Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020
Authors: LaRovere Kerri L. , Poussaint Tina Y. , Young Cameron C. , Newhams Margaret M. , Kucukak Suden , Irby Katherine , Kong Michele , Schwartz Stephanie P. , Walker Tracie C. , Bembea Melania M. , Wellnitz Kari , Havlin Kevin M. , Cvijanovich Natalie Z. , Hall Mark W. , Fitzgerald Julie C. , Schuster Jennifer E. , Hobbs Charlotte V. , Halasa Natasha B. , Singh Aalok R. , Mack Elizabeth H. , Bradford Tamara T. , Gertz Shira J. , Schwarz Adam J. , Typpo Katri V. , Loftis Laura L. , Giuliano John S. , Horwitz Steven M. , Biagas Katherine V. , Clouser Katharine N. , Rowan Courtney M. , Maddux Aline B. , Soma Vijaya L. , Babbitt Christopher J. , Aguiar Cassyanne L. , Kolmar Amanda R. , Heidemann Sabrina M. , Harvey Helen , Zambrano Laura D. , Campbell Angela P. , Randolph Adrienne G. ,   Overcoming COVID-19 Investigators, Gaspers Mary Glas , Sanders Ronald C , Zinter Matt S , Pannaraj Pia S , Port Emily , Shankman Sara , Mansour Rachel , Carroll Christopher L , McLaughlin Gwenn E , Espinal Paula S , Michelson Kelly N , Coates Bria M , Bhoojhawon Guru , Sullivan Janice E , Montgomery Vicki L , Graciano Ana Lia , Lipton Susan V , Son Mary Beth F , Chen Sabrina R , Worden Julia , McCadden Timothy , Carroll Ryan W , Yager Phoebe H , Fernandes Neil D , Hume Janet R , Levy Emily R , Malloch Lacy , Martin Lora , Howard-Claudio Candace , Gourdy David , Spinella Philip C , Cullimore Melissa L , McCulloh Russell J , Kleinman Lawrence C , Li Simon , Kuebler Joseph , Ratner Adam J , Dapul Heda , Doymaz Sule , Keenaghan Michael A , Schwartz Cody , Shein Steven L , Lansell Amanda N , Nofziger Ryan A , Staat Mary A , Thomas Neal J , Butler Andrew D , Reed Nelson , Stewart Laura , Golcha Meena , Samperio Marian , Bowens Cindy , Maamari Mia , Crandall Hillary , Smith Lincoln S , McGuire John K , Patel Manish M 
Published: November 2022

Importance

In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–related complications.

Objective

To provide an update on the spectrum of SARS-CoV-2–related neurologic involvement among children and adolescents in 2021.

Design, Setting, and Participants

Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2–related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge. A total of 2253 patients were enrolled during the investigation period. Patients suspected of having multisystem inflammatory syndrome in children (MIS-C) who did not meet criteria (n = 85) were excluded. Patients (&amp;lt;21 years) with positive SARS-CoV-2 test results (reverse transcriptase–polymerase chain reaction and/or antibody) meeting criteria for MIS-C or acute COVID-19 were included in the analysis.

Exposure

SARS-CoV-2 infection.

Main Outcomes and Measures

Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening neurologic involvement was adjudicated by experts based on clinical and/or neuroradiological features. Type and severity of neurologic involvement, laboratory and imaging data, vaccination status, and hospital discharge outcomes (death or survival with new neurologic deficits).

Results

Of 2168 patients included (58% male; median age, 10.3 years), 1435 (66%) met criteria for MIS-C, and 476 (22%) had documented neurologic involvement. Patients with neurologic involvement vs without were older (median age, 12 vs 10 years) and more frequently had underlying neurologic disorders (107 of 476 [22%] vs 240 of 1692 [14%]). Among those with neurologic involvement, 42 (9%) developed acute SARS-CoV-2–related life-threatening conditions, including central nervous system infection/demyelination (n = 23; 15 with possible/confirmed encephalitis, 6 meningitis, 1 transverse myelitis, 1 nonhemorrhagic leukoencephalopathy), stroke (n = 11), severe encephalopathy (n = 5), acute fulminant cerebral edema (n = 2), and Guillain-Barré syndrome (n = 1). Ten of 42 (24%) survived with new neurologic deficits at discharge and 8 (19%) died. Among patients with life-threatening neurologic conditions, 15 of 16 vaccine-eligible patients (94%) were unvaccinated.

Conclusions and Relevance

SARS-CoV-2–related neurologic involvement persisted in US children and adolescents hospitalized for COVID-19 or MIS-C in 2021 and was again mostly transient. Central nervous system infection/demyelination accounted for a higher proportion of life-threatening conditions, and most vaccine-eligible patients were unvaccinated. COVID-19 vaccination may prevent some SARS-CoV-2–related neurologic complications and merits further study.