Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

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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Aston Publications Explorer (Aston University)
Published
2024-10-04
DOI
https://doi.org/10.17615/zzpq-w029
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Long-Term Effects of COVID-19
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article

Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

Kurt Drury, Jesús Domínguez-Rojas, Karen Walson, M Yacoub et al.
Aston Publications Explorer (Aston University)
Long-Term Effects of COVID-19
article

Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

Kurt Drury, Jesús Domínguez-Rojas, Karen Walson, M Yacoub, Jennifer Erklauer, Facundo Jorro Barón, Brian Appavu, Kari Wellnitz, Cydni N. Williams, Andrew S. Geneslaw, Jennifer L. McGuire, Juan D. Roa, Karen Lidsky, Wendy Vargas, Samantha Dallefeld, Wendy G. Silver, Alexis Topjian, Ashish Nagpal, Courtney Robertson, Michelle E. Schober, Elizabeth Zivick, Conall Francoeur, Kellie Snooks, Hari Krishnan Kanthimathinathan, Victor B. Talisa, Shannon C. Agner, Heda Dapul, Isadora Souza Rodriguez, Peter A. Ferrazzano, Dhristie Bhagat, K. Siruguppa, Werther Brunow de Carvalho, Sixto Bogantes-Ledezma, Casey Stulce, Robert J. Kahoud, Leslie A. Dervan, Adrian Holloway, Lindsey Rasmussen, Jaime Tasayco-Muñoz, Warwick W. Butt, Laura Jurema dos Santos, Stephanie P. Schwartz, Michael Yoong, Dana C. Price, William J. Muller, Renee M. Potera, Patrice Pryce, Ericka L. Fink, Kristin P. Guilliams, Fabricio Sevilla-Acosta, Michaela Waak, Ria Pal, Raquel Farias‐Moeller, Santiago Campos-Miño, Tracie C. Walker, Shruti Agrawal, Alfonso Gutiérrez-Mata, Andrés Umaña-Calderón, Tomás Iolster, Sue J. Hong, Alicia M. Alcamo, Katelyn Even, Jieru E. Lin, Taylor B. Sewell, Adriana Yock‐Corrales, Aaron Nelson, Adriana Ulate-Campos, Mark S. Wainwright, Evangeline Wassmer, Marlina E. Lovett, Tanıl Kendirli, Helen Flockton, Chung‐Chou H. Chang, Akash Deep, Anna Janas, Zoha Mohammad, Michelle Jardine, Matthew Doerfler
article en

Abstract

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.

Aston Publications Explorer (Aston University)
University of North Carolina at Chapel Hill (US)
University of Pittsburgh, Children’s Hospital of Wisconsin Research Institute, Murdoch Children's Research Institute, Neurocritical Care Society, Birmingham Women's and Children's NHS Foundation Trust, University of Melbourne, University of Queensland, School of Medicine
Good health and well-being
Openalex Percentile: Top 73%
Long-Term Effects of COVID-19
DOIOpen Access PDFOpenAlex
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