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LaRovere, Kerri L; Poussaint, Tina Y; Young, Cameron C; Newhams, Margaret M; Kucukak, Suden; Irby, Katherine; Kong, Michele; Schwartz, Stephanie P; Walker, Tracie C; Bembea, Melania M; Wellnitz, Kari; Havlin, Kevin M; Cvijanovich, Natalie Z; Hall, Mark W; Fitzgerald, Julie C; Schuster, Jennifer E; Hobbs, Charlotte V; Halasa, Natasha B; Singh, Aalok R; Mack, Elizabeth H; Bradford, Tamara T; Gertz, Shira J; Schwarz, Adam J; Typpo, Katri V; Loftis, Laura L; Giuliano, Jr, John S; Horwitz, Steven M; Biagas, Katherine V; Clouser, Katharine N; Rowan, Courtney M; Maddux, Aline B; Soma, Vijaya L; Babbitt, Christopher J; Aguiar, Cassyanne L; Kolmar, Amanda R; Heidemann, Sabrina M; Harvey, Helen; Zambrano, Laura D; Campbell, Angela P; Randolph, Adrienne G
JAMA neurology, 01/2023, Letnik: 80, Številka: 1Journal Article
In 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. To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021. Case 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 (<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. SARS-CoV-2 infection. Patients 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). Of 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. SARS-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.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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in: SICRIS
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