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About 4 in 100 COVID-19 hospitalized children may develop neurological complications, a study finds

In a recently published article in The Lancet’s Child & Adolescent Health, scientists have described in detail neurological and psychiatric manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children. As mentioned in the study, an estimated prevalence of infection-related neurological complications and pediatric inflammatory multisystem syndrome in hospitalized children and adolescents is about 3.8 cases per 100 patients.

Background

Besides respiratory and cardiovascular complications, patients with coronavirus disease 2019 (COVID-19) are at high risk of developing neurological symptoms, including encephalopathy, stroke, neuromuscular disorders, and seizures. In pediatric COVID-19 patients, SARS-CoV-2 infection has been found to associate with multisystem inflammatory syndrome in children (MIS-C), which is a rare but serious condition with severe secondary inflammation.

Typically, SARS-CoV-2 associated MIS-C, also called pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), occurs weeks after infection onset. In a single-center study conducted in the UK, nine pediatric COVID-19 patients have been identified with neurological complications of MIS-C.

Similarly, a study conducted on 1,695 children and adolescents in the US has identified transient neurological symptoms in 365 patients and severe life-threatening neurological complications in 43 patients. However, despite the severity of the condition, not enough studies have been done to estimate the prevalence of neurological complications in SARS-CoV-2 infected children.      

In the current study, the scientists have determined the variety and prevalence of neurological or psychiatric complications associated with COVID-19 in hospitalized children and adolescents.

Study design

The study was conducted on 1,334 SARS-CoV-2-infected children and adolescents under the age of 18 years who had been hospitalized for new-onset or pre-existing neurological or psychiatric complications.

The scientists categorized patients into the COVID-19 neurology group if they were diagnosed with a primary neurological or psychiatric disorder associated with COVID-19. Similarly, patients diagnosed with PIMS-TS with neurological manifestations were categorized into the PIMS-TS neurology group.  

Important observations

Of all enrolled patients, 52 were identified to have neurological or psychiatric complications associated with COVID-19. Based on this information, the prevalence of neurological/psychiatric disorders in hospitalized pediatric COVID-19 patients was estimated to be 3.8 cases per 100 patients.  

The average age of the patients was 9 years. Regarding demographic characteristics, about 69% of patients were Black or Asian, and 31% were White. This indicates that children from minoritized ethnic groups are more susceptible to neurological complications related to SARS-CoV-2 infection.  

Of 52 identified patients, 27 were categorized into the COVID-19 neurology group, and 25 were categorized into the PIMS-TS neurology group. The major symptoms of patients in the COVID-19 neurology group were acute demyelinating syndrome, severe encephalopathy, peripheral encephalopathy (Guillain-Barre syndrome), movement disorder (chorea), psychosis, and transient ischemic attack.

In patients belonging to the PIMS-TS neurology group, the major complications were systemic features, encephalopathy, behavioral changes, hallucination, meningism, and signs of peripheral or central nervous system involvement.

Compared to patients in the PIMS-TS neurology group, patients with COVID-19 related primary neurological complications had a significantly higher prevalence of recognized neuroimmune disorders. The frequencies of intensive care admissions and immunomodulatory treatments were significantly higher among patients in the PIMS-TS neurology group compared to that in the COVID-19 neurology group patients.

At the time of discharge from the hospital, about 33% of patients in the COVID-19 neurology group and 28% of patients in the PIMS-TS neurology group had disabilities. In addition, one patient in the PIMS-TS neurology group died due to stroke.    

Study significance

The study reveals that in hospitalized children and adolescents with COVID-19, neurological or psychiatric complications are common presentations, with a prevalence of 3.8 cases per 100 patients. Importantly, the study highlights the difference in neurological manifestations between SARS-CoV-2 infected children with or without PIMS-TS.

While patients with PIMS-TS mostly exhibit multiple overlapping neurological symptoms with characteristic brain imaging patterns, such as reversible splenial lesion in the corpus callosum, patients without PIMS-TS are mostly associated with discrete, frequently recognized neuroimmune, primary neurological complications.  

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