Chronic Neurological Disorders and Predisposition to Severe COVID-19 in Pediatric Patients in the United States
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Megan Chi1, Olivia Heutlinger2, Carly Heffernan2
1Children's Health of Orange County, Orange, California; Liberty University College of Osteopathic Medicine, Lynchburg, Virginia.
Insights
Children with chronic neurological conditions face increased risks of severe COVID-19. Specific disorders like muscular dystrophies and cerebral palsy were linked to higher severity, while movement disorders showed a protective association against severe coronavirus disease 2019.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Investigated the link between chronic pediatric neurological disorders and the severity of SARS-CoV-2 infections.
- Highlighted the vulnerability of children with complex neurological conditions to severe COVID-19 outcomes.
Purpose of the Study:
- To determine the association between various chronic pediatric neurological conditions and the severity of COVID-19.
- To identify specific neurological disorders that increase the risk of severe coronavirus disease 2019 in children.
Main Methods:
- A matched retrospective case-control study involving 71,656 pediatric patients across 103 US health systems.
- Utilized a cumulative link mixed effects model to analyze the relationship between neurological disorders and COVID-19 severity (mild, moderate, severe).
- Included patients with laboratory-confirmed SARS-CoV-2 infection or diagnostic codes for infection/exposure.
Main Results:
- Chronic neurological disorders, including muscular dystrophies, central nervous system disorders, cerebral palsy, congenital neurological disorders, epilepsy, and intellectual developmental disorders, were associated with significantly higher odds of severe COVID-19.
- Muscular dystrophies and myopathies showed the highest increased odds (OR=3.22) of severe coronavirus disease 2019.
- Movement disorders were associated with lower odds of severe COVID-19 (OR=0.90).
Conclusions:
- Pediatric patients with chronic neurological disorders exhibit a higher likelihood of experiencing severe outcomes from COVID-19.
- Certain neurological conditions elevate the risk for severe coronavirus disease 2019, whereas movement disorders may offer some protection.
Background:
We investigated the association between chronic pediatric neurological conditions and the severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Methods:
This matched retrospective case-control study includes patients (n = 71,656) with chronic complex neurological disorders under 18 years of age, with laboratory-confirmed diagnosis of COVID-19 or a diagnostic code indicating infection or exposure to SARS-CoV-2, from 103 health systems in the United States. The primary outcome was the severity of coronavirus disease 2019 (COVID-19), which was classified as severe (invasive oxygen therapy or death), moderate (noninvasive oxygen therapy), or mild/asymptomatic (no oxygen therapy). A cumulative link mixed effects model was used for this study.
Results:
In this study, a cumulative link mixed effects model (random intercepts for health systems and patients) showed that the following classes of chronic neurological disorders were associated with higher odds of severe COVID-19: muscular dystrophies and myopathies (OR = 3.22; 95% confidence interval [CI]: 2.73 to 3.84), chronic central nervous system disorders (OR = 2.82; 95% CI: 2.67 to 2.97), cerebral palsy (OR = 1.97; 95% CI: 1.85 to 2.10), congenital neurological disorders (OR = 1.86; 95% CI: 1.75 to 1.96), epilepsy (OR = 1.35; 95% CI: 1.26 to 1.44), and intellectual developmental disorders (OR = 1.09; 95% CI: 1.003 to 1.19). Movement disorders were associated with lower odds of severe COVID-19 (OR = 0.90; 95% CI: 0.81 to 0.99).
Conclusions:
Pediatric patients with chronic neurological disorders are at higher odds of severe COVID-19. Movement disorders were associated with lower odds of severe COVID-19.
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