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Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem
Kerri L LaRovere1, Tina Y Poussaint2, Cameron C Young3
1Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Neurologic involvement in children hospitalized with COVID-19 or MIS-C persisted in 2021, with central nervous system conditions being a significant concern. Most severe cases occurred in unvaccinated, vaccine-eligible patients, suggesting vaccination may prevent complications.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Neurologic involvement was common in children and adolescents hospitalized with SARS-CoV-2 in 2020.
- Understanding the spectrum of these neurologic complications is crucial for patient management.
Purpose of the Study:
- To update the understanding of SARS-CoV-2-related neurologic involvement in children and adolescents during 2021.
- To identify the types and outcomes of neurologic complications in hospitalized pediatric patients.
Main Methods:
- A case series investigation of patients (<21 years) hospitalized with SARS-CoV-2-related illness between December 2020 and December 2021.
- Included patients with confirmed SARS-CoV-2 infection meeting criteria for MIS-C or acute COVID-19.
- Assessed neurologic involvement, its severity, and hospital discharge outcomes.
Main Results:
- Of 2168 patients, 476 (22%) had neurologic involvement; these patients were older and more likely to have prior neurologic disorders.
- 42 patients (9%) developed life-threatening neurologic conditions, including CNS infection/demyelination (23), stroke (11), and encephalopathy (5).
- 10 of 42 patients with life-threatening conditions survived with new deficits, and 8 died; 94% of eligible patients with these conditions were unvaccinated.
Conclusions:
- SARS-CoV-2-related neurologic involvement continued in hospitalized children and adolescents in 2021, often transient.
- Central nervous system infection/demyelination represented a larger proportion of life-threatening conditions.
- COVID-19 vaccination may prevent some SARS-CoV-2-related neurologic complications, warranting further investigation.
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.
