Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020.

Autor:	LaRovere KL; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts., Poussaint TY; Department of Radiology, Boston Children's Hospital, Boston, Massachusetts., Young CC; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts., Newhams MM; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts., Kucukak S; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts., Irby K; Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock., Kong M; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham., Schwartz SP; Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill., Walker TC; Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill., Bembea MM; Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland., Wellnitz K; Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City., Havlin KM; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, Kentucky., Cvijanovich NZ; Division of Critical Care Medicine, UCSF Benioff Children's Hospital, Oakland, California., Hall MW; Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio., Fitzgerald JC; Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia., Schuster JE; Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri., Hobbs CV; Division of Infectious Diseases, Departments of Pediatrics and Microbiology, University of Mississippi Medical Center, Jackson., Halasa NB; Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee., Singh AR; Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla., Mack EH; Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston., Bradford TT; Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center, Children's Hospital of New Orleans, New Orleans., Gertz SJ; Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey., Schwarz AJ; Division of Critical Care Medicine, Children's Health Orange County (CHOC), Orange, California., Typpo KV; Department of Pediatrics and Banner Children's at Diamond Children's Medical Center, University of Arizona, Tucson., Loftis LL; Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston., Giuliano JS Jr; Division of Critical Care, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut., Horwitz SM; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey., Biagas KV; Department of Pediatrics, Stony Brook University Renaissance School of Medicine, Stony Brook, New York., Clouser KN; Department of Pediatrics, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey., Rowan CM; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis., Maddux AB; Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora., Soma VL; Division of Pediatric Infectious Diseases, Department of Pediatrics, New York University Grossman School of Medicine, New York., Babbitt CJ; Miller Children's and Women's Hospital of Long Beach, Long Beach, California., Aguiar CL; Division of Pediatric Rheumatology, Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk., Kolmar AR; Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri., Heidemann SM; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Central Michigan University, Detroit., Harvey H; Division of Pediatric Critical Care, Rady Children's Hospital, San Diego, California., Zambrano LD; COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia., Campbell AP; COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia., Randolph AG; Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.; Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA neurology [JAMA Neurol] 2023 Jan 01; Vol. 80 (1), pp. 91-98.
DOI:	10.1001/jamaneurol.2022.3881
Abstrakt:	Importance: 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. Objective: To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021. Design, Setting, and Participants: 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. Exposure: SARS-CoV-2 infection. Main Outcomes and Measures: 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). Results: 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. Conclusions and Relevance: 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.
Databáze:	MEDLINE
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