Severe neurologic conditions common in hospitalized kids with COVID, MIS-C, data suggest – University of Minnesota Twin Cities

Pediatric patients hospitalized with severe COVID-19 or the related multisystem inflammatory syndrome in children (MIS-C) experience new neurologic problems and/or impaired function at rates of 18.0% and 24.8%, respectively, an international group of researchers suggests inJAMA Network Open.

In a secondary analysis of the Global Consortium Study of Neurologic Dysfunction in COVID-19 study, investigatorsstudied the rates of newsevere neurologic conditions among 3,568 COVID-19 or MIS-C patients younger than 18 years hospitalized from January 2020 to July 2021 at 46 centers in 10 countries. The Pediatric Cerebral Performance Category scale was used to define new neurocognitive disorders, and the Functional Status Scale determined functional impairment.

The median patient age was 8 years, 45.6% were girls, 42.5% had no underlying condition, 23.0% were Black, 28.7% were Hispanic, 63.6% were non-Hispanic, 54.0% were White, and 24.9% were another race.

"Children with the SARS-CoV-2related condition multisystem inflammatory syndrome in children (MIS-C) often require critical care due to multisystem organ dysfunction, with high survival rates but with risk of postcritical illness sequelae," the researchers wrote. "In particular, neurological manifestations of pediatric SARS-CoV-2related conditions have been associated with morbidity and mortality in prior studies."

Most patients (83.5%) had severe COVID-19, and 16.5% had MIS-C.Of the patients hospitalized with severe COVID-19, 18% had a serious neurologic condition, as did 24.8% of those with MIS-C. COVID-19 patients with serious neurologic disease were more likely than those without such a condition to have new neurocognitive disease or functional impairment at hospital release (27.7% vs 14.6%).

The most common new neurocognitive disorders or functional impairments in COVID-19 patients were acute encephalopathy (brain dysfunction; 61.9%), seizures or status epilepticus (40.7%), and delirium and coma (7.5%). Among MIS-C patients,acute encephalopathy (76.0%), delirium (11.6%), dysautonomia (disrupted autonomic nervous system;10.9%), and seizures or status epilepticus (9.6%) were most common.

A total of 28.0% of MIS-C patients with severe neurologic illness or functional impairment at hospital release had new neurocognitive manifestations and/or impaired function, compared with 15.5% without serious neurologic problems.

Future studies should aim to better understand the pathophysiology behind the severe neurological manifestations and to investigate the role of surveillance, treatment, and follow-up of these patients with high risk of neurocognitive and/or functional morbidities.

COVID-19 patients with severe neurologic disorders were less likely to be Hispanic (26.7% vs 30.4%), more likely to have at least one chronic condition (46.6% vs 32.5%), and more likely to have a preexisting neurologic condition (45.7% vs 16.3%) than those without a severe neurologic disorder. Similarly, patients with MIS-C and a severe neurologic condition were more likely to have a preexisting neurologic condition than those without severe neurologic manifestations (11.6% vs 5.9%).

After adjustment, among patients with severe neurologic problems, those with acute COVID-19 infection and those with MIS-C were more likely to have new neurocognitive and/or functional impairment at hospital release (odds ratios, 1.85 and 2.18, respectively).

Of COVID-19 patients with severe neurologic conditions, 4.8% died in the hospital, compared with 0.3% of those without such conditions.Similarly, among MIS-C patients, those with severe neurologic disorders had a much higher in-hospital death rate (4.9%) than those without such a disorder (0.5%). COVID-19 and MIS-C survivors with severe neurologic problems were also more likely to need physical and occupational therapy and rehabilitation consultations.

"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," the study authors wrote."Future studies should aim to better understand the pathophysiology behind the severe neurological manifestations and to investigate the role of surveillance, treatment, and follow-up of these patients with high risk of neurocognitive and/or functional morbidities."

In a relatedcommentary, Michael Wolf, MD, of Vanderbilt University Medical Center, said the study highlights the critical need for neurologic monitoring in hospitalized children with COVID-19 or MIS-C.

"As Francoeur et alobserve and emphasize, patients younger than 18 years with new functional and neurocognitive impairments require resource-intensive multidisciplinary care before and after hospital discharge," he wrote. "While programs for structured follow-up are uncommon, there exists a growing focus on long-term, patient-centered outcomes for children recovering from critical illness."

"Lessons learned from large cohorts of patients with sepsis, acute SARS-CoV-2 infection, MIS-C, and other systemic illnesses should deepen clinicians' appreciation of the links between short-term disease manifestations and long-term consequences for the most vulnerable pediatric patients," he added.

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Severe neurologic conditions common in hospitalized kids with COVID, MIS-C, data suggest - University of Minnesota Twin Cities