Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity.

Autor:	Francoeur C; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada., Alcamo AM; Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia.; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia., Robertson CL; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Wainwright MS; Division of Pediatric Neurology, University of Washington, Seattle Children's Hospital, Seattle., Roa JD; Department of Pediatrics, Universidad Nacional de Colombia, Bogotá, Colombia.; Department of Pediatric Neurology, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia., Lovett ME; Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus., Stulce C; Department of Pediatrics, The University of Chicago, Chicago, Illinois., Yacoub M; Division of Critical Care, Department of Pediatrics, University Medical Center Children's Hospital, Las Vegas, Nevada., Potera RM; Department of Pediatrics, The University of Texas Southwestern Medical Center, Dallas., Zivick E; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston., Holloway A; Division of Critical Care, Department of Pediatrics, University of Maryland Medical Center, Baltimore., Nagpal A; Department of Pediatrics, Section of Critical Care Medicine, Oklahoma Children's Hospital at Oklahoma University Health, College of Medicine, The University of Oklahoma Health Sciences, Oklahoma City., Wellnitz K; Division of Pediatric Critical Care, Department of Pediatrics, Carver College of Medicine, University of Iowa Health Care, Iowa City., Even KM; Division of Pediatric Critical Care Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey., Brunow de Carvalho W; Department of Pediatrics, University of São Paulo, São Paulo, Brazil., Rodriguez IS; Department of Pediatrics, University of São Paulo, São Paulo, Brazil., Schwartz SP; Department of Pediatrics, University of North Carolina at Chapel Hill Hospitals, Chapel Hill., Walker TC; Department of Pediatrics, University of North Carolina at Chapel Hill Hospitals, Chapel Hill., Campos-Miño S; Pediatric Intensive Care Unit, Hospital Metropolitano, Quito, Ecuador., Dervan LA; Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle., Geneslaw AS; Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York., Sewell TB; Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York., Pryce P; Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, Columbia University Irving Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York., Silver WG; Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York., Lin JE; Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York., Vargas WS; Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York., Topjian A; Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia.; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia., McGuire JL; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia.; Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia., Domínguez Rojas JA; Division of Pediatric Critical Care, Department of Pediatrics, Hospital de Emergencia Villa El Salvador, Lima, Peru., Tasayco-Muñoz J; Division of Pediatric Critical Care, Department of Pediatrics, Hospital de Emergencia Villa El Salvador, Lima, Peru., Hong SJ; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Muller WJ; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Doerfler M; Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Williams CN; Pediatric Critical Care and Neurotrauma Recovery Program, Department of Pediatrics, Oregon Health & Science University, Portland.; Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland., Drury K; Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland., Bhagat D; Department of Neurology, New York University Langone Health, New York., Nelson A; Department of Neurology, New York University Langone Health, New York., Price D; Department of Neurology, New York University Langone Health, New York., Dapul H; Division of Pediatric Critical Care, Department of Pediatrics, Hassenfeld Children's Hospital, New York University Langone Health, New York., Santos L; Division of Pediatric Critical Care, Department of Pediatrics, Hassenfeld Children's Hospital, New York University Langone Health, New York., Kahoud R; Division of Pediatric Critical Care Medicine, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota., Appavu B; Division of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, The University of Arizona, College of Medicine, Phoenix., Guilliams KP; Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri.; Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri.; Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri., Agner SC; Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri.; Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri.; Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri., Walson KH; Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia., Rasmussen L; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Standford University Medicine, Lucile Packard Children's Hospital Stanford, Stanford, California., Pal R; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Janas A; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Standford University Medicine, Lucile Packard Children's Hospital Stanford, Stanford, California., Ferrazzano P; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison., Farias-Moeller R; Division of Child Neurology, Department of Neurology, Medical College of Wisconsin, Children's Wisconsin, Milwaukee., Snooks KC; Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee., Chang CH; Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Iolster T; Department of Pediatrics, Hospital Universitario Austral, Buenos Aires, Argentina., Erklauer JC; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston.; Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston., Jorro Baron F; Department of Pediatrics, Hospital General de Niños Pedro Elizade, Buenos Aires, Argentina., Wassmer E; Birmingham Children's Hospital, Birmingham, United Kingdom.; Aston Institute of Health and Neurodevelopment, Birmingham, United Kingdom.; Aston University, Birmingham, United Kingdom., Yoong M; Department of Neurology, Royal London Children's Hospital, London, United Kingdom., Jardine M; Pediatric Critical Care Unit, University Hospital of Wales, Cardiff, United Kingdom., Mohammad Z; Pediatric Intensive Care Unit, University Hospitals Leicester NHS Trust, Leicester, United Kingdom., Deep A; Department of Women and Children's Health, King's College Hospital, London, United Kingdom., Kendirli T; Department of Pediatric Critical Care Medicine, Ankara University School of Medicine, Ankara, Turkey., Lidsky K; Division of Pediatric Critical Care Medicine, Wolfson Children's Hospital, Jacksonville, Florida., Dallefeld S; Department of Pediatrics, Dell Children's Hospital, Austin, Texas., Flockton H; Paediatric Critical Care Unit, Oxford University Hospitals, Oxford, United Kingdom., Agrawal S; Paediatric Intensive Care Unit, Cambridge University Hospitals, Cambridge, United Kingdom., Siruguppa KS; Division of Pediatric Critical Care, Department of Pediatrics, University of California, San Francisco.; Fresno Medical Education and Research Program, Department of Medicine, University of California, San Francisco, Fresno.; Department of Pediatrics, Community Medical Centers, Fresno, California., Waak M; Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia., Gutiérrez-Mata A; Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children's Hospital, San José, Costa Rica., Butt W; Department of Critical Care, Melbourne Medical School, The University of Melbourne, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia., Bogantes-Ledezma S; Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children's Hospital, San José, Costa Rica., Sevilla-Acosta F; Department of Pediatrics, La Anexión Hospital, Guanacaste, Costa Rica., Umaña-Calderón A; Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children's Hospital, San José, Costa Rica., Ulate-Campos A; Department of Pediatric Neurology, Dr. Carlos Sáenz Herrera National Children's Hospital, San José, Costa Rica., Yock-Corrales A; Department of Emergency Service, Dr. Carlos Sáenz Herrera National Children's Hospital, San José, Costa Rica., Talisa VB; Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania., Kanthimathinathan HK; West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom., Schober ME; Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City., Fink EL; Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Jun 03; Vol. 7 (6), pp. e2414122. Date of Electronic Publication: 2024 Jun 03.
DOI:	10.1001/jamanetworkopen.2024.14122
Abstrakt:	Importance: Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective: To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants: This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure: Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures: The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. Results: Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P < .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. Conclusions and Relevance: The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.
Databáze:	MEDLINE
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