NYMC Faculty Publications

Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020

Kerri L. LaRovere, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Tina Y. Poussaint, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.
Cameron C. Young, Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Margaret M. Newhams, Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Suden Kucukak, Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Katherine Irby, Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock.
Michele Kong, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham.
Stephanie P. Schwartz, Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill.
Tracie C. Walker, Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill.
Melania M. Bembea, Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Kari Wellnitz, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City.
Kevin M. Havlin, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, Kentucky.
Natalie Z. Cvijanovich, Division of Critical Care Medicine, UCSF Benioff Children's Hospital, Oakland, California.
Mark W. Hall, Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Julie C. Fitzgerald, Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Jennifer E. Schuster, Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
Charlotte V. Hobbs, Division of Infectious Diseases, Departments of Pediatrics and Microbiology, University of Mississippi Medical Center, Jackson.
Natasha B. Halasa, Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Aalok R. Singh, Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla.
Elizabeth H. Mack, Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston.
Tamara T. Bradford, Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans.
Shira J. Gertz, Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey.
Adam J. Schwarz, Division of Critical Care Medicine, Children's Health Orange County (CHOC), Orange, California.
Katri V. Typpo, Department of Pediatrics and Banner Children's at Diamond Children's Medical Center, University of Arizona, Tucson.
Laura L. Loftis, Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston.
John S. Giuliano, Division of Critical Care, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Steven M. Horwitz, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Katherine V. Biagas, Department of Pediatrics, Stony Brook University Renaissance School of Medicine, Stony Brook, New York.
Katharine N. Clouser, Department of Pediatrics, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey.
Courtney M. Rowan, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis.
Aline B. Maddux, Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora.
Vijaya L. Soma, Division of Pediatric Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine, New York.

Author Type(s)

Faculty

Journal Title

JAMA Neurology

First Page

91

Last Page

98

Document Type

Article

Publication Date

1-1-2023

Department

Pediatrics

Abstract

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.

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