Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020
Author
LaRovere, K.L.Poussaint, T.Y.
Young, C.C.
Newhams, M.M.
Kucukak, S.
Irby, K.
Kong, M.
Schwartz, S.P.
Walker, T.C.
Bembea, M.M.
Wellnitz, K.
Havlin, K.M.
Cvijanovich, N.Z.
Hall, M.W.
Fitzgerald, J.C.
Schuster, J.E.
Hobbs, C.V.
Halasa, N.B.
Singh, A.R.
Mack, E.H.
Bradford, T.T.
Gertz, S.J.
Schwarz, A.J.
Typpo, K.V.
Loftis, L.L.
Giuliano, J.S., Jr
Horwitz, S.M.
Biagas, K.V.
Clouser, K.N.
Rowan, C.M.
Maddux, A.B.
Soma, V.L.
Babbitt, C.J.
Aguiar, C.L.
Kolmar, A.R.
Heidemann, S.M.
Harvey, H.
Zambrano, L.D.
Campbell, A.P.
Randolph, A.G.
Overcoming COVID-19 Investigators
Affiliation
Department of Pediatrics and Banner Children's at Diamond Children's Medical Center, University of ArizonaIssue Date
2022-11-07
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AMER MEDICAL ASSOCCitation
LaRovere, K. L., Poussaint, T. Y., Young, C. C., Newhams, M. M., Kucukak, S., Irby, K., ... & Overcoming COVID-19 Investigators. (2023). Changes in distribution of severe neurologic involvement in US pediatric inpatients with COVID-19 or multisystem inflammatory syndrome in children in 2021 vs 2020. JAMA neurology, 80(1), 91-98.Journal
JAMA neurologyRights
© 2022 LaRovere KL et al. JAMA Neurology. This is an open access article distributed under the terms of the CC-BY License.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.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.Note
Open access articleISSN
2168-6157PubMed ID
36342679Version
Final published versionae974a485f413a2113503eed53cd6c53
10.1001/jamaneurol.2022.3881
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Except where otherwise noted, this item's license is described as © 2022 LaRovere KL et al. JAMA Neurology. This is an open access article distributed under the terms of the CC-BY License.
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