TY - JOUR
T1 - Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C
AU - Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) Investigators
AU - Fink, Ericka L.
AU - Robertson, Courtney L.
AU - Wainwright, Mark S.
AU - Roa, Juan D.
AU - Lovett, Marlina E.
AU - Stulce, Casey
AU - Yacoub, Mais
AU - Potera, Renee M.
AU - Zivick, Elizabeth
AU - Holloway, Adrian
AU - Nagpal, Ashish
AU - Wellnitz, Kari
AU - Czech, Theresa
AU - Even, Katelyn M.
AU - Brunow de Carvalho, Werther
AU - Rodriguez, Isadora Souza
AU - Schwartz, Stephanie P.
AU - Walker, Tracie C.
AU - Campos-Miño, Santiago
AU - Dervan, Leslie A.
AU - Geneslaw, Andrew S.
AU - Sewell, Taylor B.
AU - Pryce, Patrice
AU - Silver, Wendy G.
AU - Lin, Jieru Egeria
AU - Vargas, Wendy S.
AU - Topjian, Alexis
AU - Alcamo, Alicia M.
AU - McGuire, Jennifer L.
AU - Domínguez Rojas, Jesus Angel
AU - Muñoz, Jaime Tasayco
AU - Hong, Sue J.
AU - Muller, William J.
AU - Doerfler, Matthew
AU - Williams, Cydni N.
AU - Drury, Kurt
AU - Bhagat, Dhristie
AU - Nelson, Aaron
AU - Price, Dana
AU - Dapul, Heda
AU - Santos, Laura
AU - Kahoud, Robert
AU - Francoeur, Conall
AU - Appavu, Brian
AU - Guilliams, Kristin P.
AU - Agner, Shannon C.
AU - Walson, Karen H.
AU - Rasmussen, Lindsey
AU - Janas, Anna
AU - Ferrazzano, Peter
AU - Farias-Moeller, Raquel
AU - Snooks, Kellie C.
AU - Chang, Chung Chou H.
AU - Yun, James
AU - Schober, Michelle E.
N1 - Funding Information:
Declaration of Interest: Related funding: This study was in part funded by the Neurocritical Care Society Investing in Clinical Neurocritical Care Research (INCLINE) grant (EF, MS, CR). Unrelated funding: Fink: National Institutes of Health; payment to the institution. Schober: National Institutes of Health; payment to the institution. Robertson: National Institutes of Health and Army Medical Research and Material Command (AMRMC)/Rubicon Biotechnologies grants; both payments to the institution. National Neurotrauma Society Payment to C. Robertson (travel costs for NNS symposium, Pittsburgh 2019). National Neurotrauma Society President, Council Pediatric Neurocritical Care Research Group Executive Committee, Past-Chair (2016-2018). Wainwright: Sage Therapeutics: Member, Clinical Advisory Board; payment to him. Roa: None.
Funding Information:
Research Coordinators: Melissa L. Hutchinson, MD, MA; Josey Hensley RN, BSN, CCRN; Lisa Steele RN, BSN, CCRN (Nationwide Children's Hospital); Tracy Jones, BS (Oklahoma University Health Sciences Center); Geoffrey M. Houtz (University of North Carolina School of Medicine); Jacqueline Lee-Eng, BSc; Mikaela Gatterman, R. EEG T (Seattle Children's Hospital); Jacqueline Harrison, BA (Children's Hospital of Philadelphia); Sarah F Frankl, MD (University of Michigan); Ben Orwoll, MD (Oregon Health & Science University); Travis Kirkpatrick, RN; Aysun Tekin, MD (Mayo Clinic Rochester); Marianne Dufour (Universit? Laval); Luisa Gil Diaz, BS; Jessica Weibrecht, BA; Amy Ouyang, BA (Washington University in St. Louis); Maureen G Richardson, BSN, RN, CPN (Children's Healthcare of Atlanta); Paige Selenski, Rebecca Rehborg, BA; Rupa Nallamothu, MBBS (Medical College of Wisconsin); Ronke Awojoodu MPH, BSN; Colleen Mennie RN, BSN (John Hopkins University); Dr Jos? Albino da Paz, PhD (University of S?o Paulo). University of Pittsburgh Data Coordinating Center (Department of Critical Care Medicine's Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) center and UPMC Children's Hospital of Pittsburgh's Division of Pediatric Critical Care Medicine):, Research staff: Pamela Rubin, RN; David Maloney, BS; Nicole Toney, MPH; Ali Smith Scott, BA. Data coordination: Dan Ricketts, MET; Edvin Music, MSIS, MBA; Jonathan Holton, MSIS. Statistical analysis: James Yun, MS, Joyce Chang, PhD. GCS-NeuroCOVID Consortium Steering Committee: Sherry H.-Y. Chou, MD, MSc (Northwestern University?Feinberg School of Medicine, USA); Raimund Helbok, MD (Medical University of Innsbruck, Innsbruck, Austria); Paul Vespa, MD (University of California, Los Angeles, USA); Daiwai Olson, RN, PhD (University of Texas Southwestern, USA); Claude Hemphill, MD (University of California, San Francisco, USA); Chethan P Venkatasubba Rao MD (Baylor College of Medicine, USA); Nerissa Ko, MD, MS (University of California, San Francisco, USA); Jose I. Suarez, MD (The Johns Hopkins University School of Medicine, USA); Shraddha Mainali, MD (Virginia Commonwealth University, USA); Molly McNett, PhD (The Ohio State University, USA). Neurocritical Care Society for hosting the GCS-NeuroCOVID Consortium weblink to register for study participation. Pediatric research networks. We thank Pediatric Acute Lung Injury and Sepsis Investigators, Pediatric Neurocritical Care Research Group, Canadian Critical Care Trials Group, European Society for Pediatric and Neonatal Intensive Care, Australia and New Zealand Intensive Care Society, World Federation of Pediatric Intensive and Critical Care Societies, Red Colaborativa Pedi?trica de Latinoam?rica, United Kingdom Paediatric Critical Care Society Study group, Prevalence of Acute critical Neurological disease in children: a Global Epidemiological Assessment Investigators, Brazilian Research in Intensive Care network and the Pediatric Acute & Critical Care Medicine Asian Network for allowing distribution of this study opportunity to their members. Finally, special thank you to the families and children in our care and to health care providers for their devotion to public health during the pandemic.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/3
Y1 - 2022/3
N2 - 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.
AB - 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.
KW - Child development
KW - Neurological manifestations
KW - Pediatrics
KW - SARS-CoV-2
UR - http://www.scopus.com/inward/record.url?scp=85122662722&partnerID=8YFLogxK
U2 - 10.1016/j.pediatrneurol.2021.12.010
DO - 10.1016/j.pediatrneurol.2021.12.010
M3 - Article
C2 - 35066369
AN - SCOPUS:85122662722
SN - 0887-8994
VL - 128
SP - 33
EP - 44
JO - Pediatric Neurology
JF - Pediatric Neurology
ER -