Division of Pediatric Critical Care Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
JAMA Netw Open. 2024 Jun 3;7(6):e2414122. doi: 10.1001/jamanetworkopen.2024.14122.
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.
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.
Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke.
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.
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.
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.
急性 SARS-CoV-2 相关多系统炎症综合征（MIS-C）患儿住院期间的神经表现较为常见，且可能增加新发神经认知或功能障碍的风险。
评估 SARS-CoV-2 相关住院期间严重神经表现与出院时新发神经认知或功能障碍之间的关联。
设计、地点和参与者：本前瞻性队列研究纳入了来自 10 个国家 46 个中心的 18 岁以下因急性 SARS-CoV-2 或 MIS-C 住院的患者。研究时间为 2020 年 1 月 2 日至 2021 年 7 月 31 日。
严重神经表现包括急性脑病、癫痫发作或癫痫持续状态、脑膜炎或脑炎、交感风暴或自主神经功能障碍、心脏骤停、昏迷、谵妄和中风。
主要结局为出院时新发神经认知（基于小儿脑功能分类量表）和/或功能障碍（基于功能状态量表）。采用多变量逻辑回归分析，检验 SARS-CoV-2 相关疾病中严重神经表现与新发疾病之间的关系。
共有 3568 名 18 岁以下患者（中位年龄为 8 岁[IQR，1-14 岁]；54.3%为男性）纳入本研究。大多数（2980 例[83.5%]）患有急性 SARS-CoV-2；其余（588 例[16.5%]）患有 MIS-C。在急性 SARS-CoV-2 患者中，536 例（18.0%）在住院期间出现严重神经表现，146 例 MIS-C 患者（24.8%）也出现严重神经表现。在急性 SARS-CoV-2 幸存者中，与无严重神经表现者相比，有严重神经表现者出院时更可能出现新发神经认知或功能障碍（27.7%[n=142] vs 14.6%[n=356]；P<0.001）。在 MIS-C 幸存者中，39 例（28.0%）有严重神经表现者出院时出现新发神经认知和/或功能障碍，而 68 例（15.5%）无严重神经表现者出现新发神经认知和/或功能障碍（P=0.002）。在校正严重神经表现患者的危险因素后，急性 SARS-CoV-2 患者（比值比，1.85[95%CI，1.27-2.70]；P=0.001）和 MIS-C 患者（比值比，2.18[95%CI，1.22-3.89]；P=0.009）发生新发神经认知和/或功能障碍的可能性更高。
本研究结果表明，急性 SARS-CoV-2 或 MIS-C 合并严重神经表现的儿童和青少年可能存在长期受损的高风险，他们可能受益于筛查和早期干预以帮助恢复。
