tetano
Editor, Senior Moderator
Pediatr Neurol
. 2021 Dec 28;128:33-44.
doi: 10.1016/j.pediatrneurol.2021.12.010. Online ahead of print.
Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C
Ericka L Fink[SUP] 1 [/SUP], Courtney L Robertson[SUP] 2 [/SUP], Mark S Wainwright[SUP] 3 [/SUP], Juan D Roa[SUP] 4 [/SUP], Marlina E Lovett[SUP] 5 [/SUP], Casey Stulce[SUP] 6 [/SUP], Mais Yacoub[SUP] 7 [/SUP], Renee M Potera[SUP] 8 [/SUP], Elizabeth Zivick[SUP] 9 [/SUP], Adrian Holloway[SUP] 10 [/SUP], Ashish Nagpal[SUP] 11 [/SUP], Kari Wellnitz[SUP] 12 [/SUP], Theresa Czech[SUP] 13 [/SUP], Katelyn M Even[SUP] 14 [/SUP], Werther Brunow de Carvalho[SUP] 15 [/SUP], Isadora Souza Rodriguez[SUP] 15 [/SUP], Stephanie P Schwartz[SUP] 16 [/SUP], Tracie C Walker[SUP] 16 [/SUP], Santiago Campos-Miño[SUP] 17 [/SUP], Leslie A Dervan[SUP] 18 [/SUP], Andrew S Geneslaw[SUP] 19 [/SUP], Taylor B Sewell[SUP] 19 [/SUP], Patrice Pryce[SUP] 20 [/SUP], Wendy G Silver[SUP] 21 [/SUP], Jieru Egeria Lin[SUP] 21 [/SUP], Wendy S Vargas[SUP] 21 [/SUP], Alexis Topjian[SUP] 22 [/SUP], Alicia M Alcamo[SUP] 22 [/SUP], Jennifer L McGuire[SUP] 23 [/SUP], Jesus Angel Domínguez Rojas[SUP] 24 [/SUP], Jaime Tasayco Muñoz[SUP] 24 [/SUP], Sue J Hong[SUP] 25 [/SUP], William J Muller[SUP] 25 [/SUP], Matthew Doerfler[SUP] 25 [/SUP], Cydni N Williams[SUP] 26 [/SUP], Kurt Drury[SUP] 27 [/SUP], Dhristie Bhagat[SUP] 28 [/SUP], Aaron Nelson[SUP] 28 [/SUP], Dana Price[SUP] 28 [/SUP], Heda Dapul[SUP] 29 [/SUP], Laura Santos[SUP] 29 [/SUP], Robert Kahoud[SUP] 30 [/SUP], Conall Francoeur[SUP] 31 [/SUP], Brian Appavu[SUP] 32 [/SUP], Kristin P Guilliams[SUP] 33 [/SUP], Shannon C Agner[SUP] 33 [/SUP], Karen H Walson[SUP] 34 [/SUP], Lindsey Rasmussen[SUP] 35 [/SUP], Anna Janas[SUP] 35 [/SUP], Peter Ferrazzano[SUP] 36 [/SUP], Raquel Farias-Moeller[SUP] 37 [/SUP], Kellie C Snooks[SUP] 38 [/SUP], Chung-Chou H Chang[SUP] 39 [/SUP], James Yun[SUP] 39 [/SUP], Michelle E Schober[SUP] 40 [/SUP], Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) Investigators
Affiliations
Abstract
Background: Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C).
Methods: Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed.
Results: Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05.
Conclusions: In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.
Keywords: Child development; Neurological manifestations; Pediatrics; SARS-CoV-2.
. 2021 Dec 28;128:33-44.
doi: 10.1016/j.pediatrneurol.2021.12.010. Online ahead of print.
Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C
Ericka L Fink[SUP] 1 [/SUP], Courtney L Robertson[SUP] 2 [/SUP], Mark S Wainwright[SUP] 3 [/SUP], Juan D Roa[SUP] 4 [/SUP], Marlina E Lovett[SUP] 5 [/SUP], Casey Stulce[SUP] 6 [/SUP], Mais Yacoub[SUP] 7 [/SUP], Renee M Potera[SUP] 8 [/SUP], Elizabeth Zivick[SUP] 9 [/SUP], Adrian Holloway[SUP] 10 [/SUP], Ashish Nagpal[SUP] 11 [/SUP], Kari Wellnitz[SUP] 12 [/SUP], Theresa Czech[SUP] 13 [/SUP], Katelyn M Even[SUP] 14 [/SUP], Werther Brunow de Carvalho[SUP] 15 [/SUP], Isadora Souza Rodriguez[SUP] 15 [/SUP], Stephanie P Schwartz[SUP] 16 [/SUP], Tracie C Walker[SUP] 16 [/SUP], Santiago Campos-Miño[SUP] 17 [/SUP], Leslie A Dervan[SUP] 18 [/SUP], Andrew S Geneslaw[SUP] 19 [/SUP], Taylor B Sewell[SUP] 19 [/SUP], Patrice Pryce[SUP] 20 [/SUP], Wendy G Silver[SUP] 21 [/SUP], Jieru Egeria Lin[SUP] 21 [/SUP], Wendy S Vargas[SUP] 21 [/SUP], Alexis Topjian[SUP] 22 [/SUP], Alicia M Alcamo[SUP] 22 [/SUP], Jennifer L McGuire[SUP] 23 [/SUP], Jesus Angel Domínguez Rojas[SUP] 24 [/SUP], Jaime Tasayco Muñoz[SUP] 24 [/SUP], Sue J Hong[SUP] 25 [/SUP], William J Muller[SUP] 25 [/SUP], Matthew Doerfler[SUP] 25 [/SUP], Cydni N Williams[SUP] 26 [/SUP], Kurt Drury[SUP] 27 [/SUP], Dhristie Bhagat[SUP] 28 [/SUP], Aaron Nelson[SUP] 28 [/SUP], Dana Price[SUP] 28 [/SUP], Heda Dapul[SUP] 29 [/SUP], Laura Santos[SUP] 29 [/SUP], Robert Kahoud[SUP] 30 [/SUP], Conall Francoeur[SUP] 31 [/SUP], Brian Appavu[SUP] 32 [/SUP], Kristin P Guilliams[SUP] 33 [/SUP], Shannon C Agner[SUP] 33 [/SUP], Karen H Walson[SUP] 34 [/SUP], Lindsey Rasmussen[SUP] 35 [/SUP], Anna Janas[SUP] 35 [/SUP], Peter Ferrazzano[SUP] 36 [/SUP], Raquel Farias-Moeller[SUP] 37 [/SUP], Kellie C Snooks[SUP] 38 [/SUP], Chung-Chou H Chang[SUP] 39 [/SUP], James Yun[SUP] 39 [/SUP], Michelle E Schober[SUP] 40 [/SUP], Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) Investigators
Affiliations
- PMID: 35066369
- DOI: 10.1016/j.pediatrneurol.2021.12.010
Abstract
Background: Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C).
Methods: Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed.
Results: Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05.
Conclusions: In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.
Keywords: Child development; Neurological manifestations; Pediatrics; SARS-CoV-2.