Study: Changes in the distribution of severe neurologic involvement in US pediatric patients with COVID-19 or multisystem inflammatory syndrome in children in 2021 versus 2020. Image credit: Sergey Nivens/Shutterstock
Record
In 2020, 22% of hospitalized pediatric patients at 52 US sites experienced neurologic involvement in multisystem inflammatory syndrome in children (MIS-C) or severe acute coronavirus disease 2019 (COVID-19), and 12% experienced severe sequelae. The SARS-CoV-2 Delta variant (B.1.617.2) prevailed in June 2021, leading to increased pediatric hospitalizations in the US. By 2021, children could receive vaccines against COVID-19. The present study evaluated patients hospitalized in 2021 for the degree of neurological involvement associated with SARS-CoV-2 and reported hospital outcomes in US adolescents and children, taking into account their COVID-19 vaccination status.
About the study
In the present study, the researchers described the extent of neurological involvement caused by SARS-CoV-2 in children and adolescents. The team conducted active surveillance of nearly 55 hospitals in 31 states to identify US patients over the age of 21 who were infected with SARS-CoV-2 or who were eligible according to the Centers for Disease Control and Prevention (CDC) criteria for children who hospitalized with MIS-C between December 15, 2020 and December 31, 2021 with acute COVID-19 showed symptoms consistent with COVID-19, as well as a positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) or result of the antigen test. Patients with MIS-C had either a positive SARS-CoV-2 respiratory test result or an antibody test. Qualified staff members extracted the required information from medical data. Medical data were used to identify patients with severe deficits in motor, cognitive, language and verbal functions and life-threatening neurological diseases.
Results
Of the 2,168 patients, 58% were men, with a median age of 10.3 years. Among them, 34% developed acute COVID-19, while 66% had MIS-C. Patients with neurological involvement were generally older and had more underlying neurological diseases. Younger children were more likely to experience seizures, while teenagers were more likely to experience loss of smell and taste. Almost 91% of patients with neurological involvement experienced non-life-threatening neurological symptoms, with headache, disorientation, weakness and loss of taste or smell being the most common. Furthermore, 90% of patients with nonfatal neurologic involvement survived without neurologic decline, 5% died, and 4% were discharged alive while still having neurologic deficits caused by the sequelae of their severe illness. Of the 476 subjects with neurological involvement, 42 developed a variety of life-threatening neurological symptoms, including 23 with acute central nervous system (CNS) infection or acute disseminated encephalomyelitis (ADEM). Neurological conditions that could prove fatal were seen more frequently during the Delta wave of infections than during the pre-Delta phases. Of the 42 patients, 10 had new neurologic lesions at discharge and eight succumbed to the disorders. There were five confirmed and nine probable cases of encephalitis. EEG abnormalities such as diffuse background slowing, localized seizures, or epileptic discharges were observed. The majority of brain magnetic resonance imaging (MRI) results showed features similar to ADEM, including multifocal, nonenhancing lesions characterized by T2 prolongation as well as decreased diffusion, mainly in the deep periventricular and paracortical white matter, basal ganglia, thalamus, brainstem, and posterior fossa, while in one case cortical interference was observed in the supratentorial. One patient’s MRI showed low-titer positivity for myelin oligodendrocyte glycoprotein antibody along with left temporal lobe involvement that improved on a follow-up MRI performed after nine months. Seven of the 23 patients diagnosed with acute CNS infection/ADEM had severe outcomes. Of 155 vaccine-eligible patients with neurologic involvement with confirmed COVID-19 vaccination status, 147 were unvaccinated against COVID-19, including 15 of 16 patients with neurologic disorders that were life-threatening. Zoe.
conclusion
Overall, the study findings showed that in children and adolescents hospitalized for MIS-C or COVID-19, the neurological dysfunction associated with SARS-CoV-2 persisted but was mostly transient. The most life-threatening disorders more often involved CNS infection or demyelination, and most patients eligible to receive the COVID-19 vaccine had not been vaccinated. Further research is needed to determine whether the COVID-19 vaccine can prevent some neurological sequelae associated with SARS-CoV-2.
