Journal article
Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome
JAMA neurology, Vol.78(5), pp.536-547
05/01/2021
DOI: 10.1001/jamaneurol.2021.0504
PMCID: PMC7936352
PMID: 33666649
Abstract
Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear.
To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19.
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.
Severe acute respiratory syndrome coronavirus 2.
Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge.
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-Barré 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 μg/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.
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.
Details
- Title: Subtitle
- Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome
- Creators
- Kerri L LaRovere - Harvard UniversityBecky J Riggs - Johns Hopkins UniversityTina Y Poussaint - Harvard UniversityCameron C Young - Harvard UniversityMargaret M Newhams - Harvard UniversityMia Maamari - The University of Texas at DallasTracie C Walker - University of North Carolina at Chapel HillAalok R Singh - Westchester Medical CenterHeda Dapul - New York UniversityCharlotte V Hobbs - University of MississippiGwenn E McLaughlin - University of MiamiMary Beth F Son - Harvard UniversityAline B Maddux - University of DenverKatharine N Clouser - Hackensack University Medical CenterCourtney M Rowan - University of IndianapolisJohn K McGuire - University of WashingtonJulie C Fitzgerald - University of PennsylvaniaShira J Gertz - Saint Barnabas Medical CenterSteven L Shein - Rainbow Babies & Children's HospitalAlvaro Coronado Munoz - The University of Texas Health Science Center at HoustonNeal J Thomas - Pennsylvania State UniversityKatherine Irby - University of Arkansas for Medical SciencesEmily R Levy - Mayo Clinic in FloridaMary A Staat - University of CincinnatiMark W Tenforde - Centers for Disease Control and PreventionLeora R Feldstein - Centers for Disease Control and PreventionNatasha B Halasa - Vanderbilt UniversityJohn S Giuliano Jr - Yale UniversityMark W Hall - Nationwide Children's HospitalMichele Kong - University of Alabama at BirminghamChristopher L Carroll - Connecticut Children's Medical CenterJennifer E Schuster - Children's Mercy HospitalSule Doymaz - SUNY Downstate Health Sciences UniversityLaura L Loftis - Baylor College of MedicineKeiko M Tarquinio - Emory UniversityChristopher J Babbitt - Miller Children's & Women's HospitalRyan A Nofziger - Akron Children's HospitalLawrence C Kleinman - Rutgers, The State University of New JerseyMichael A Keenaghan - Kings County Hospital CenterNatalie Z Cvijanovich - University of California, San FranciscoPhilip C Spinella - Washington University in St. LouisJanet R Hume - University of MinnesotaKari Wellnitz - University of IowaElizabeth H Mack - Medical University of South CarolinaKelly N Michelson - Northwestern UniversityHeidi R Flori - University of MichiganManish M Patel - Centers for Disease Control and PreventionAdrienne G Randolph - Harvard UniversityOvercoming COVID-19 Investigators
- Resource Type
- Journal article
- Publication Details
- JAMA neurology, Vol.78(5), pp.536-547
- DOI
- 10.1001/jamaneurol.2021.0504
- PMID
- 33666649
- PMCID
- PMC7936352
- NLM abbreviation
- JAMA Neurol
- ISSN
- 2168-6149
- eISSN
- 2168-6157
- Grant note
- K23 DK119463 / NIDDK NIH HHS UL1 TR001863 / NCATS NIH HHS
- Language
- English
- Date published
- 05/01/2021
- Academic Unit
- Critical Care; Stead Family Department of Pediatrics
- Record Identifier
- 9984354118502771
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