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27-06-2024 | Coronavirus | Editor's Choice | News

Children hospitalized with SARS-CoV-2 or MIS-C at risk for long-term neurological impairment

Author: Dr. Priya Venkatesan

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medwireNews: Children hospitalized with SARS-CoV-2 or multisystem inflammatory syndrome (MIS-C) who have a severe neurological manifestation during admission are more likely to develop a new neurocognitive or functional morbidity at discharge than those who do not, suggests an analysis of the pediatric GCS-NeuroCOVID trial.

Ericka Fink (UPMC Children’s Hospital of Pittsburgh, Pennsylvania, USA) and co-researchers note in JAMA Network Open that “severe neurological manifestations were common” among the 3568 children and adolescents in the study who were admitted to hospital with either acute SARS-CoV-2 (n=2980) or MIS-C (n=588), at rates of 18.0% and 24.8%, respectively.

Acute encephalopathy was the most common neurological manifestation for both SARS-CoV-2 and MIS-C patients, occurring in a respective 61.9% and 76.0% of patients.

These patients with severe neurological manifestations had a significantly increased risk for a new neurocognitive and/or functional morbidity at hospital discharge compared with those who did not, with odds ratios of 1.85 for those with SARS-CoV-2 and 2.18 for those with MIS-C, after adjusting for factors including race, steroid administration, lymphocyte counts, and sodium levels.

They were also “more likely to receive inpatient services including physical and occupational therapy and rehabilitation consults,” say the researchers, adding that these individuals may be at risk for ongoing post-discharge sequalae.

In a linked editorial, Michael Wolf, from the Monroe Carell Jr Children’s Hospital at Vanderbilt, in Nashville, Tennessee, USA, agrees that the analysis demonstrates “an association between severe neurological manifestations and new functional or neurocognitive morbidity,” and adds that the risk factors for and downstream consequences of neurological sequelae in hospitalized children and adolescents with these conditions need to be better understood.

For their study, Fink and colleagues performed a secondary analysis of case report data for participants of the international GCS-NeuroCOVID study. The median age of the patients was 8.0 years and 54.3% were male.

The primary outcome was a new neurocognitive and/or functional morbidity at hospital discharge, defined as a Pediatric Cerebral Performance Category score of 3 or more points, indicative of at least moderate to severe disability, and a change of 1 or more points from the prehospitalization baseline.

This occurred in 27.7% of children with SARS-CoV-2 who had a severe neurological manifestation during hospitalization, including acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. This was a significantly higher rate than for the patients with SARS-CoV-2 without severe neurological manifestations, at 14.6%.

Similarly, the primary outcome occurred in significantly more children with MIS-C who had a severe neurological manifestation while hospitalized than those who did not, at 28.0% versus 15.5%.

The investigators note that children with severe neurological manifestations during hospitalization were more likely than those without to have pre-existing neurological conditions, as reported for 45.7% versus 16.3% of those with acute SARS-CoV-2 infection, and 11.6% versus 5.9% of those with MIS-C.

Patients with severe neurological manifestations were also more likely to have low platelet counts on admission to hospital, irrespective of diagnosis. This “may serve as a red flag for patients deserving scrutiny acutely and in follow-up,” says the team.

Wolf highlights that “children with chronic neurological disorders are known to be at increased risk of severe COVID-19,” adding that the analyses “underscore a critical need for vigilant neurological monitoring in this vulnerable population.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

JAMA Netw Open 2024; 7: e2414122
JAMA Netw Open 2024; 7: e2414127

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