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Parent-administered Neurodevelopmental Follow up in Children After Picornavirus CNS Infections
Carol Stephens1, Clare Reynolds1, Molly Cremin1
1From the Department of Pediatrics, Cork University Hospital, Wilton, Cork, Republic of Ireland.
Insights
Neurodevelopmental assessment in children after central nervous system (CNS) infections with enteroviruses (EV) or parechoviruses (hPeV) revealed that 43.9% required monitoring. Early screening is vital for understanding long-term impacts of these pediatric CNS infections.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Developmental Pediatrics
Background:
- Limited data exists on the long-term neurodevelopmental outcomes of children with central nervous system (CNS) infections caused by enteroviruses (EV) or parechoviruses (hPeV).
- Previous studies primarily focused on short-term results following these viral CNS infections.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes in children who experienced CNS infections with EV or hPeV.
- To identify children requiring further neurodevelopmental assessment or intervention after picornavirus CNS infections.
Main Methods:
- A cohort of children with confirmed EV or hPeV CNS infections (2014-2019) was assessed using the Ages and Stages Instrument (ASQ3).
- Clinical data from the infective episode and caregiver-reported ASQ3 results were collected.
- Neurodevelopmental outcomes were analyzed in relation to pathogen type and clinical parameters.
Main Results:
- Of 43 children with ASQ3 results, 18 (43.9%) showed scores indicating a need for monitoring or professional review.
- No significant association was found between age, inflammatory markers, or cerebrospinal fluid pleocytosis and ASQ3 scores.
- Seven children required formal neurodevelopmental review, with 3 scoring significantly below the mean in multiple areas, irrespective of the specific picornavirus pathogen.
Conclusions:
- Parent-administered neurodevelopmental screening can identify children at risk following early picornavirus CNS infections.
- A significant subgroup of children with a history of CNS enterovirus or parechovirus infection may require formal neurodevelopmental evaluation.
- Community-based developmental screening programs are crucial for a comprehensive understanding of the neurodevelopmental impact of early childhood CNS infections.
Background:
Data on the neurodevelopment of children who experienced central nervous system (CNS) infections with enteroviruses (EV) or parechoviruses (hPeV) is scarce and mostly limited to follow up of short-term outcomes.
Methods:
Parents of children who presented between 2014 and 2019, underwent a lumbar puncture and whose cerebrospinal fluid was polymerase chain reaction positive for EV or hPeV, were asked to complete a care-giver-administered neurodevelopmental assessment tool (The Ages and Stages Instrument [ASQ3]). Clinical data of the infective episode were collected from patient notes.
Results:
Of 101 children, 43 (10 hPeV+, 33 EV+) submitted ASQ3 results. Median age at assessment was 38.9 months (interquartile range, 15.4-54.8), the follow-up interval 3 years (median 37 months; interquartile range, 13.9-53.1). Age, inflammatory markers, and cerebrospinal fluid pleocytosis during the infective event were not associated with ASQ3 scores. In 23 children (17 EV+, 6 hPeV+), no neurodevelopmental concerns were reported. Two more had preexisting developmental delay and were excluded. Of the remaining, 18/41 (43.9%) reported ASQ3 scores indicating need for monitoring or professional review in at least 1 category, not differing by pathogen (EV 14/31, 45.2%; hPeV 4/10, 40%; P = 0.71). Seven children will require formal review, scoring ≥2 SD below the mean in at least 1 category (6/31 EV+, 1/10 hPeV+, P = 0.7), 3 scored ≥2 SD below the mean in more than 1 area.
Conclusions:
Parent-administered developmental assessment of children with a history of early picornavirus infection of the CNS identified a subgroup that requires formal neurodevelopmental review. Wider application of community-based developmental screening will complement our understanding of the impact of CNS infections in early childhood.
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