Pediatric Neurological Manifestations Tied to SARS-CoV-2 and MIS-C
Children and adolescents with acute SARS-CoV-2 or multisystem inflammatory syndrome in children (MIS-C) could be at high risk for long-term impairment and severe neurological manifestations. As a result, they may benefit from further screening and intervention, according to results published in a prospective cohort study in JAMA Network Open.
“Identifying the patients at the highest risk of new and persistent impairment is essential to direct them to the follow-up care necessary to best support their recovery and adaptation,” said lead author Conall Francoeur, MDCM, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada, and co-authors. “Despite strong agreement about the importance of postdischarge follow-up care of children who are critically ill, few systematic, multidisciplinary post–pediatric intensive care unit (ICU) follow-up programs exist … by identifying cohorts of patients at high risk of postdischarge sequelae, future research could demonstrate the value of these programs and their potential effects on improving long-term outcomes.”
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Researchers included patients under 18 years old who had been hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021, across 46 centers in 10 countries. Data was recorded at each study site using a case report form featuring common data elements including information on demographics, illness, laboratory, imaging, and outcomes. Neurological manifestations were previously defined and included a broad spectrum of symptoms such as headache, malaise, encephalopathy, and coma. The primary outcome was defined as new neurocognitive and/or functional morbidity at hospital discharge.
In total, 3568 children and adolescents were included in the study. Participants had a median age of 8 years and were 54.3% male. Most participants (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 18% had a severe neurological manifestation during hospitalization, as well as 146 patients with MIS-C (24.8%). Among patients 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 patients with MIS-C, 28% (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.
Researchers noted a few study limitations, including potential misestimation of neurological manifestation prevalence due to medical record review, difficulties in diagnosing conditions like encephalopathy across different ages, and an inability to accurately determine incidental SARS-CoV-2 positivity or capture all relevant patients. Additionally, differentiating new neurological symptoms from preexisting conditions was difficult, authors said, and imbalances in baseline covariates existed. Data were collected at discharge, preventing evaluation of long-term implications such as long-COVID.
“Future studies should aim to better understand the pathophysiology behind the severe neurological manifestations and investigate the role of surveillance, treatment, and follow-up of these patients with high risk of neurocognitive and/or functional morbidities,” authors concluded.
