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Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity
Conall Francoeur1, Alicia M Alcamo2,3,4, Courtney L Robertson5
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
Insights
Children hospitalized with severe neurological issues from acute SARS-CoV-2 or MIS-C face increased neurocognitive and functional risks. Early screening and intervention are crucial for recovery and preventing long-term impairment.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroscience
Background:
- Neurological issues are common in children hospitalized with acute SARS-CoV-2 and multisystem inflammatory syndrome in children (MIS-C).
- These neurological manifestations may elevate the risk of subsequent neurocognitive or functional impairments in pediatric patients.
Purpose of the Study:
- To investigate the association between severe neurological manifestations during acute SARS-CoV-2 or MIS-C hospitalization and new neurocognitive or functional morbidities at discharge.
- To identify children at higher risk for long-term impairment following SARS-CoV-2 infection or MIS-C.
Main Methods:
- A prospective cohort study involving 3568 patients under 18 across 46 centers in 10 countries.
- Data collected from January 2020 to July 2021 for patients hospitalized with acute SARS-CoV-2 or MIS-C.
- Severe neurological manifestations included encephalopathy, seizures, meningitis/encephalitis, dysautonomia, cardiac arrest, coma, delirium, and stroke. Neurocognitive and functional outcomes were assessed using standardized scales.
Main Results:
- 18.0% of acute SARS-CoV-2 patients and 24.8% of MIS-C patients experienced severe neurological manifestations.
- Survivors with severe neurological manifestations had significantly higher rates of new neurocognitive/functional morbidity at discharge (27.7% for SARS-CoV-2 vs. 14.6%; 28.0% for MIS-C vs. 15.5%).
- Adjusted analyses showed increased odds of morbidity for both acute SARS-CoV-2 (OR, 1.85) and MIS-C (OR, 2.18) patients with severe neurological manifestations.
Conclusions:
- Severe neurological manifestations in children hospitalized with acute SARS-CoV-2 or MIS-C are associated with a significantly higher risk of neurocognitive and functional morbidity at discharge.
- These findings highlight the potential for long-term impairment in affected children.
- Early screening and intervention strategies are recommended for children experiencing severe neurological manifestations to support recovery and mitigate long-term consequences.
Importance:
Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity.
Objective:
To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge.
Design, Setting, And Participants:
This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021.
Exposure:
Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke.
Main Outcomes And Measures:
The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition.
Results:
Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P < .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge.
Conclusions And Relevance:
The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.
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