The Astrid Lindgren Children’s Hospital at Karolinska is leading the fight against severe hyperinflammation in children

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It is not known exactly how many children have been infected with COVID­19, but children tend to experience a milder course of the illness, and it is rare for a child to become seriously ill with acute COVID­19. Children can, however, be affected by MIS-C (Multisystem Inflammatory Syndrome in Children), which is a form of hyperinflammation associated with COVID­19.

MIS-C is a very uncommon but potentially life-threatening condition that primarily affects children who were previously completely healthy. It emerges 1-2 months after the child had been (often unnoticed) infected with COVID­19.

The paediatric rheumatology department at the Astrid Lindgren Children's Hospital (ALCH) was quick to take leading national responsibility with regard to caring for children with MIS-C. In as early as spring 2020, a care programme was compiled that is now used throughout most of the country. An MIS-C tab has also been successfully added to the Swedish register for paediatric rheumatism, where all children in Sweden with MIS­C are included and brought together in one place, to eliminate the risk of any child being left out and excluded from follow-ups.

Karin Palmblad heads the department for paediatric rheumatology at ALCH. She says that children with MIS­C are often extremely ill, and several require intensive care. Those that do not require intensive care still have extensive care requirements, with frequent tests, monitoring and strong pharmacological treatment including everything from intravenous immunoglobulins, high doses of cortisone, and specific cytokine inhibitors (mainly the IL­1 inhibitor, anakinra). Proximity to paediatric intensive care is also required. All of this places heavy demands on resources.

"We have had a nationwide collaboration in place since April 2020, where we have registered new cases of MIS­C and decided upon treatment strategies."

So far, there have been 140 cases of MIS­C in Sweden. Of these, 55 have been cared for at ALCH. What is particularly notable is that 30 of these have come during 2021.

"We must ensure that we have the resources to take care of these children – not just for the acute care but also for the subsequent following-up to monitor future developments. It is a bit of a challenge to bring everything together", says Karin Palmblad.

Long-COVID in children and young adults
Another group that has become particularly topical in the field of paediatric infectious health comprises children and young adults with long-term symptoms following relatively mild cases of COVID­19. This represents a completely different type of problem than the cases of hyperinflammation. Long-term symptoms such as fatigue, impaired concentration, recurring fever and palpitations are common complaints.
"Although we have seen similar problems after other viral infections, it is this that currently dominates the referrals to our infection clinic", says Malin Ryd Rinder, who heads the department for paediatric infections.

"We have implemented a multidisciplinary clinic, with physiotherapists, psychologists and other sub-specialists, and we are now working to develop a nationwide care programme that also includes structured follow-ups for these families. We receive great support from our collaboration with the department for adult infections, and particularly with the section for health professionals. More than fifty families are currently being cared for at our clinic", continues Ryd Rinder.