study has found important differences in the two main ways children have become seriously ill from the coronavirus, findings that can help doctors and parents better recognize the conditions and understand more about the children at risk for each.
The study, published Wednesday in the journal JAMA, analyzed 1,116 cases of young people treated in 66 hospitals in 31 states. Just over half of the patients had acute COVID-19, the mainly lung-related disease that affects most adults who become ill with the virus, while 539 patients had the inflammatory syndrome that broke out in some children weeks after they had a typically mild illness had. first infection.
The researchers found some similarities, as well as significant differences, in the symptoms and characteristics of the patients, who ranged from infants to 20-year-olds and were hospitalized between March 15 and October 31 last year.
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Young people with the syndrome, called Multisystem Inflammatory Syndrome in Children, or MIS-C, were more likely to be between 6 and 12 years old, while more than 80% of patients with acute COVID-19 were either under 6 years old or over 12.
More than two-thirds of patients with either condition were black or Hispanic, which experts say is most likely a reflection of socioeconomic and other factors that have disproportionately exposed some communities to the virus.
“It is still shocking that the vast majority of patients are not white, and that is true of MIS-C and acute COVID,” said Dr. Jean Ballweg, Medical Director of Pediatric Heart Transplant and Advanced Heart Failure at Children’s Hospital & Medical Center. in Omaha, Nebraska, which was not involved in the investigation. “There is clearly racial inequality there.”
For reasons unclear, while Hispanic youth were equally likely to be at risk for both conditions, black children seemed to be at greater risk of developing the inflammatory syndrome than the acute illness, said Dr. Adrienne Randolph, senior author of the study. and a pediatric intensive care specialist at Boston Children’s Hospital.
One possible clue mentioned by the authors is that with Kawasaki disease, a rare childhood inflammatory syndrome that resembles some aspects of MIS-C, black children appear to have more heart defects and respond less to any of the standard treatments. , intravenous immunoglobulin.
The researchers found that young people with the inflammatory syndrome were significantly more likely to have no underlying medical conditions than those with acute COVID-19. Yet more than a third of the patients with acute COVID had no prior medical condition. “It’s not that previously healthy children are completely free here,” said Randolph.
The study evaluated obesity separately from other underlying health conditions and only in patients 2 years of age or older, finding that a slightly higher percentage of young people with acute COVID-19 were obese.
Dr. Srinivas Murthy, associate professor of pediatrics at the University of British Columbia, who was not involved in the study, said he was not convinced that the findings showed that healthy children were at higher risk for MIS-C. It could be “mostly a numbers game, with the proportion of infected children and the proportion of healthy children out there, rather than saying that there is something immune in healthy children that puts them at a disproportionately higher risk,” he said.
Overall, he said, the study’s documentation of the differences between the two conditions was helpful, especially as it reflected “a fairly representative range of hospitals in the US”
Young people with inflammatory syndrome were more likely to receive intensive care treatment. Their symptoms were much more likely: gastrointestinal problems, inflammation and involvement of the skin and mucous membranes. They were also much more likely to have heart-related problems, although many of the acute COVID patients did not receive detailed cardiac assessments, the study said.
About the same number of patients with any condition – more than half – required respiratory support, with just under a third of those requiring mechanical ventilation. About the same number of patients died in each group: 10 with MIS-C and eight with acute COVID-19.
The data does not reflect a recent rise in the incidence of the inflammatory syndrome that followed an increase in total COVID-19 infections across the country during the winter holidays. Some hospitals have reported that there is a higher number of critically ill MIS-C patients in the current wave than in previous waves.
“I’ll be fascinated to see a comparison with this group from November 1, because I think we all felt that the kids with MIS-C have been even sicker lately,” Ballweg said.
An optimistic sign from the study was that most severe heart problems in young people with inflammatory syndrome improved to normal within 30 days. Still, Randolph said any residual effects remain unknown, which is why one of her co-authors, Dr. Jane Newburger, associate chief for academic affairs in the cardiology department at Boston Children’s Hospital, is conducting a nationwide study to evaluate children with inflammatory syndrome. track for up to five years.
“We can’t say 100% for sure that everything will be normal in the long run,” Randolph said.
This article originally appeared in The New York Times.
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