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Generally, children infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV-2) have mild symptoms or are asymptomatic. However, some children have severe and critical symptoms affecting several organ systems, including the gastrointestinal, cardiovascular, respiratory, and neurological systems. These severe and critical symptoms are associated with multisystem inflammatory syndrome in children (MISC). This study aimed to describe the clinical features, ventilation modalities usage, and outcome conditions of these children. This was a retrospective study of children with COVID-19 and MISC who were treated in the COVID-19 isolation pediatric intensive care unit (PICU) of Saiful Anwar General Hospital over one year. The data were obtained from medical records and were analyzed descriptively. A total of 491 pediatric patients with suspected COVID-19 were included; 51 had a confirmed COVID-19 diagnosis; 9/491 (1.8%) were patients with MISC who were treated in the PICU; and 7/9 (78%.0) of MISC patients in the PICU used mechanical ventilators. The frequency of MISC patients with gastrointestinal problems was 7/9 (78%) patients, respiratory problems was 9/9 (100%), and myocardial injury (increased troponin) was 5/9 (56%) patients. All MISC patients admitted to the PICU experienced shock with vasoactive drugs including dobutamine, epinephrine, norepinephrine and vasopressin. All MISC patients with severe and critical symptoms had comorbidities. Invasive mechanical ventilation was provided for 7 patients, and 2 patients received non-invasive ventilation. The mean of PEEP used in the invasive ventilation was 7-9 cmH2O. The length of the ventilator usage was 2-21 days, with 2 patients passing away, both with a comorbidity and multiorgan system injuries. It can be concluded that pediatric patients with confirmed COVID-19 may also have MISC with severe and critical symptoms. Early recognition of pediatric patients with MISC is necessary to reduce morbidity and mortality. Keywords: COVID-19, multisystem inflammatory syndrome, children

Clinical Characteristics of Multisystem Inflammatory Syndrome in Children With Severe and Critical Symptoms in the Pediatric Intensive Care Unit