Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C

Fink E.L.; Robertson C.L.; Wainwright M.S.; Roa J.D.; Lovett M.E.; Stulce C.; Yacoub M.; Potera R.M.; Zivick E.; Holloway A.; Nagpal A.; Wellnitz K.; Czech T.; Even K.M.; Brunow de Carvalho W.; Rodriguez I.S.; Schwartz S.P.; Walker T.C.; Campos-Miño S.; Dervan L.A.; Geneslaw A.S.; Sewell T.B.; Pryce P.; Silver W.G.; Lin J.E.; Vargas W.S.; Topjian A.; Alcamo A.M.; McGuire J.L.; Domínguez Rojas J.A.; Muñoz J.T.; Hong S.J.; Muller W.J.; Doerfler M.; Williams C.N.; Drury K.; Bhagat D.; Nelson A.; Price D.; Dapul H.; Santos L.; Kahoud R.; Francoeur C.; Appavu B.; Guilliams K.P.; Agner S.C.; Walson K.H.; Rasmussen L.; Janas A.; Ferrazzano P.; Farias-Moeller R.; Snooks K.C.; Chang C.-C.H.; Yun J.; Schober M.E. · Pediatric Neurology (2022) · DOI: 10.1016/j.pediatrneurol.2021.12.010

Resumen

Background: Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C). Methods: Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed. Results: Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological 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 neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05. Conclusions: In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.