The neurologic impact of COVID-19 on pediatric patients

Although primarily still seen as a respiratory disease, coronavirus disease 2019 (COVID-19) impacts other areas of the body as well. A new investigation in JAMA Neurology examines the neurologic involvement in children and teenagers from COVID-19 or multisystem inflammatory syndrome in children (MIS-C).¹

Investigators looked at a case series of patients from the Overcoming COVID-19 public health registry at 61 hospitals in the United States. Those enrolled in the study were aged <21 years, had been hospitalized between March 15, 2020, and December 15, 2020, and had a positive severe acute respiratory syndrome coronavirus 2 test result (either antibody or reverse transcriptase-polymerase chain reaction test). Patients who met the criteria for MIS-C were also included. Neurologic involvement criteria were met if the patient had acute neurologic signs, symptoms, or diseases when he or she first presented or at any time during the hospital stay.

A total of 1695 patients from 52 hospital sites had documented neurologic involvement. Those with neurologic involvement were more likely to have an underlying neurologic disorder (81 of 365 [22%]) compared with those without (113 of 1330 [8%]). However, a similar number had previously been healthy (195 [53%] vs 723 [54%]) and had met the criteria for MIS-C (126 [35%] vs 490 [37%]). Among the patients who have neurologic involvement, most had transient symptoms and survived. Forty-three had life-threatening conditions that were clinically adjudicated to be linked to COVID-19 and included severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). When compared to the 322 patients who did not have life-threatening conditions, those who did were found to have higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Among the 43 patients with severe COVID-linked neurologic involvement, 17 had new neurologic deficits when they left the hospital and 11 died.

The investigators concluded that neurologic involvement was fairly common among children who were hospitalized for either COVID-19 or MIS-C, but most of the involvement was transient. Life-threatening or fatal neurologic involvement was infrequent, but the long-term neurodevelopmental outcomes remain unknown and require further study.

Reference

1. LaRovere K, Riggs B, Poussaint T, et al. Neurologic involvement in children and adolescents hospitalized in the United States for COVID-19 or multisystem inflammatory syndrome. JAMA Neurol. March 5, 2021. Epub ahead of print. doi:10.1001/jamaneurol.2021.0504