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Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or
Ericka L Fink1, Courtney L Robertson2, Mark S Wainwright3
1Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, Pittsburgh, Pennsylvania; Safar Center for Resuscitation Research, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Neurological issues affected 44% of hospitalized children with COVID-19 or MIS-C, increasing ICU risk. Older age, MIS-C, and prior conditions were key risk factors for these neurological symptoms.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Neurological manifestations are a concern in pediatric COVID-19 and MIS-C.
- Understanding their frequency and impact is crucial for patient management.
Purpose of the Study:
- To characterize the frequency, early impact, and risk factors of neurological manifestations in hospitalized children with SARS-CoV-2 infection or MIS-C.
Main Methods:
- A multicenter, cross-sectional study was conducted.
- Data were collected from children under 18 hospitalized with SARS-CoV-2 or MIS-C between January 2020 and April 2021.
- Multivariable logistic regression identified risk factors for neurological manifestations.
Main Results:
- 44% of 1493 children experienced neurological manifestations (40% with acute SARS-CoV-2, 66% with MIS-C).
- Headache and acute encephalopathy were most common.
- Neurological manifestations correlated with higher ICU admission rates and specific risk factors including older age, MIS-C, pre-existing conditions, and pain.
Conclusions:
- Nearly half of hospitalized children with SARS-CoV-2 related conditions had neurological issues.
- Neurological manifestations were linked to ICU admission and pre-existing neurological conditions.
- Post-hospital assessment and neuroprotective strategies are essential.
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.
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