Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C

Abstract

Background Our objective was to characterize the frequency, early impact, and risk factors for neurologic manifestations in hospitalized children with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C). Basic Procedures Multicenter, cross-sectional study of neurologic manifestations in children age < 18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020-April 2021. Multivariable logistic regression to identify risk factors for neurologic manifestations was performed. Main Findings Of 1,493 children, 1,278 (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 neurologic manifestation. The most common neurologic 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 neurologic manifestations were more likely to require ICU care (51% vs. 22%), p<0·001. In multivariable logistic regression, children with neurologic manifestations were older (odds ratio [OR] 1·1 and 95% confidence interval [95% CI] 1·07-1·13), and more likely to have MIS-C vs. acute SARS-CoV-2 (OR 2·16, 95% CI 1·45, 3·24), pre-existing neurologic and metabolic conditions (OR 3·48, 95% CI 2·37-5·15; and OR 1·65, 95% CI 1·04-2·66, respectively), and pharyngeal (OR 1·74, 95% CI 1·16-2·64) or abdominal pain (OR 1·43, 95% CI 1·03-2·00); all p<0·05. Principal Conclusions In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurologic manifestations, which were associated with ICU admission and pre-existing neurologic condition. Post-hospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.

Severity of SARS-CoV-2 Omicron BA.2 infection in unvaccinated hospitalized children: comparison to influenza and parainfluenza infections

“…Our study confirms previous findings from South Africa that the Omicron variant might be associated with increased seizure risks 8 . Prior to the Omicron outbreak, seizure was not a common manifestation of pediatric COVID-19[ 38 , 39 ]. Since the Omicron surge, 15.0% of hospitalized children with COVID-19 were admitted due to neurological complications compared to the 3.8% reported for other SARS-CoV-2 variants during the pre-vaccinated era in the UK[ 40 ].…”

Cerebrovascular Complications of COVID-19 Disease in Children: A Single-Center Case Series

“…These are mostly case reports or case series; larger cohorts have been aimed at adult patients [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. One possible complication of COVID-19 in children is paediatric multisystem inflammatory syndrome, PIMS-TS [ 8 , 9 ], which has relatively accurate diagnostic criteria with multisystem involvement [ 9 , 10 , 11 , 12 ]. No patient from our group met this typical diagnostic criteria.…”

Neurological Symptoms of SARS-CoV-2 Infection in Pediatric Patients

“…In our study, three patients were admitted to the ICU for respiratory difficulty; however, no patient was admitted to the ICU due to neurological symptoms. In another large cohort study, 1,278 children were diagnosed with acute SARS-CoV-2, of whom 215 were diagnosed with MIS-C. Forty-four percent of patients in that cohort showed neurological signs, and the most common neurological signs were headache (16%) and acute encephalopathy (15%) [16]. Headaches mainly showed a tensiontype-like phenotype and were bifrontal, while 25% of patients had migraine-like characteristics [17].…”