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

ImportanceIn 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.ObjectiveTo provide an update on the spectrum of SARS-CoV-2–related neurologic involvement among children and adolescents in 2021.Design, Setting, and ParticipantsCase 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.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresPatients 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).ResultsOf 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 RelevanceSARS-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.