Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020-Reference-Cited by-同舟云学术

Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020

Published:2023-01-01 Issue:1 Volume:80 Page:91
ISSN:2168-6149
Container-title:JAMA Neurology
language:en
Short-container-title:JAMA Neurol

Author:

LaRovere Kerri L.¹,Poussaint Tina Y.²,Young Cameron C.³,Newhams Margaret M.³,Kucukak Suden³,Irby Katherine⁴,Kong Michele⁵,Schwartz Stephanie P.⁶,Walker Tracie C.⁶,Bembea Melania M.⁷,Wellnitz Kari⁸,Havlin Kevin M.⁹,Cvijanovich Natalie Z.¹⁰,Hall Mark W.¹¹,Fitzgerald Julie C.¹²,Schuster Jennifer E.¹³,Hobbs Charlotte V.¹⁴,Halasa Natasha B.¹⁵,Singh Aalok R.¹⁶,Mack Elizabeth H.¹⁷,Bradford Tamara T.¹⁸,Gertz Shira J.¹⁹,Schwarz Adam J.²⁰,Typpo Katri V.²¹,Loftis Laura L.²²,Giuliano John S.²³,Horwitz Steven M.²⁴,Biagas Katherine V.²⁵,Clouser Katharine N.²⁶,Rowan Courtney M.²⁷,Maddux Aline B.²⁸,Soma Vijaya L.²⁹,Babbitt Christopher J.³⁰,Aguiar Cassyanne L.³¹,Kolmar Amanda R.³²,Heidemann Sabrina M.³³,Harvey Helen³⁴,Zambrano Laura D.³⁵,Campbell Angela P.³⁵,Randolph Adrienne G.³³⁶,Gaspers Mary Glas³⁷,Sanders Ronald C³⁷,Zinter Matt S³⁷,Pannaraj Pia S³⁷,Port Emily³⁷,Shankman Sara³⁷,Mansour Rachel³⁷,Carroll Christopher L³⁷,McLaughlin Gwenn E³⁷,Espinal Paula S³⁷,Michelson Kelly N³⁷,Coates Bria M³⁷,Bhoojhawon Guru³⁷,Sullivan Janice E³⁷,Montgomery Vicki L³⁷,Graciano Ana Lia³⁷,Lipton Susan V³⁷,Son Mary Beth F³⁷,Chen Sabrina R³⁷,Worden Julia³⁷,McCadden Timothy³⁷,Carroll Ryan W³⁷,Yager Phoebe H³⁷,Fernandes Neil D³⁷,Hume Janet R³⁷,Levy Emily R³⁷,Malloch Lacy³⁷,Martin Lora³⁷,Howard-Claudio Candace³⁷,Gourdy David³⁷,Spinella Philip C³⁷,Cullimore Melissa L³⁷,McCulloh Russell J³⁷,Kleinman Lawrence C³⁷,Li Simon³⁷,Kuebler Joseph³⁷,Ratner Adam J³⁷,Dapul Heda³⁷,Doymaz Sule³⁷,Keenaghan Michael A³⁷,Schwartz Cody³⁷,Shein Steven L³⁷,Lansell Amanda N³⁷,Nofziger Ryan A³⁷,Staat Mary A³⁷,Thomas Neal J³⁷,Butler Andrew D³⁷,Reed Nelson³⁷,Stewart Laura³⁷,Golcha Meena³⁷,Samperio Marian³⁷,Bowens Cindy³⁷,Maamari Mia³⁷,Crandall Hillary³⁷,Smith Lincoln S³⁷,McGuire John K³⁷,Patel Manish M³⁷,

Affiliation:

1. Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts

2. Department of Radiology, Boston Children’s Hospital, Boston, Massachusetts

3. Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts

4. Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock

5. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham

6. Department of Pediatrics, University of North Carolina at Chapel Hill Children’s Hospital, Chapel Hill

7. Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland

8. Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City

9. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children’s Hospital, Louisville, Kentucky

10. Division of Critical Care Medicine, UCSF Benioff Children’s Hospital, Oakland, California

11. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio

12. Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia

13. Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri

14. Division of Infectious Diseases, Departments of Pediatrics and Microbiology, University of Mississippi Medical Center, Jackson

15. Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

16. Pediatric Critical Care Division, Maria Fareri Children’s Hospital at Westchester Medical Center, New York Medical College, Valhalla

17. Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston

18. Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center, Children’s Hospital of New Orleans, New Orleans

19. Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey

20. Division of Critical Care Medicine, Children’s Health Orange County (CHOC), Orange, California

21. Department of Pediatrics and Banner Children’s at Diamond Children’s Medical Center, University of Arizona, Tucson

22. Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Houston

23. Division of Critical Care, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut

24. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey

25. Department of Pediatrics, Stony Brook University Renaissance School of Medicine, Stony Brook, New York

26. Department of Pediatrics, Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, Hackensack, New Jersey

27. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis

28. Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora

29. Division of Pediatric Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine, New York

30. Miller Children’s and Women’s Hospital of Long Beach, Long Beach, California

31. Division of Pediatric Rheumatology, Department of Pediatrics, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk

32. Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri

33. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Central Michigan University, Detroit

34. Division of Pediatric Critical Care, Rady Children’s Hospital, San Diego, California

35. COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia

36. Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts

37. for the Overcoming COVID-19 Investigators

Abstract

ImportanceIn 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.ObjectiveTo provide an update on the spectrum of SARS-CoV-2–related neurologic involvement among children and adolescents in 2021.Design, Setting, and ParticipantsCase 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 (&lt;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.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresPatients 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).ResultsOf 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 RelevanceSARS-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.

Publisher

American Medical Association (AMA)

Subject

Neurology (clinical)

Link

https://jamanetwork.com/journals/jamaneurology/articlepdf/2798383/jamaneurology_larovere_2022_br_220007_1672852464.40076.pdf

Reference16 articles.

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