Over 44 Percent Children Hospitalized For COVID-19 Had At Least One Neurologic Manifestation Including Headaches And/Or Altered Mental Status

Pediatric COVID-19 Infections: A new study by researchers from UPMC Children's Hospital of Pittsburgh-USA, Johns Hopkins Children’s Center-USA, University of Washington-USA, Seattle Children's Hospital-USA, Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud-Colombia and University of Utah-USA has found that over 44 percent children hospitalized for COVID-19 had at least one neurologic manifestation including headaches and/or altered mental status.


 
The key findings of the study were:
 
-44% of hospitalized children and SARS-CoV-2 condition had neurologic manifestations
 
-More children with MIS-C had neurologic manifestation vs. acute SARS-CoV-2
 
-Headache and encephalopathy were the most common neurologic manifestations
 
-Older children and those with preexisting conditions were at higher risk
 
The study objective was to characterize the frequency, early impact, and risk factors for neurologic manifestations in hospitalized children with acute SARS-CoV-2 infection or Multisystem Inflammatory Syndrome in Children (MIS-C).
 
The study involved a multicenter, cross-sectional study of neurologic manifestations in children age < 18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020-April 2021. Multivariable logistic regression to identify risk factors for neurologic manifestations was performed.
 
Of 1,493 children, 1,278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C.
 
The Pediatric COVID-19 Infections study findings found that overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurologic manifestation. The most common neurologic findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both p<0.05. Children with neurologic manifestations were more likely to require ICU care (51% vs. 22%), p<0·001. In multivariable logistic regression, children with neurologic manifestations were older (odds ratio [OR] 1·1 and 95% confidence interval [95% CI] 1·07-1·13), and more likely to have MIS-C vs. acute SARS-CoV-2 (OR 2·16, 95% CI 1·45, 3·24), pre-existing neurologic and metabolic conditions (OR 3·48, 95% CI 2·37-5·15; and OR 1·65, 95% CI 1·04-2·66, respectively), and pharyngeal (OR 1·74, 95% CI 1·16-2·64) or abdominal pain (OR 1·43, 95% CI 1·03-2·00); all p<0·05.
 
The study findings were published in the peer reviewed journal: pediatric Neurology. https://www.pedneur.com/article/S0887-8994(21)00276-9/fulltext
 
In the current situation where pediatric admissions due to COVID-19 are increasing in many countries including the United States, Denmark, Israel, Japan, etc, it is important that both parents and physicians pay attention to what is developing around the world with regards to pediatric COVID-19 infections and also NeuroCOVID.
 
The study found that of hospitalized children who tested or were presumed positive for SARS-CoV-2, 44% developed neurological symptoms, and these kids were more likely to require intensive care than their peers who didn't experience such symptoms.
 
Interestingly the most common neurologic symptoms were headache and altered mental status, known as acute encephalopathy.
 
These preliminary findings are the first insights from the pediatric arm of GCS-NeuroCOVID, an international, multi-center consortium aiming to understand how COVID-19 affects the brain and nervous system. All the researchers in this study were involved with the consortium.
 
Lead author Dr Ericka Fink, MD., pediatric intensivist at UPMC Children's Hospital of Pittsburgh, and associate professor of critical care medicine and pediatrics at Pittsburgh University told Thailand Medical News, "The SARS-CoV-2 virus can affect pediatric patients in different ways: It can cause acute disease, where symptomatic illness comes on soon after infection, or children may develop an inflammatory condition called MIS-C weeks after clearing the virus. One of the consortium's big questions was whether neurological manifestations are similar or different in pediatric patients, depending on which of these two conditions they have."
In order to address this question, the study team recruited 30 pediatric critical care centers around the world. Of 1,493 hospitalized children, 1,278, or 86%, were diagnosed with acute SARS-CoV-2; 215 children, or 14%, were diagnosed with MIS-C, or multisystem inflammatory syndrome in children, which typically appears several weeks after clearing the virus and is characterized by fever, inflammation and organ dysfunction.
 
It was found that the most common neurologic manifestations linked with acute COVID-19 were headache, acute encephalopathy and seizures, while youths with MIS-C most often had headache, acute encephalopathy and dizziness. Rarer symptoms of both conditions included loss of smell, vision impairment, stroke and psychosis.
 
Dr Fink added, "Thankfully, mortality rates in children are low for both acute SARS-CoV-2 and MIS-C. But this study shows that the frequency of neurological manifestations is high and it may actually be higher than what we found because these symptoms are not always documented in the medical record or assessable. For example, we can't know if a baby is having a headache."
 
The detailed study analysis showed that neurological manifestations were more common in kids with MIS-C compared to those with acute SARS-CoV-2, and children with MIS-C were more likely than those with acute illness to have two or more neurologic manifestations.
 
The study team recently launched a follow up study to determine whether acute SARS-CoV-2 and MIS-C with or without neurologic manifestations have lasting effects on children's health and quality of life after discharge from hospital.
 
Dr Fink further added, "Another long-term goal of this study is to build a database that tracks neurological manifestations over time not just for SARS-CoV-2, but for other types of infections as well. Some countries have excellent databases that allow them to easily track and compare children who are hospitalized, but we don't have such a resource in the U.S."
 
The study team concluded, “Different patterns of neurologic and non-neurologic symptoms occurred in children with acute SARS-CoV-2 versus MIS-C diagnosis, which may help identify children needing close neurologic monitoring. Consequences of critical illness and pediatric sepsis, including neurologic manifestations, functional health, and health-related quality of life impairments are increasingly recognized, but little is known in children with acute SARS-CoV-2 and MIS-C. Children with life-threatening neurologic involvement (n=43) during admission in the Overcoming COVID-19 study, were at risk of new neurologic deficits at hospital discharge (40%), and death (26%). Studies regarding treatment efficacy of interventions in children with neurologic manifestations in SARS-CoV-2-related conditions are vitally needed.”
 
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