Analysis of Severe COVID-19 among Children in Foshan, China

Abstract

Abstract Background This study aimed to analyze the clinical characteristics, treatments, and prognosis of severe neurological impairment among children infected with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) following the change in epidemic prevention policy in China in December 2022.Methods A total of 9 pediatric patients with severe neurological impairment caused by SARS-CoV-2 infection from December 17, 2022 to December 31, 2022 in the First People’s Hospital of Foshan were retrospectively analyzed.Results Seven (71.43%) of the nine cases involved patients under the age of three, while the other two cases were older than three and had underlying medical conditions. All patients presented with fever and neurological symptoms such as disorders of consciousness and/or convulsive seizures. Besides, all patients showed sudden aggravation (e.g., fulminant cerebral edema) within 24 hours of fever, without respiratory symptoms (e.g., cough). Interleukin-6 (IL-6), lactate dehydrogenase (LDH) and D-dimer were significantly increased in all nine cases. Except for three patients who survived more than 48 hours after the first rescue treatment, five died within 48 hours after hospitalization, while one died of secondary bacterial infection after seven days of treatment. All patients suffered from shock rapidly after onset, and five patients developed multiple organ failure (respiratory, heart, liver, kidney and skeletal muscle) in a short time. In terms of in-hospital treatments, five cases were treated with glucocorticoids, three with intravenous immunoglobulin (IVIG), and two with blood purification and tocilizumab.Conclusion SARS-CoV-2 infection can cause severe neurological damage in pediatric patients. Hyperpyrexia, convulsion, and inflammatory factors could serve as early warning indicators. Administering glucocorticoids immunoglobulin, blood purification and tocilizumab might have some therapeutic effects, but further research is needed to establish their effectiveness.