tetano
Editor, Senior Moderator
JAMA Neurol
. 2022 Nov 7.
doi: 10.1001/jamaneurol.2022.3881. Online ahead of print.
Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020
Kerri L LaRovere[SUP] 1 [/SUP], Tina Y Poussaint[SUP] 2 [/SUP], Cameron C Young[SUP] 3 [/SUP], Margaret M Newhams[SUP] 3 [/SUP], Suden Kucukak[SUP] 3 [/SUP], Katherine Irby[SUP] 4 [/SUP], Michele Kong[SUP] 5 [/SUP], Stephanie P Schwartz[SUP] 6 [/SUP], Tracie C Walker[SUP] 6 [/SUP], Melania M Bembea[SUP] 7 [/SUP], Kari Wellnitz[SUP] 8 [/SUP], Kevin M Havlin[SUP] 9 [/SUP], Natalie Z Cvijanovich[SUP] 10 [/SUP], Mark W Hall[SUP] 11 [/SUP], Julie C Fitzgerald[SUP] 12 [/SUP], Jennifer E Schuster[SUP] 13 [/SUP], Charlotte V Hobbs[SUP] 14 [/SUP], Natasha B Halasa[SUP] 15 [/SUP], Aalok R Singh[SUP] 16 [/SUP], Elizabeth H Mack[SUP] 17 [/SUP], Tamara T Bradford[SUP] 18 [/SUP], Shira J Gertz[SUP] 19 [/SUP], Adam J Schwarz[SUP] 20 [/SUP], Katri V Typpo[SUP] 21 [/SUP], Laura L Loftis[SUP] 22 [/SUP], John S Giuliano Jr[SUP] 23 [/SUP], Steven M Horwitz[SUP] 24 [/SUP], Katherine V Biagas[SUP] 25 [/SUP], Katharine N Clouser[SUP] 26 [/SUP], Courtney M Rowan[SUP] 27 [/SUP], Aline B Maddux[SUP] 28 [/SUP], Vijaya L Soma[SUP] 29 [/SUP], Christopher J Babbitt[SUP] 30 [/SUP], Cassyanne L Aguiar[SUP] 31 [/SUP], Amanda R Kolmar[SUP] 32 [/SUP], Sabrina M Heidemann[SUP] 33 [/SUP], Helen Harvey[SUP] 34 [/SUP], Laura D Zambrano[SUP] 35 [/SUP], Angela P Campbell[SUP] 35 [/SUP], Adrienne G Randolph[SUP] 3 36 [/SUP], Overcoming COVID-19 Investigators
Collaborators, Affiliations
Abstract
Importance: In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complications.
Objective: To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021.
Design, setting, and participants: Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2-related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge. A total of 2253 patients were enrolled during the investigation period. Patients suspected of having multisystem inflammatory syndrome in children (MIS-C) who did not meet criteria (n = 85) were excluded. Patients (<21 years) with positive SARS-CoV-2 test results (reverse transcriptase-polymerase chain reaction and/or antibody) meeting criteria for MIS-C or acute COVID-19 were included in the analysis.
Exposure: SARS-CoV-2 infection.
Main outcomes and measures: Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening neurologic involvement was adjudicated by experts based on clinical and/or neuroradiological features. Type and severity of neurologic involvement, laboratory and imaging data, vaccination status, and hospital discharge outcomes (death or survival with new neurologic deficits).
Results: Of 2168 patients included (58% male; median age, 10.3 years), 1435 (66%) met criteria for MIS-C, and 476 (22%) had documented neurologic involvement. Patients with neurologic involvement vs without were older (median age, 12 vs 10 years) and more frequently had underlying neurologic disorders (107 of 476 [22%] vs 240 of 1692 [14%]). Among those with neurologic involvement, 42 (9%) developed acute SARS-CoV-2-related life-threatening conditions, including central nervous system infection/demyelination (n = 23; 15 with possible/confirmed encephalitis, 6 meningitis, 1 transverse myelitis, 1 nonhemorrhagic leukoencephalopathy), stroke (n = 11), severe encephalopathy (n = 5), acute fulminant cerebral edema (n = 2), and Guillain-Barré syndrome (n = 1). Ten of 42 (24%) survived with new neurologic deficits at discharge and 8 (19%) died. Among patients with life-threatening neurologic conditions, 15 of 16 vaccine-eligible patients (94%) were unvaccinated.
Conclusions and relevance: SARS-CoV-2-related neurologic involvement persisted in US children and adolescents hospitalized for COVID-19 or MIS-C in 2021 and was again mostly transient. Central nervous system infection/demyelination accounted for a higher proportion of life-threatening conditions, and most vaccine-eligible patients were unvaccinated. COVID-19 vaccination may prevent some SARS-CoV-2-related neurologic complications and merits further study.
. 2022 Nov 7.
doi: 10.1001/jamaneurol.2022.3881. Online ahead of print.
Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020
Kerri L LaRovere[SUP] 1 [/SUP], Tina Y Poussaint[SUP] 2 [/SUP], Cameron C Young[SUP] 3 [/SUP], Margaret M Newhams[SUP] 3 [/SUP], Suden Kucukak[SUP] 3 [/SUP], Katherine Irby[SUP] 4 [/SUP], Michele Kong[SUP] 5 [/SUP], Stephanie P Schwartz[SUP] 6 [/SUP], Tracie C Walker[SUP] 6 [/SUP], Melania M Bembea[SUP] 7 [/SUP], Kari Wellnitz[SUP] 8 [/SUP], Kevin M Havlin[SUP] 9 [/SUP], Natalie Z Cvijanovich[SUP] 10 [/SUP], Mark W Hall[SUP] 11 [/SUP], Julie C Fitzgerald[SUP] 12 [/SUP], Jennifer E Schuster[SUP] 13 [/SUP], Charlotte V Hobbs[SUP] 14 [/SUP], Natasha B Halasa[SUP] 15 [/SUP], Aalok R Singh[SUP] 16 [/SUP], Elizabeth H Mack[SUP] 17 [/SUP], Tamara T Bradford[SUP] 18 [/SUP], Shira J Gertz[SUP] 19 [/SUP], Adam J Schwarz[SUP] 20 [/SUP], Katri V Typpo[SUP] 21 [/SUP], Laura L Loftis[SUP] 22 [/SUP], John S Giuliano Jr[SUP] 23 [/SUP], Steven M Horwitz[SUP] 24 [/SUP], Katherine V Biagas[SUP] 25 [/SUP], Katharine N Clouser[SUP] 26 [/SUP], Courtney M Rowan[SUP] 27 [/SUP], Aline B Maddux[SUP] 28 [/SUP], Vijaya L Soma[SUP] 29 [/SUP], Christopher J Babbitt[SUP] 30 [/SUP], Cassyanne L Aguiar[SUP] 31 [/SUP], Amanda R Kolmar[SUP] 32 [/SUP], Sabrina M Heidemann[SUP] 33 [/SUP], Helen Harvey[SUP] 34 [/SUP], Laura D Zambrano[SUP] 35 [/SUP], Angela P Campbell[SUP] 35 [/SUP], Adrienne G Randolph[SUP] 3 36 [/SUP], Overcoming COVID-19 Investigators
Collaborators, Affiliations
- PMID: 36342679
- DOI: 10.1001/jamaneurol.2022.3881
Abstract
Importance: In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complications.
Objective: To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021.
Design, setting, and participants: Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2-related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge. A total of 2253 patients were enrolled during the investigation period. Patients suspected of having multisystem inflammatory syndrome in children (MIS-C) who did not meet criteria (n = 85) were excluded. Patients (<21 years) with positive SARS-CoV-2 test results (reverse transcriptase-polymerase chain reaction and/or antibody) meeting criteria for MIS-C or acute COVID-19 were included in the analysis.
Exposure: SARS-CoV-2 infection.
Main outcomes and measures: Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening neurologic involvement was adjudicated by experts based on clinical and/or neuroradiological features. Type and severity of neurologic involvement, laboratory and imaging data, vaccination status, and hospital discharge outcomes (death or survival with new neurologic deficits).
Results: Of 2168 patients included (58% male; median age, 10.3 years), 1435 (66%) met criteria for MIS-C, and 476 (22%) had documented neurologic involvement. Patients with neurologic involvement vs without were older (median age, 12 vs 10 years) and more frequently had underlying neurologic disorders (107 of 476 [22%] vs 240 of 1692 [14%]). Among those with neurologic involvement, 42 (9%) developed acute SARS-CoV-2-related life-threatening conditions, including central nervous system infection/demyelination (n = 23; 15 with possible/confirmed encephalitis, 6 meningitis, 1 transverse myelitis, 1 nonhemorrhagic leukoencephalopathy), stroke (n = 11), severe encephalopathy (n = 5), acute fulminant cerebral edema (n = 2), and Guillain-Barré syndrome (n = 1). Ten of 42 (24%) survived with new neurologic deficits at discharge and 8 (19%) died. Among patients with life-threatening neurologic conditions, 15 of 16 vaccine-eligible patients (94%) were unvaccinated.
Conclusions and relevance: SARS-CoV-2-related neurologic involvement persisted in US children and adolescents hospitalized for COVID-19 or MIS-C in 2021 and was again mostly transient. Central nervous system infection/demyelination accounted for a higher proportion of life-threatening conditions, and most vaccine-eligible patients were unvaccinated. COVID-19 vaccination may prevent some SARS-CoV-2-related neurologic complications and merits further study.