Study reveals fresh insight on children's condition related to COVID-19

A UK study into critically ill children admitted to paediatric intensive care units with symptoms of a rare, new inflammatory syndrome, has combined data from units across the country to offer the first nationwide insights into the true extent of the condition.

Reports have emerged in recent weeks, during the COVID-19 pandemic, of children presenting with symptoms of a new condition similar to those seen in Kawasaki disease and Toxic Shock Syndrome. The new condition has been termed Paediatric Inflammatory Multi-System Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS), and affects older children. There have been reports of cases in the UK, across Europe, and the United States.

This latest study brings together data on 78 children, admitted to 15 intensive care units over a six week period between April and May 2020. Some of these cases have been previously reported in smaller studies, but this study brings together the largest number of cases in a cohort of children with this condition needing life support. Comparison with historical data shows an average of 11 fold increase (peaking at 26-fold) in intensive care admissions compared to similar inflammatory conditions.

As well as a fever, which was present in all cases, children presented with a variety of other symptoms, including shock, vomiting and abdominal pain. Data also showed that 78% of admissions were Black, Asian, or Minority Ethnic children. Encouragingly, the majority of children were discharged from hospital/PICU within one week, however two children sadly died.

Most of the children did not have active evidence of COVID-19 infection, but did have antibodies to COVID-19, meaning they had been infected in the recent past. The study has demonstrated that high quality intensive care support is essential for children who are seriously affected. Rapid national collaborations such as this are the key to unlocking knowledge that improves current treatment and aids the ongoing search for drugs to prevent or treat this condition.

Dr Patrick Davies, lead researcher and Consultant Paediatric Intensivist at the Nottingham Children’s Hospital said: “The vast majority of the critically ill children we describe had a short stay in PICU and were thankfully discharged. Although it can cause significant illness, this condition appears to be rare. The key to successful treatment is close collaboration between many specialties”.

Dr Barney Scholefield, senior author, Paediatric intensive care consultant at Birmingham Women’s and Children’s NHS Foundation Trust and researcher at the University of Birmingham said: “A large group of children’s intensive care clinicians from across the NHS have rapidly worked together to help understand this condition. The successful collaboration has resulted in a wealth of information to help treat cases currently and in any future waves of COVID-19.”

Dr Padmanabhan Ramnarayan, senior author and Consultant in Paediatric Intensive Care Retrieval at Great Ormond Street Hospital said: “This is a new condition and, in just a matter of weeks, clinicians across the world have already made tremendous progress in understanding it. However, many aspects of the condition remain unclear, such as why it only affects some children or what the long-term implications of having this condition are. One of our findings is that complications such as coronary aneurysms do occur in a small minority of patients. This clearly highlights the importance of following up on these patients – and this will be high on the agenda for clinical teams at GOSH and elsewhere.”

Other GOSH contributors towards the co-authoring of this paper include Mae Johnson, Pascale du Pre and Joe Brierley.

The Royal College of Paediatrics and Child Health has published advice for parents who are concerned about PIMS-TS. www.rcpch.ac.uk/resources/pims-covid-19-linked-syndrome-affecting-children-information-families