Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020
Creators: name: Bradford, T.T.
name: Schuster, J.E.
name: LaRovere, K.L.
name: Hall, M.W.
name: Babbitt, C.J.
name: Poussaint, T.Y.
name: Biagas, K.V.
name: Hobbs, C.V.
name: Havlin, K.M.
name: Soma, V.L.
name: Halasa, N.B.
name: Cvijanovich, N.Z.
name: Schwartz, S.P.
name: Walker, T.C.
name: Schwarz, A.J.
name: Rowan, C.M.
name: Zambrano, L.D.
name: Giuliano, J.S., Jr.
name: Irby, K.
name: Clouser, K.N.
name: Bembea, M.M.
name: Randolph, A.G.
name: Mack, E.H.
name: Kong, M.
name: Gertz, S.J.
name: Young, C.C.
name: Harvey, H.
name: Kolmar, A.R.
name: Aguiar, C.L.
name: Wellnitz, K.
name: Campbell, A.P.
name: Newhams, M.M.
name: Maddux, A.B.
name: Overcoming COVID-19 Investigators
name: Kucukak, S.
name: Loftis, L.L.
name: Heidemann, S.M.
name: Typpo, K.V.
name: Singh, A.R.
name: Fitzgerald, J.C.
name: Horwitz, S.M.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2023

description: 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 (<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.