LaRovere Kerri L, Riggs Becky J, Poussaint Tina Y, Young Cameron C, Newhams Margaret M, Maamari Mia, Walker Tracie C, Singh Aalok R, Dapul Heda, Hobbs Charlotte V, McLaughlin Gwenn E, Son Mary Beth F, Maddux Aline B, Clouser Katharine N, Rowan Courtney M, McGuire John K, Fitzgerald Julie C, Gertz Shira J, Shein Steven L, Munoz Alvaro Coronado, Thomas Neal J, Irby Katherine, Levy Emily R, Staat Mary A, Tenforde Mark W, Feldstein Leora R, Halasa Natasha B, Giuliano John S, Hall Mark W, Kong Michele, Carroll Christopher L, Schuster Jennifer E, Doymaz Sule, Loftis Laura L, Tarquinio Keiko M, Babbitt Christopher J, Nofziger Ryan A, Kleinman Lawrence C, Keenaghan Michael A, Cvijanovich Natalie Z, Spinella Philip C, Hume Janet R, Wellnitz Kari, Mack Elizabeth H, Michelson Kelly N, Flori Heidi R, Patel Manish M, Randolph Adrienne G
Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
JAMA Neurol. 2021 May 1;78(5):536-547. doi: 10.1001/jamaneurol.2021.0504.
Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear.
To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19.
SETTING, DESIGN, AND PARTICIPANTS: Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features.
Severe acute respiratory syndrome coronavirus 2.
Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge.
Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19-related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died.
In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown.
2019年冠状病毒病（COVID-19）会影响成年患者的神经系统。儿童和青少年神经受累的范围尚不清楚。
了解与COVID-19相关的儿童和青少年神经受累的范围和严重程度。
设置、设计和参与者：对2020年3月15日至2020年12月15日期间在美国61家医院住院的患者（年龄<21岁）进行病例系列研究，这些患者在“战胜COVID-19”公共卫生登记系统中的严重急性呼吸综合征冠状病毒2检测结果呈阳性（逆转录聚合酶链反应和/或抗体检测），其中616例（36%）符合儿童多系统炎症综合征标准。有神经受累的患者在就诊时或住院期间有急性神经体征、症状或疾病。危及生命的受累情况由专家根据临床和/或神经放射学特征判定。
严重急性呼吸综合征冠状病毒2。
神经受累的类型和严重程度、实验室和影像学数据以及出院时的结局（死亡或存活但有新的神经功能缺损）。
在1695例患者中（909例[54%]为男性；中位[四分位间距]年龄为9.1[2.4 - 15.3]岁），来自52个地点的365例（22%）有记录的神经受累。与无神经受累的患者相比（1330例中的113例[8%]），有神经受累的患者更可能有潜在的神经疾病（365例中的81例[22%]），但此前健康的人数相似（195例[53%]对723例[54%]），且符合儿童多系统炎症综合征标准的人数也相似（126例[35%]对490例[37%]）。在有神经受累的患者中，322例（88%）有短暂症状并存活，43例（12%）出现临床上判定与COVID-19相关的危及生命的情况，包括严重脑病（n = 15；5例有胼胝体病变）、中风（n = 12）、中枢神经系统感染/脱髓鞘（n = 8）、吉兰 - 巴雷综合征/变异型（n = 4）和急性暴发性脑水肿（n = 4）。与无危及生命情况的患者（n = 322）相比，有危及生命神经情况的患者中性粒细胞与淋巴细胞比值更高（中位值分别为12.2对4.4），且报告的D - 二聚体大于3μg/mL纤维蛋白原当量单位的频率更高（21例[49%]对72例[22%]）。在43例出现与COVID-19相关的危及生命神经受累的患者中，17例幸存者（40%）出院时有新的神经功能缺损，11例患者（26%）死亡。
在本研究中，许多因COVID-19或儿童多系统炎症综合征住院的儿童和青少年有神经受累，大多为短暂症状。与COVID-19相关的一系列危及生命和致命的神经疾病很少发生。对长期神经发育结局的影响尚不清楚。
