Neurologic Manifestations Are Prevalent in Children Hospitalized With COVID-19, MIS-C

Neurologic manifestations are common in children hospitalized with SARS-CoV-2 or multisystem inflammatory syndrome (MIS-C), occurring in over half of cases and contributing to higher mortality and long-term sequelae, according to study results published in COVID Reports.

Researchers conducted a multicenter, cross-sectional study from June 2020 to June 2023 in 13 teaching hospitals across 11 Indonesian cities to evaluate the prevalence, impact, and risk factors of neurologic manifestations in children with COVID-19 or MIS-C. Patients were diagnosed via laboratory confirmation or the Centers for Disease Control and Prevention-based clinical criteria. Data were collected from hospital records, including demographics, comorbidities, clinical features, neurologic manifestations, and outcomes. Neurologic diagnoses were made by pediatric neurologists at each site. Multivariable logistic regression was employed for statistical analysis.

Among 1397 children, the median age was 5 (IQR, 5-12) years and 57.8% were boys. Most (91.8%) patients had acute SARS-CoV-2 and 8.2% had MIS-C. Notable preexisting conditions observed were respiratory (45%) and neurologic (42.2%) disorders. Acute, constitutional, nonneurologic symptoms reported were fever (67.6%), cough (41.9%), and diarrhea (17%).

Neurologic manifestations occurred in 51.2% of patients, with no significant difference between SARS-CoV-2 (50.1%) and MIS-C (57.4%). Among patients with SARS-CoV-2, seizures (25.3%), acute encephalopathy (16.1%), and headache (11.4%) were most common, while those with MIS-C reported seizures (37.7%), syncope (35.1%), and acute encephalopathy (33.3%), with syncope significantly higher in patients with MIS-C (P <.0001). Children with preexisting neurologic disorders had a substantially higher risk for neurologic manifestations (82.8%).

The overall mortality rate was 16.1%, rising to 26.3% in patients with neurologic manifestations, who were also more likely to recover with sequelae (13.5%). Most (74%) patients recovered without sequelae (P =.001).

About 25% of patients required intensive care unit (ICU) care, with higher admission rates in patients with acute SARS-CoV-2 and nonneurologic manifestations vs those with MIS-C and neurologic manifestations (P <.0001). Additionally, patients with acute SARS-CoV-2 were more often admitted to wards and experienced shorter ICU and hospital stays compared with those with MIS-C (P <.0001).

In the overall cohort, factors significantly associated with neurologic manifestations were as follows:

• Younger age (odds ratio [OR], 1.2; 95% CI, 1.02-1.57);
• Preexisting neurologic conditions (OR, 12.1; 95% CI, 9.37-15.86);
• Respiratory issues (OR, 1.33; 95% CI, 1.08-1.65);
• Renal/urologic conditions (OR, 1.5; 95% CI, 1.09-2.11);
• Fever (OR, 1.5; 95% CI, 1.25-1.96); and,
• Anorexia (OR, 1.4; 95% CI, 1.04-1.95).

Protective factors included gastrointestinal conditions (OR, 0.76; 95% CI, 0.80-0.98), hematologic/immunologic conditions (OR, 0.72; 95% CI, 0.56-0.95), malignancy (OR, 0.61; 95% CI, 0.44-0.85), and abdominal pain (OR, 0.57; 95% CI, 0.40-0.83; all P <.05).

In the SARS-CoV-2 cohort, factors associated with neurologic manifestations were as follows:

• Younger age and preexisting respiratory conditions (OR, 1.59; 95% CI, 1.27-1.99);
• Congenital/genetic conditions (OR, 1.69; 95% CI, 1.19-2.39);
• Metabolic conditions (OR, 1.45; 95% CI, 1.06-1.97);
• Technology-dependent conditions (OR, 9.99; 95% CI, 2.25-43.88);
• Renal-urologic conditions (OR, 1.91; 95% CI, 1.35-2.71);
• Fever (OR, 1.7; 95% CI, 1.34-2.17); and,
• Diarrhea (OR, 1.46; 95% CI, 1.08-1.97).

In the MIS-C cohort, neurologic manifestations were significantly linked to younger age, female sex, and preexisting gastrointestinal (OR, 4.08; 95% CI, 1.60-10.39) and metabolic conditions (OR, 4.54; 95% CI, 1.36-15.06).

Study limitations include bias due to incomplete data as a result of the retrospective design.

The researchers concluded, “Results indicate that younger age, along with preexisting neurological, respiratory, and renal conditions, correlates with a heightened risk of neurological manifestations.”

This article originally appeared on Infectious Disease Advisor