Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity-Reference-Cited by-同舟云学术

Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

Published:2024-06-10 Issue:6 Volume:7 Page:e2414122
ISSN:2574-3805
Container-title:JAMA Network Open
language:en
Short-container-title:JAMA Netw Open

Author:

Francoeur Conall¹,Alcamo Alicia M.²³⁴,Robertson Courtney L.⁵,Wainwright Mark S.⁶,Roa Juan D.⁷⁸,Lovett Marlina E.⁹,Stulce Casey¹⁰,Yacoub Mais¹¹,Potera Renee M.¹²,Zivick Elizabeth¹³,Holloway Adrian¹⁴,Nagpal Ashish¹⁵,Wellnitz Kari¹⁶,Even Katelyn M.¹⁷,Brunow de Carvalho Werther¹⁸,Rodriguez Isadora S.¹⁸,Schwartz Stephanie P.¹⁹,Walker Tracie C.¹⁹,Campos-Miño Santiago²⁰,Dervan Leslie A.²¹,Geneslaw Andrew S.²²,Sewell Taylor B.²²,Pryce Patrice²³,Silver Wendy G.²⁴,Lin Jieru E.²⁴,Vargas Wendy S.²⁴,Topjian Alexis²³⁴,McGuire Jennifer L.⁴²⁵²⁶,Domínguez Rojas Jesus Angel²⁷,Tasayco-Muñoz Jaime²⁷,Hong Sue J.⁵,Muller William J.²⁸,Doerfler Matthew²⁸,Williams Cydni N.²⁹³⁰,Drury Kurt³⁰,Bhagat Dhristie³¹,Nelson Aaron³¹,Price Dana³¹,Dapul Heda³²,Santos Laura³²,Kahoud Robert³³,Appavu Brian³⁴,Guilliams Kristin P.³⁵³⁶³⁷,Agner Shannon C.³⁵³⁶³⁷,Walson Karen H.³⁸,Rasmussen Lindsey³⁹,Pal Ria⁴⁰,Janas Anna³⁹,Ferrazzano Peter⁴¹,Farias-Moeller Raquel⁴²,Snooks Kellie C.⁴³,Chang Chung-Chou H.⁴⁴,Iolster Tomás⁴⁵,Erklauer Jennifer C.⁴⁶⁴⁷,Jorro Baron Facundo⁴⁸,Wassmer Evangeline⁴⁹⁵⁰⁵¹,Yoong Michael⁵²,Jardine Michelle⁵³,Mohammad Zoha⁵⁴,Deep Akash⁵⁵,Kendirli Tanil⁵⁶,Lidsky Karen⁵⁷,Dallefeld Samantha⁵⁸,Flockton Helen⁵⁹,Agrawal Shruti⁶⁰,Siruguppa Krishna Sumanth⁶¹⁶²⁶³,Waak Michaela⁶⁴,Gutiérrez-Mata Alfonso⁶⁵,Butt Warwick⁶⁶⁶⁷,Bogantes-Ledezma Sixto⁶⁵,Sevilla-Acosta Fabricio⁶⁸,Umaña-Calderón Andres⁶⁵,Ulate-Campos Adriana⁶⁵,Yock-Corrales Adriana⁶⁹,Talisa Victor Brodzik⁴⁴,Kanthimathinathan Hari Krishnan⁷⁰,Schober Michelle E.⁷¹,Fink Ericka L.⁴⁴,

Affiliation:

1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada

2. Division of Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

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

4. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia

5. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

6. Division of Pediatric Neurology, University of Washington, Seattle Children’s Hospital, Seattle

7. Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, Colombia

8. Department of Pediatric Neurology, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia

9. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus

10. Department of Pediatrics, The University of Chicago, Chicago, Illinois

11. Division of Critical Care, Department of Pediatrics, University Medical Center Children’s Hospital, Las Vegas, Nevada

12. Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas

13. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston

14. Division of Critical Care, Department of Pediatrics, University of Maryland Medical Center, Baltimore

15. Department of Pediatrics, Section of Critical Care Medicine, Oklahoma Children’s Hospital at Oklahoma University Health, College of Medicine, The University of Oklahoma Health Sciences, Oklahoma City

16. Division of Pediatric Critical Care, Department of Pediatrics, Carver College of Medicine, University of Iowa Health Care, Iowa City

17. Division of Pediatric Critical Care Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey

18. Department of Pediatrics, University of São Paulo, São Paulo, Brazil

19. Department of Pediatrics, University of North Carolina at Chapel Hill Hospitals, Chapel Hill

20. Pediatric Intensive Care Unit, Hospital Metropolitano, Quito, Ecuador

21. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle

22. Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York

23. Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, New York

24. Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York

25. Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania

26. Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia

27. Division of Pediatric Critical Care, Department of Pediatrics, Hospital de Emergencia Villa El Salvador, Lima, Peru

28. Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois

29. Pediatric Critical Care and Neurotrauma Recovery Program, Department of Pediatrics, Oregon Health & Science University, Portland

30. Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland

31. Department of Neurology, New York University Langone Health, New York

32. Division of Pediatric Critical Care, Department of Pediatrics, Hassenfeld Children’s Hospital, New York University Langone Health, New York

33. Division of Pediatric Critical Care Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota

34. Division of Neurology, Barrow Neurological Institute at Phoenix Children’s Hospital, The University of Arizona, College of Medicine, Phoenix

35. Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri

36. Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri

37. Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri

38. Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia

39. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Standford University Medicine, Lucile Packard Children’s Hospital Stanford, Stanford, California

40. Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania

41. Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison

42. Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee

43. Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee

44. Division of Pediatric Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania

45. Department of Pediatrics, Hospital Universitario Austral, Buenos Aires, Argentina

46. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston

47. Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston

48. Department of Pediatrics, Hospital General de Niños Pedro Elizade, Buenos Aires, Argentina

49. Birmingham Children’s Hospital, Birmingham, United Kingdom

50. Aston Institute of Health and Neurodevelopment, Birmingham, United Kingdom

51. Aston University, Birmingham, United Kingdom

52. Department of Neurology, Royal London Children’s Hospital, London, United Kingdom

53. Pediatric Critical Care Unit, University Hospital of Wales, Cardiff, United Kingdom

54. Pediatric Intensive Care Unit, University Hospitals Leicester NHS Trust, Leicester, United Kingdom

55. Department of Women and Children’s Health, King’s College Hospital, London, United Kingdom

56. Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey

57. Division of Pediatric Critical Care Medicine, Wolfson Children’s Hospital, Jacksonville, Florida

58. Department of Pediatrics, Dell Children’s Hospital, Austin, Texas

59. Paediatric Critical Care Unit, Oxford University Hospitals, Oxford, United Kingdom

60. Paediatric Intensive Care Unit, Cambridge University Hospitals, Cambridge, United Kingdom

61. Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco

62. Fresno Medical Education and Research Program, Department of Medicine, University of California, San Francisco, Fresno

63. Department of Pediatrics, Community Medical Centers, Fresno, California

64. Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia

65. Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children’s Hospital, San José, Costa Rica

66. Department of Critical Care, Melbourne Medical School, The University of Melbourne, The Royal Children’s Hospital Melbourne, Melbourne, Victoria, Australia

67. Clinical Sciences, Murdoch Children’s Research Institute, Parkville, Victoria, Australia

68. Department of Pediatrics, La Anexión Hospital, Guanacaste, Costa Rica

69. Department of Emergency Service, Dr. Carlos Sáenz Herrera National Children’s Hospital, San José, Costa Rica

70. West Midlands Regional Genetics Laboratory, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom

71. Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City

Abstract

ImportanceNeurological 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.ObjectiveTo 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 ParticipantsThis 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.ExposureSevere 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 MeasuresThe 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.ResultsOverall, 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 &lt; .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 RelevanceThe 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.

Publisher

American Medical Association (AMA)

Link

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2819749/francoeur_2024_oi_240483_1721138849.92074.pdf

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