Children hospitalized with COVID-19 frequently show neurological symptoms

Neurological symptoms frequently occur in children and adolescents hospitalized with COVID-19 and have been shown in a large case series of pediatric patients in the United States.

Adrian Randolph, MD, MD, Boston Children’s Hospital, found that more than 1 in 5 (22%) of the 1,695 people admitted to acute COVID-19 or multiorgan inflammation syndrome (MIS-C) in children under the age of 21 He reported having a neurological involvement. And co-author.

Although most symptoms were transient, Randolph et al. Wrote that 12% of children with neurological involvement developed life-threatening neurological disorders. JAMA Neurology..

“Our findings emphasize that neurological involvement is common in children and adolescents admitted with COVID-19,” said Kelly Larover, MD, co-author of Boston Children’s Hospital. I am. “Children underlying neuropathy may be at increased risk of neurological complications, but we also found that many children were previously healthy and had no previous neurological condition,” she said. Said Today’s MedPage.

Most children and adolescents do not develop severe COVID-19.Report of life-threatening neurological involvement in developing patients MIS-C, a rare inflammatory disease Temporarily associated with SARS-CoV-2 infection, since the pandemic began Increasing cases when infection rate rises sharply..

In their study, Randolph and his collaborators Overcoming COVID-19 Registration of pediatric patients from 61 hospitals in 31 states from March 15 to December 15, 2020. Participants were hospitalized for acute illness and were positive for SARS-CoV-2 test and symptoms associated with acute COVID-19? MIS-C CDC standard.. Patients with asymptomatic SARS-CoV-2 infection or hospitalization or death unrelated to COVID-19 were excluded.

More than half (54%) of the participants were male, with a median age of 9 years. Patients with neurological involvement were more likely to have an underlying neurological disorder (22%) than those without (8%), whereas similar numbers were previously healthy. (53% vs 54%), met MIS-C criteria (35% vs 37%).

The neurological symptoms associated with COVID-19 vary with age, from seizures and status epilepticus in younger patients to anosmia, ageusia, headache, malaise, and weakness in older patients. Overall, about 1 in 4 pediatric patients with neurological involvement changed consciousness and confusion.

Most (88%) pediatric patients with neurological involvement showed transient symptoms and survived. Forty-three patients (12%) developed COVID-19-related life-threatening conditions.

• Severe encephalopathy (15 patients, including 5 with splenial lesions)
• Stroke (12 patients)
• Neuroinfectious disease or demyelination (8 patients)
• Guillain-Barré syndrome or its variants (4 patients)
• Acute fulminant cerebral edema (4 patients)

Patients with life-threatening neurological conditions have a higher ratio of neutrophils to lymphocytes (median 12.2 vs. 4.4) and exceed 3 μg / mL fibrinogen equivalent units of D- Dimers were reported more frequently (49% vs. 22%). Engagement was not life-threatening.

Of the patients with life-threatening neurological conditions, 11 (26%) died and 17 (40%) survived with new neurological sequelae. The children who died included four patients with stroke and four patients with severe encephalopathy. Of the survivors with new deficiencies, 16 (94%) were previously healthy, none had previously had neuropathy, and 7 (41%) met MIS-C criteria. It was.

“Black children and adolescents of Hispanic or Latino and non-Hispanic descent accounted for a high proportion of cases with severe neurological involvement,” said Tina Young, also co-author of Boston Children’s Hospital. Dr. Pusanto said.

“Young individuals with widespread neurological symptoms or severe neurological conditions after exposure to COVID-19 or a positive SARS-CoV-2 test are at high suspicion of COVID-19-related neurological involvement. There should be an indicator, “Pusan ​​said. Today’s MedPage.

“Even in healthy children, it is important to minimize exposure by following CDC guidelines, because the full extent of neurological involvement and its long-term effects on cognition and development are unknown.” She added.

The study had some limitations, the researchers said. Cases originate only from the reporting hospital and do not reflect the true extent and severity of the neurological involvement of COVID-19. In patients with underlying neurological disorders, some symptoms can be exacerbations of their condition. Not all patients have images, and some symptoms, such as anosmia and ageusia, can be underreported in very young patients.