Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C
Creators: name: Kahoud, R.
name: Doerfler, M.
name: Janas, A.
name: Hong, S.J.
name: Potera, R.M.
name: Topjian, A.
name: Yacoub, M.
name: Rodriguez, I.S.
name: Yun, J.
name: Pryce, P.
name: Czech, T.
name: Guilliams, K.P.
name: Walson, K.H.
name: Geneslaw, A.S.
name: Drury, K.
name: Nagpal, A.
name: Lin, J.E.
name: Dapul, H.
name: Farias-Moeller, R.
name: Robertson, C.L.
name: Campos-Miño, S.
name: Bhagat, D.
name: Roa, J.D.
name: Francoeur, C.
name: Stulce, C.
name: Snooks, K.C.
name: Alcamo, A.M.
name: Chang, C.-C.H.
name: Ferrazzano, P.
name: Domínguez Rojas, J.A.
name: Muller, W.J.
name: Muñoz, J.T.
name: Wellnitz, K.
name: Williams, C.N.
name: Zivick, E.
name: Vargas, W.S.
name: Holloway, A.
name: Santos, L.
name: Fink, E.L.
name: Appavu, B.
name: Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) Investigators
name: Schober, M.E.
name: Rasmussen, L.
name: Wainwright, M.S.
name: Even, K.M.
name: Agner, S.C.
name: Sewell, T.B.
name: Lovett, M.E.
name: Silver, W.G.
name: Price, D.
name: Brunow de Carvalho, W.
name: Schwartz, S.P.
name: Nelson, A.
name: Dervan, L.A.
name: Walker, T.C.
name: McGuire, J.L.
Publisher: name: Elsevier Inc.
Year: 2022

description: 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.