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Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome #MMPMID33666649
LaRovere KL; Riggs BJ; Poussaint TY; Young CC; Newhams MM; Maamari M; Walker TC; Singh AR; Dapul H; Hobbs CV; McLaughlin GE; Son MBF; Maddux AB; Clouser KN; Rowan CM; McGuire JK; Fitzgerald JC; Gertz SJ; Shein SL; Munoz AC; Thomas NJ; Irby K; Levy ER; Staat MA; Tenforde MW; Feldstein LR; Halasa NB; Giuliano JS Jr; Hall MW; Kong M; Carroll CL; Schuster JE; Doymaz S; Loftis LL; Tarquinio KM; Babbitt CJ; Nofziger RA; Kleinman LC; Keenaghan MA; Cvijanovich NZ; Spinella PC; Hume JR; Wellnitz K; Mack EH; Michelson KN; Flori HR; Patel MM; Randolph AG
JAMA Neurol 2021[May]; 78 (5): 536-547 PMID33666649show ga
IMPORTANCE: Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. OBJECTIVE: To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. SETTING, DESIGN, AND PARTICIPANTS: Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. EXPOSURES: Severe acute respiratory syndrome coronavirus 2. MAIN OUTCOMES AND MEASURES: Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. RESULTS: Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barre syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 mug/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19-related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. CONCLUSIONS AND RELEVANCE: In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown.
|Adolescent[MESH]
|COVID-19/*complications/etiology/mortality[MESH]
|Child[MESH]
|Child, Preschool[MESH]
|Critical Care[MESH]
|Female[MESH]
|Hospitalization[MESH]
|Humans[MESH]
|Male[MESH]
|Nervous System Diseases/*etiology/mortality[MESH]
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free
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JAMA+Neurol 2021 ; 78 (5): 536-547
