UK Study Finds That About 4 Percent Of Children Hospitalized For COVID-19 Will Ultimately Develop Neurological Complications!

Pediatric COVID-19: A new study by researchers from various British institutions and hospitals including the University of Liverpool, Great Ormond Street Hospital for Children, Evelina Children's Hospital, Leeds Teaching Hospitals NHS Trust, University of Newcastle, Oxford Children's Hospital, Nottingham Children's Hospital, University of Glasgow, University of Newcastle and many others, have found that roughly 4% of children hospitalized for COVID-19 will ultimately develop neurological complications!

To date, the degree of neurological and psychiatric complications associated with pediatric SARS-CoV-2 infection is poorly understood. The study team aimed to analyze the range and prevalence of these complications in hospitalized children and adolescents.
 
In the study , between April 2, 2020, and Feb 1, 2021, 52 cases were identified; in England, there were 51 cases among 1334 children and adolescents hospitalized with COVID-19, giving an estimated prevalence of 3·8 (95% CI 2·9–5·0) cases per 100 pediatric patients. 22 (42%) patients were female and 30 (58%) were male; the median age was 9 years (range 1–17). 36 (69%) patients were Black or Asian, 16 (31%) were White. 27 (52%) of 52 patients were classified into the COVID-19 neurology group and 25 (48%) were classified into the PIMS-TS neurology group. In the COVID-19 neurology group, diagnoses included status epilepticus (n=7), encephalitis (n=5), Guillain-Barré syndrome (n=5), acute demyelinating syndrome (n=3), chorea (n=2), psychosis (n=2), isolated encephalopathy (n=2), and transient ischaemic attack (n=1). The PIMS-TS neurology group more often had multiple features, which included encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioural change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Recognised neuroimmune disorders were more common in the COVID-19 neurology group than in the PIMS-TS neurology group (13 [48%] of 27 patients vs 1 [<1%] of 25 patients, p=0·0003). Compared with the COVID-19 neurology group, more patients in the PIMS-TS neurology group were admitted to intensive care (20 [80%] of 25 patients vs six [22%] of 27 patients, p=0·0001) and received immunomodulatory treatment (22 [88%] patients vs 12 [44%] patients, p=0·045). 17 (33%) patients (10 [37%] in the COVID-19 neurology group and 7 [28%] in the PIMS-TS neurology group) were discharged with disability; one (2%) died (who had stroke, in the PIMS-TS neurology group).
 
This Pediatric COVID-19 study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. (Primary neurological disorder associated with COVID-19).  Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall. Further studies should investigate underlying mechanisms for neurological involvement in COVID-19 and the longer-term outcomes.
 
The study findings were published in the peer reviewed medical journal: The Lancet’s Child & Adolescent Health. 2352-4642(21)00193-0/fulltext">https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00193-0/fulltext
 
The study team described in detail neurological and psychiatric manifestations of SARS-CoV-2 infection in children.
 
An estimated prevalence of infection-related neurological complications and pediatric inflammatory multisystem syndrome in hospitalized children and adolescents is about 3.8 cases per 100 patients.
 
Aside from respiratory and cardiovascular complications, patients with COVID-19 disease are at high risk of developing neurological symptoms, including encephalopathy, stroke, neuromuscular disorders, and seizures. In pediatric COVID-19 patients, SARS-CoV-2 infection has been found to associate with multisystem inflammatory syndrome in children (MIS-C), which is a rare but serious condition with severe secondary inflammation.
 
It was reported that typically, SARS-CoV-2 associated MIS-C, also called pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), occurs weeks after infection onset.
 
In a single-center study conducted in the UK, nine pediatric COVID-19 patients have been identified with neurological complications of MIS-C.
 
A similar a study conducted on 1,695 children and adolescents in the US has identified transient neurological symptoms in 365 patients and severe life-threatening neurological complications in 43 patients.
 
However, despite the severity of the condition, not enough studies have been done to estimate the prevalence of neurological complications in SARS-CoV-2 infected children.      
 
For this new study, the study team had determined the variety and prevalence of neurological or psychiatric complications associated with COVID-19 in hospitalized children and adolescents.
 
The research was conducted on 1,334 SARS-CoV-2-infected children and adolescents under the age of 18 years who had been hospitalized for new-onset or pre-existing neurological or psychiatric complications.
 
The study team categorized patients into the COVID-19 neurology group if they were diagnosed with a primary neurological or psychiatric disorder associated with COVID-19. Similarly, patients diagnosed with PIMS-TS with neurological manifestations were categorized into the PIMS-TS neurology group.  
 
Interestingly, of all enrolled patients, 52 were identified to have neurological or psychiatric complications associated with COVID-19.
 
Based on this information, the prevalence of neurological/psychiatric disorders in hospitalized pediatric COVID-19 patients was estimated to be 3.8 cases per 100 patients.  
 
The study found that the average age of the patients was 9 years. Regarding demographic characteristics, about 69% of patients were Black or Asian, and 31% were White. This indicates that children from minoritized ethnic groups are more susceptible to neurological complications related to SARS-CoV-2 infection.  
 
From the 52 identified patients, 27 were categorized into the COVID-19 neurology group, and 25 were categorized into the PIMS-TS neurology group.
 
Importantly the major symptoms of patients in the COVID-19 neurology group were acute demyelinating syndrome, severe encephalopathy, peripheral encephalopathy (Guillain-Barre syndrome), movement disorder (chorea), psychosis, and transient ischemic attack.
 
 
It was also found that in patients belonging to the PIMS-TS neurology group, the major complications were systemic features, encephalopathy, behavioral changes, hallucination, meningism, and signs of peripheral or central nervous system involvement.
 
However when compared to patients in the PIMS-TS neurology group, patients with COVID-19 related primary neurological complications had a significantly higher prevalence of recognized neuroimmune disorders. The frequencies of intensive care admissions and immunomodulatory treatments were significantly higher among patients in the PIMS-TS neurology group compared to that in the COVID-19 neurology group patients.
 
In the study data, at the time of discharge from the hospital, about 33% of patients in the COVID-19 neurology group and 28% of patients in the PIMS-TS neurology group had disabilities. In addition, one patient in the PIMS-TS neurology group died due to stroke.  
 
The new study reveals that in hospitalized children and adolescents with COVID-19, neurological or psychiatric complications are common presentations, with a prevalence of 3.8 cases per 100 patients. Importantly, the study highlights the difference in neurological manifestations between SARS-CoV-2 infected children with or without PIMS-TS.
 
The study team added, “While patients with PIMS-TS mostly exhibit multiple overlapping neurological symptoms with characteristic brain imaging patterns, such as reversible splenial lesion in the corpus callosum, patients without PIMS-TS are mostly associated with discrete, frequently recognized neuroimmune, primary neurological complications. “
 
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