Heart dysfunction seen in kids weeks after recovery from post-COVID inflammatory syndrome – Detroit Free Press

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Kids who develop the rare post-COVID-19 complicationknown asmultisystem inflammatory syndrome in children, or MIS-C, are at high risk for heart problems that could make it more difficult for the heart to pump blood efficiently for weeks after they are thought to have recovered, a new study from doctors at Children's Hospital of Michigan found.

About 20% of children who developed MIS-Chad heart function changes that could be detected with an echochardiogram, which is an ultrasound of the heart, and an electrocardiogram 10 weeksafter they recovered, said Dr.Gautam Singh, chief of pediatric cardiology at Childrens Hospital of Michigan and the lead author of the study. A smaller subset of them continued to have heart dysfunction, mostly asymptomatic, for up to five months after they were hospitalized.

"With treatment, most of them have recovered and have done well," said Singh, who also isa professor of pediatrics at Central Michigan University; he noted, however, that because COVID-19and MIS-C are so new, ongoing study is needed to get a more complete picture ofpotentially long-term complications.

Levi Nobles, 7, of Shelby Township was among the Michigan children hospitalized with the newly identified disease associated with novel coronavirus. Called Multisystem Inflammatory Syndrome, it's sickened hundreds of kids nationally and can be deadly. Levi is now continuing to recover at home.(Photo: Provided by Hannah Peck)

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The observational pre-print study, published online in May in theJournal of the American Society of Echocardiography,examined 54 children who were admitted to the Detroit hospitalbetween March 2020 and January and treated for MIS-C, which causes multipleorgans,including heart and blood vessels, tobecomeinflamed. Itcan lead to organ failure anddamage.

"Wefound that acutely, most of them had involvement of the heart," Singh said. "The function was either affected orvalves became leakyor inflamed or there was buildup of some fluid around the heart, compromising heart function. And some were so much in shock that they required life support. Almost invariably, half of them required going on mechanical ventilation or a breathing machine, heart-supporting medications ...and many other supports to their systems for them to survive and do well.

"Fortunately, they all did very well, and they went home, which is great gratification. Whenwe studied these children and followed them about five tosix months (later), we found about 19% to 20% have some involvement of their heart function that was not clinically obvious, but by echocardiographic measurements."

Levi Nobles, 7, of Shelby Township was among the Michigan children hospitalized with the newly identified disease associated with novel coronavirus. Called multisystem inflammatory syndrome in children, or MIS-C, it's sickened hundreds of kids nationally and can be deadly. Levi is now continuing to recover at home.(Photo: Provided by Hannah Peck)

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It means, he said, that children who have had MIS-C shouldn't resume sports or athletic activity without getting cleared by a pediatric cardiologist first, which is in line with guidance from the U.S. Centers for Disease Control and Prevention.

"That is because the heart is involved, and any timeheart muscles become inflamed, you don't want to exert or participate in ...sports or strenuous physical activities within the first three to six months ... after there was inflammation of the heart muscles," Singh said. "You want the heart to recover completely; otherwise, if you participate in strenuous physical activities, it may damage your heart."

In addition, he said, the studysuggests echocardiograms could be used to identify which children should be treated most aggressively to prevent cardiac damage when they are admitted to the hospital with MIS-C.

"Since COVID-19 is a novel or new infection, we were not certain to start with when these children presented with MIS-C ... how aggressively and with what medications to treat them."

The research showed that children who had profoundly decreased heart function when they were admitted to the hospital with MIS-Cwere more likely to end up in the intensive care unit and need ventilator support to survive. But if medication to modulate their immune systems was given to them early, they had better outcomes, Singh said.

Since the pandemic began, there have been 123 confirmed cases of MIS-C in Michigan and five or fewer deaths. Nationally, the CDC reports that3,742 children have had MIS-C and 35 have died from it.

About 70% of the children in Michiganwho have beendiagnosed with MIS-C were sick enough to require hospitalization in an intensive care unit, according to state data. Some of them needed heart-lung bypass machines, known as extracorporeal membrane oxygenation, or ECMO, to survive.

Most children who contract COVID-19 will not get severely ill, be hospitalized or die. It is unclear, Singh said, why some kids develop MIS-C and others do not.

"We don't have the exact etiology about it, but there are certain common factors what we call association, not cause and effect that we have noticed," Singh said. "Lots of these children have comorbiditieslike asthma, obesity. Unfortunately, the majority of these children were African American, which reflects the population of Detroit as well. But none of them had any cardiac problem, actually, prior to their MIS-C or prior to the exposure to COVID-19."

Symptoms of MIS-C can appear four to six weeks after a child had COVID-19 or exposure to someone with the virus, and include:

Singh said children 12 and older, who are now eligible for COVID-19 vaccines, should get the shots to prevent not only COVID-19 and potential long-term complications from the virus, butMIS-C as well. And if vaccines are approved for younger kids later this year, they, too, should be inoculated, he said.

"Once you see a child having and suffering from MIS-C you will not hesitate to recommend a vaccine," Singh said.

Contact Kristen Jordan Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus.

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Heart dysfunction seen in kids weeks after recovery from post-COVID inflammatory syndrome - Detroit Free Press