tetano
Editor, Senior Moderator
BMC Pediatr
. 2025 Sep 24;25(1):688.
doi: 10.1186/s12887-025-05970-5. Clinical characteristics and outcomes of COVID-19-Associated acute encephalopathy in pediatric patients during the Omicron wave in beijing: a single-center prospective study
SiYuan Huang[SUP] 1 [/SUP], Jing Chen[SUP] #[/SUP][SUP] 2 [/SUP], Fang Li[SUP] 1 [/SUP], Wei Li[SUP] 1 [/SUP], Ning Li[SUP] 1 [/SUP], YuChun Yan[SUP] 1 [/SUP], Dong Qu[SUP] 3 4 [/SUP], Shuang Liu[SUP] 5 [/SUP]
Affiliations
Background: The Omicron variant has become the predominant strain globally, yet pediatric data on COVID-19-associated acute encephalopathy (AE) remain scarce. This study aimed to characterize the clinical features and outcomes of Omicron-related AE in a PICU cohort.
Methods: We prospectively analyzed 10 pediatric patients (aged ≤ 18 years) diagnosed with COVID-19-associated AE at Capital Center of Children's health Capital Medical University from December 2022 to January 2023. AE diagnosis followed the Japanese Society of Child Neurology criteria. Demographic, clinical, laboratory, radiological, and outcome data were collected.
Results: Median page was 35 months (IQR 17.0-62.5), with 80% ≤4 years old. All patients presented with fever and altered mental status; 40% had seizures. Cranial MRI revealed symmetric brain lesions in all cases: 70% acute necrotizing encephalopathy (ANE), 10% encephalitis with splenial lesions (MERS), and 10% acute encephalopathy with subcortical demyelination (AESD). Elevated inflammatory markers (procalcitonin 31.27 ng/mL [IQR 23.8-38.7], IL-6 21.6 pg/mL [IQR 12.3-34.9]) and CSF pleocytosis were common. Six patients (60%) died within 48 h of PICU admission, all unvaccinated and ≤ 4 years old. Survivors exhibited long-term neurological sequelae (quadriparesis, hypotonia).
Conclusions: Omicron-associated AE in young children is characterized by rapidly progressive neurological deterioration, with 60% mortality in this cohort and persistent deficits in survivors. Symmetric MRI lesions, elevated procalcitonin, and CSF cytokine elevation may serve as early diagnostic indicators. Vaccination gaps and innate immune dysregulation likely contribute to severe outcomes.
Keywords: COVID-19; Critical care; Neuroinflammation; Omicron variant; Pediatric acute encephalopathy.
. 2025 Sep 24;25(1):688.
doi: 10.1186/s12887-025-05970-5. Clinical characteristics and outcomes of COVID-19-Associated acute encephalopathy in pediatric patients during the Omicron wave in beijing: a single-center prospective study
SiYuan Huang[SUP] 1 [/SUP], Jing Chen[SUP] #[/SUP][SUP] 2 [/SUP], Fang Li[SUP] 1 [/SUP], Wei Li[SUP] 1 [/SUP], Ning Li[SUP] 1 [/SUP], YuChun Yan[SUP] 1 [/SUP], Dong Qu[SUP] 3 4 [/SUP], Shuang Liu[SUP] 5 [/SUP]
Affiliations
- PMID: 40993593
- PMCID: PMC12462391
- DOI: 10.1186/s12887-025-05970-5
Background: The Omicron variant has become the predominant strain globally, yet pediatric data on COVID-19-associated acute encephalopathy (AE) remain scarce. This study aimed to characterize the clinical features and outcomes of Omicron-related AE in a PICU cohort.
Methods: We prospectively analyzed 10 pediatric patients (aged ≤ 18 years) diagnosed with COVID-19-associated AE at Capital Center of Children's health Capital Medical University from December 2022 to January 2023. AE diagnosis followed the Japanese Society of Child Neurology criteria. Demographic, clinical, laboratory, radiological, and outcome data were collected.
Results: Median page was 35 months (IQR 17.0-62.5), with 80% ≤4 years old. All patients presented with fever and altered mental status; 40% had seizures. Cranial MRI revealed symmetric brain lesions in all cases: 70% acute necrotizing encephalopathy (ANE), 10% encephalitis with splenial lesions (MERS), and 10% acute encephalopathy with subcortical demyelination (AESD). Elevated inflammatory markers (procalcitonin 31.27 ng/mL [IQR 23.8-38.7], IL-6 21.6 pg/mL [IQR 12.3-34.9]) and CSF pleocytosis were common. Six patients (60%) died within 48 h of PICU admission, all unvaccinated and ≤ 4 years old. Survivors exhibited long-term neurological sequelae (quadriparesis, hypotonia).
Conclusions: Omicron-associated AE in young children is characterized by rapidly progressive neurological deterioration, with 60% mortality in this cohort and persistent deficits in survivors. Symmetric MRI lesions, elevated procalcitonin, and CSF cytokine elevation may serve as early diagnostic indicators. Vaccination gaps and innate immune dysregulation likely contribute to severe outcomes.
Keywords: COVID-19; Critical care; Neuroinflammation; Omicron variant; Pediatric acute encephalopathy.