Neurological involvement in hospitalized children with SARS-CoV-2 infection: a multinational study
Carmen Yea, Michelle Barton, Ari Bitnun, Shaun K. Morris, Tala El Tal, Rolando Ulloa‐Gutiérrez, Helena Brenes-Chacón, Adriana Yock‐Corrales, Gabriela Ivankovich‐Escoto, Alejandra Soriano‐Fallas, Marcela Hernández-de Mezerville, Peter J. Gill, Alireza Nateghian, Behzad Haghighi Aski, Ali Anari Manafi, Rachel Dwilow, Jared Bullard, Jesse Papenburg, Rosie Scuccimarri, Marie‐Astrid Lefebvre, Suzette Cooke, Tammie Dewan, Léa Restivo, Alison Lopez, Manish Sadarangani, Ashley Roberts, Jacqueline Wong, Nicole Le Saux, Jennifer Bowes, Rupeena Purewal, Janell Lautermilch, Cheryl Foo, Joanna Merckx, Joan Robinson, E. Ann Yeh
Abstract
ABSTRACT: Background and Objectives: Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2. Methods: This was a multicenter observational study of children <18 years of age with confirmed SARS-CoV-2 infection or multisystemic inflammatory syndrome (MIS-C) and laboratory evidence of SARS-CoV-2 infection in children, admitted to 15 tertiary hospitals/healthcare centers in Canada, Costa Rica, and Iran February 2020–May 2021. Descriptive statistical analyses were performed and logistic regression was used to identify factors associated with neurological involvement. Results: One-hundred forty-seven (21%) of 697 hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Headache ( n = 103), encephalopathy ( n = 28), and seizures ( n = 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15–2.55; p = 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46–5.59; p < 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46–3.15; p < 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58–3.40; p < 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08–3.42; p = 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49–5.97, p = 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58–4.82; p < 0.001). Discussion: In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.