Children with MIS-C or COVID-19 and severe neuro symptoms face long-term impairment risk
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Key takeaways:
- Children with COVD-19 or MIS-C who have severe neurological manifestations are more likely to have long-term morbidity.
- More work is needed to understand the long-term impact of acute SARS-CoV-2 or MIS-C.
Children hospitalized with SARS-CoV-2 or an inflammatory syndrome associated with SARS-CoV-2 infection who experience severe neurological manifestations may be at a higher risk for long-term impairment, a study found.
Cases of multisystem inflammatory syndrome in children (MIS-C) — a potentially severe illness in children infected with SARS-CoV-2 — have decreased significantly since the first year of the pandemic but increased last fall amid a rise in COVID-19 activity.
Early in the pandemic, critical care researchers were unsure of how the SARS-CoV-2 virus would impact children, particularly those who presented with critical illness, one of the co-authors of the new study told Healio.
“We thought that if we could band together across centers and countries, we could have the ability to better understand whether any neurologic symptoms and conditions were prevalent among hospitalized children with acute COVID-19 or MIS-C, evaluate their hospital course, and assess for risk factors for children with worse neurologic outcomes,” Ericka Fink, MD, MS, a professor of critical care medicine and pediatrics at the University of Pittsburgh, told Healio.
Fink and colleagues began by reaching out to pediatric research networks and creating a case report form to collect data, including patient demographics like age and pre-existing conditions, neurological and non-neurological symptoms, hospital treatments and laboratory testing, and neurological outcome at discharge. Study teams submitted data on patients from 46 care centers in 10 countries.
“Consistent with adult research, we found the association of worse neurologic outcomes in children with pre-existing neurologic conditions compared with those who did not have these conditions,” Alicia Alcamo, MD, MPH, assistant professor of anesthesiology, critical care and pediatrics at the University of Pennsylvania Perelman School of Medicine, told Healio. “However, we were not expecting to find worse outcomes when controlling for this exposure.”
Of the 3,568 patients younger than 18 years who were included in the study, 83.5% had acute SARS-CoV-2, and the remaining 16.5% had MIS-C. Among patients with acute SARS-CoV-2, 18% had a severe neurological manifestations during hospitalization, as did 24.8% of the patients with MIS-C.
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% vs. 14.6%; P < .001).
Among the survivors with MIS-C, 28% with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% of those without severe neurological manifestations (P = .002).
When adjusting for risk factors in those with severe neurological manifestations, patients with acute SARS-CoV-2 (OR = 1.85; 95% CI, 1.27-2.70) or with MIS-C (OR = 2.18; 95% CI, 1.22-3.89) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge.
“The frequency of severe neurologic manifestations, occurring in 18% of children with acute COVID-19, and in 25% of those with MIS-C, was surprisingly high among hospitalized children, and was associated with new impairment at discharge,” Alcamo said.
Alcamo added that the association of neurological manifestations with new functional and neurocognitive outcomes in acute SARS-CoV-2 infection and MIS-C paralleled previous findings in other critically ill children, “such as those with sepsis.”
“We believe that these data further support the need for primary care providers to have a higher level of concern to evaluate for new and potentially long-lasting sequelae in hospitalized children,” Alcamo said. “More work is needed to understand the longer term impact of acute SARS-CoV-2 or MIS-C on these outcomes.”
Fink said that although the study included international sites, lesser income countries, which bear a much larger burden in terms of worse child outcomes, are not represented.
“We would like to shine a spotlight on our colleagues and families around the world to bring greater awareness and action,” Fink said.
The study was accompanied by an editorial authored by Michael S. Wolf, MD, assistant professor of pediatrics and a critical care physician at Vanderbilt University Medical Center, who noted that the study “builds on previous work” and “exemplifies the unique contributions of the field of pediatric neurocritical care.”
“Lessons learned from large cohorts of patients with sepsis, acute SARS-CoV-2 infection, MIS-C, and other systemic illnesses should deepen clinicians’ appreciation of the links between short-term disease manifestations and long-term consequences for the most vulnerable pediatric patients,” Wolf wrote.
Alcamo said more work is needed to “understand the mechanisms of functional and neurocognitive impairment following acute SARS-CoV-2 and MIS-C.” Also needed are effective preventative and therapeutic interventions specific to the pediatric population, she said.
“Understanding the impact of SARS-CoV-2-related illness on long-term outcomes in children may further expand our knowledge of long-term outcomes relevant to children following hospitalizations for other acute illnesses resulting in sequelae affecting function, quality of life, and other important patient and family centered outcomes,” Alcamo said.
References:
Francoeur C, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.14122.
Wolf MS, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.14127.
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