About 4 in 100 COVID-19 hospitalized children may develop neurological complications, a study finds

By Dr. Sanchari Sinha Dutta, Ph.D.Jul 15 2021

In a recently published article in The Lancet’s Child & Adolescent Health, scientists have described in detail neurological and psychiatric manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children. As mentioned in the study, an estimated prevalence of infection-related neurological complications and pediatric inflammatory multisystem syndrome in hospitalized children and adolescents is about 3.8 cases per 100 patients.

Study: Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study. Image Credit: FamVeld / Shutterstock

Background

Besides respiratory and cardiovascular complications, patients with coronavirus disease 2019 (COVID-19) are at high risk of developing neurological symptoms, including encephalopathy, stroke, neuromuscular disorders, and seizures. In pediatric COVID-19 patients, SARS-CoV-2 infection has been found to associate with multisystem inflammatory syndrome in children (MIS-C), which is a rare but serious condition with severe secondary inflammation.

Typically, SARS-CoV-2 associated MIS-C, also called pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), occurs weeks after infection onset. In a single-center study conducted in the UK, nine pediatric COVID-19 patients have been identified with neurological complications of MIS-C.

Similarly, a study conducted on 1,695 children and adolescents in the US has identified transient neurological symptoms in 365 patients and severe life-threatening neurological complications in 43 patients. However, despite the severity of the condition, not enough studies have been done to estimate the prevalence of neurological complications in SARS-CoV-2 infected children.      

In the current study, the scientists have determined the variety and prevalence of neurological or psychiatric complications associated with COVID-19 in hospitalized children and adolescents.

Study design

The study was conducted on 1,334 SARS-CoV-2-infected children and adolescents under the age of 18 years who had been hospitalized for new-onset or pre-existing neurological or psychiatric complications.

The scientists categorized patients into the COVID-19 neurology group if they were diagnosed with a primary neurological or psychiatric disorder associated with COVID-19. Similarly, patients diagnosed with PIMS-TS with neurological manifestations were categorized into the PIMS-TS neurology group.  

Important observations

Of all enrolled patients, 52 were identified to have neurological or psychiatric complications associated with COVID-19. Based on this information, the prevalence of neurological/psychiatric disorders in hospitalized pediatric COVID-19 patients was estimated to be 3.8 cases per 100 patients.  

The average age of the patients was 9 years. Regarding demographic characteristics, about 69% of patients were Black or Asian, and 31% were White. This indicates that children from minoritized ethnic groups are more susceptible to neurological complications related to SARS-CoV-2 infection.  

Of 52 identified patients, 27 were categorized into the COVID-19 neurology group, and 25 were categorized into the PIMS-TS neurology group. The major symptoms of patients in the COVID-19 neurology group were acute demyelinating syndrome, severe encephalopathy, peripheral encephalopathy (Guillain-Barre syndrome), movement disorder (chorea), psychosis, and transient ischemic attack.

In patients belonging to the PIMS-TS neurology group, the major complications were systemic features, encephalopathy, behavioral changes, hallucination, meningism, and signs of peripheral or central nervous system involvement.

Compared to patients in the PIMS-TS neurology group, patients with COVID-19 related primary neurological complications had a significantly higher prevalence of recognized neuroimmune disorders. The frequencies of intensive care admissions and immunomodulatory treatments were significantly higher among patients in the PIMS-TS neurology group compared to that in the COVID-19 neurology group patients.

At the time of discharge from the hospital, about 33% of patients in the COVID-19 neurology group and 28% of patients in the PIMS-TS neurology group had disabilities. In addition, one patient in the PIMS-TS neurology group died due to stroke.    

Study significance

The study reveals that in hospitalized children and adolescents with COVID-19, neurological or psychiatric complications are common presentations, with a prevalence of 3.8 cases per 100 patients. Importantly, the study highlights the difference in neurological manifestations between SARS-CoV-2 infected children with or without PIMS-TS.

While patients with PIMS-TS mostly exhibit multiple overlapping neurological symptoms with characteristic brain imaging patterns, such as reversible splenial lesion in the corpus callosum, patients without PIMS-TS are mostly associated with discrete, frequently recognized neuroimmune, primary neurological complications.