Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Kwei-Shan, 5 Fu-Shin Street, Taoyuan, 333, Taiwan.
Division of Pediatric Critical Care and Pediatric Neurocritical Care Center, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
BMC Pediatr. 2024 Mar 25;24(1):211. doi: 10.1186/s12887-024-04699-x.
SARS-CoV-2 posed a threat to children during the early phase of Omicron wave because many patients presented with febrile seizures. The study aimed to investigate predicting factors for acute encephalopathy of children infected by SARS-CoV-2 Omicron variant presenting with febrile seizures.
The retrospective study analyzed data from pediatric patients who visited the emergency department of Chang Gung Memorial Hospital in Taiwan between April and July 2022. We specifically focused on children with COVID-19 who presented with febrile seizures, collecting demographic, clinical, and laboratory data at the pediatric emergency department, as well as final discharge diagnoses. Subsequently, we conducted a comparative analysis of the clinical and laboratory characteristics between patients diagnosed with acute encephalopathy and those with other causes of febrile seizures.
Overall, 10,878 children were included, of which 260 patients presented with febrile seizures. Among them, 116 individuals tested positive for SARS-CoV-2 and of them, 14 subsequently developed acute encephalopathy (12%). Those with acute encephalopathy displayed distinctive features, including older age (5.1 vs. 2.6 years old), longer fever duration preceding the first seizure (1.6 vs. 0.9 days), cluster seizure (50% vs. 16.7%), status epilepticus (50% vs. 13.7%) and occurrences of bradycardia (26.8% vs. 0%) and hypotension (14.3% vs. 0%) in the encephalopathy group. Besides, the laboratory findings in the encephalopathy group are characterized by hyperglycemia (mean (95% CI) 146 mg/dL (95% CI 109-157) vs. 108 mg/dL (95% CI 103-114) and metabolic acidosis (mean (95% CI) pH 7.29(95% CI 7.22-7.36) vs. 7.39 (95%CI 7.37-7.41)).
In pediatric patients with COVID-19-related febrile seizures, the occurrence of seizures beyond the first day of fever, bradycardia, clustered seizures, status epilepticus, hyperglycemia, and metabolic acidosis should raise concerns about acute encephalitis/encephalopathy. However, the highest body temperature and the severity of leukocytosis or C-reactive protein levels were not associated with poor outcomes.
在奥密克戎变异株流行的早期，SARS-CoV-2 对儿童构成了威胁，因为许多患者出现了热性惊厥。本研究旨在探讨儿童感染 SARS-CoV-2 奥密克戎变异株后出现热性惊厥的急性脑病的预测因素。
这项回顾性研究分析了 2022 年 4 月至 7 月期间在台湾长庚纪念医院儿科急诊就诊的 COVID-19 患儿的数据。我们特别关注出现热性惊厥的 COVID-19 患儿，收集了儿科急诊的人口统计学、临床和实验室数据，以及最终出院诊断。随后，我们对急性脑病和其他热性惊厥病因患者的临床和实验室特征进行了比较分析。
共有 10878 名儿童入组，其中 260 名患儿出现热性惊厥。其中，116 名患儿 SARS-CoV-2 检测阳性，其中 14 名患儿随后出现急性脑病（12%）。急性脑病患儿具有独特的特征，包括年龄较大（5.1 岁 vs. 2.6 岁）、首次发作前发热时间较长（1.6 天 vs. 0.9 天）、惊厥发作呈簇状（50% vs. 16.7%）、癫痫持续状态（50% vs. 13.7%），以及心动过缓（26.8% vs. 0%）和低血压（14.3% vs. 0%）。此外，脑病组的实验室检查结果表现为高血糖（平均（95%CI）146mg/dL（95%CI 109-157）vs. 108mg/dL（95%CI 103-114）和代谢性酸中毒（平均（95%CI）pH7.29（95%CI 7.22-7.36）vs. 7.39（95%CI 7.37-7.41））。
在 COVID-19 相关热性惊厥患儿中，发热后第 1 天以上出现惊厥、心动过缓、惊厥发作呈簇状、癫痫持续状态、高血糖和代谢性酸中毒应引起对急性脑炎/脑病的关注。然而，最高体温和白细胞增多或 C 反应蛋白水平的严重程度与不良结局无关。
