TY - JOUR
T1 - Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity
AU - Francoeur, Conall
AU - Alcamo, Alicia M
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 - Even, Katelyn M
AU - Brunow de Carvalho, Werther
AU - Rodriguez, Isadora S
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 E
AU - Vargas, Wendy S
AU - Topjian, Alexis
AU - McGuire, Jennifer L
AU - Domínguez Rojas, Jesus Angel
AU - Tasayco-Muñoz, Jaime
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 - Appavu, Brian
AU - Guilliams, Kristin P
AU - Agner, Shannon C
AU - Walson, Karen H
AU - Rasmussen, Lindsey
AU - Pal, Ria
AU - Janas, Anna
AU - Ferrazzano, Peter
AU - Wassmer, Evangeline
N1 - CC BY
PY - 2024/6/10
Y1 - 2024/6/10
N2 - Importance: Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective: To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants: This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure: Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures: The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. Results: Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P <.001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P =.002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P =.001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P =.009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. Conclusions and Relevance: The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.
AB - Importance: Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective: To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants: This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure: Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures: The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. Results: Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P <.001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P =.002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P =.001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P =.009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. Conclusions and Relevance: The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.
KW - Severity of Illness Index
KW - Prospective Studies
KW - Humans
KW - Child, Preschool
KW - Hospitalization - statistics & numerical data
KW - Male
KW - Infant
KW - Systemic Inflammatory Response Syndrome - epidemiology
KW - Nervous System Diseases - etiology - epidemiology
KW - COVID-19 - complications - epidemiology
KW - SARS-CoV-2
KW - Adolescent
KW - Female
KW - Child
KW - COVID-19/complications
KW - Systemic Inflammatory Response Syndrome/epidemiology
KW - Nervous System Diseases/etiology
KW - Hospitalization/statistics & numerical data
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819749
UR - http://www.scopus.com/inward/record.url?scp=85195628981&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2024.14122
DO - 10.1001/jamanetworkopen.2024.14122
M3 - Article
C2 - 38857050
VL - 7
JO - JAMA Network Open
JF - JAMA Network Open
IS - 6
M1 - e2414122
ER -