{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T05:33:22Z","timestamp":1781760802725,"version":"3.54.5"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T00:00:00Z","timestamp":1600041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The clinical manifestations and natural history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)\u2013related multisystem inflammatory syndrome in children (MIS-C) are poorly defined. Using a systematic review of individual cases and case series and collating elements of the clinical course, the objective of this study was to provide a detailed clinical description and natural history of MIS-C.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Case reports and series of MIS-C were recovered from repeated MEDLINE searches, a single EMBASE search, and table of contents reviews of major general medicine and pediatric journals performed between June 3 and July 23, 2020. Fever, evidence of inflammation, and evidence of organ dysfunction were required for inclusion.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>MEDLINE and EMBASE searches produced 129 articles, and 10 articles were identified from journal contents or article bibliographies; 16 reports describing 505 children with MIS-C comprise this review. Thirty-two children (14.7%) had negative results for SARS-CoV-2 by nucleic acid and\/or antibody testing. The weighted median age was 9 years (6 months to 20 years). Clinical findings included fever (100%), gastrointestinal symptoms (88.0%), rash (59.2%), conjunctivitis (50.0%), cheilitis\/ \u201cstrawberry tongue\u201d (55.7%), or extremity edema\/erythema (47.5%). Median serum C-reactive protein, ferritin, fibrinogen, and D-dimer concentrations were above the normal range. Intravenous gammaglobulin (78.1%) and methylprednisolone\/prednisone (57.6%) were the most common therapeutic interventions; immunomodulation was used in 24.3% of cases. Myocardial dysfunction requiring ionotropic support (57.4%) plus extracorporeal membrane oxygenation (5.3%), respiratory distress requiring mechanical ventilation (26.1%), and acute kidney injury (11.9%) were the major complications; anticoagulation was used commonly (54.4%), but thrombotic events occurred rarely (3.5%). Seven (1.4%) children died.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>MIS-C following SARS-CoV-2 infection frequently presents with gastrointestinal complaints and\/or rash; conjunctivitis, cheilitis, and\/or extremity changes also occur frequently. Serious complications occur frequently and respond to aggressive supportive therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piaa112","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T19:13:49Z","timestamp":1599246829000},"page":"746-751","source":"Crossref","is-referenced-by-count":62,"title":["The Natural History of Severe Acute Respiratory Syndrome Coronavirus 2\u2013Related Multisystem Inflammatory Syndrome in Children: A Systematic Review"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6291-8528","authenticated-orcid":false,"given":"Stephen C","family":"Aronoff","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA"},{"name":"St Christopher\u2019s Hospital for Children, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashleigh","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T","family":"Del Vecchio","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA"},{"name":"St Christopher\u2019s Hospital for Children, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"key":"2021020516553127200_CIT0001","doi-asserted-by":"crossref","first-page":"e20200702","DOI":"10.1542\/peds.2020-0702","article-title":"Epidemiology of COVID-19 among children in 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