Courtney Robertson, MD
a
Departments of Anesthesiology and Critical Care Medicine, and Pediatrics of The Johns Hopkins University SOM (Baltimore, MD), United States
Disclosure information not submitted.
James Yun
Statistician
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
Disclosure information not submitted.
Mark Wainwright, MD, PhD
Professor, Neurology
University of Washington & Seattle Children's Hospital, United States
Disclosure information not submitted.
Juan Roa, MD
a
Department of Pediatrics, Division of Critical Care of the Universidad Nacional de Colombia and Fundación Universitaria de Ciencias de la Salud (Colombia), United States
Disclosure information not submitted.
Michelle Schober, MD, MS
a
Department of Pediatrics, Division of Critical Care1 of the University of Utah, Salt Lake City, UT, United States 84132, United States
Disclosure information not submitted.
Ericka Fink, MD, FCCM
Childrens Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Title: GCS-NeuroCOVID: Neurological Manifestations and Outcomes in Children with and without Comorbidities
Introduction: Children with comorbidities are at increased risk of severe disease due to SARS-CoV-2 (COVID-19) infection and Multisystem Inflammatory Syndrome–Children (MIS-C). We hypothesized that children with comorbidities hospitalized with COVID-19 or MIS-C will experience more neurologic manifestations and worse outcomes compared to children without comorbidities.
Methods: Secondary study of the Global Consortium Study of Neurological Dysfunction in COVID-19 (GCS-NeuroCOVID) study, a multinational study enrolling children < 18 years of age hospitalized with confirmed/presumed COVID-19 or MIS-C. Neurological manifestations, lengths of hospital and intensive care unit (ICU) stay, hospital disposition and mortality were analyzed by comorbidity status. A multivariable logistic regression was performed to analyze the association of comorbidity with neurologic manifestation.
Results: Overall, 824 (55%) children had any comorbidity and 646 (43%) had any neurologic manifestation. Children with comorbidity were older (median [interquartile range] 9.5 [4-15] vs. 6.4 [0.5-12], had more COVID-19 (58%) vs. MIS-C (32%) and ICU admissions (39% vs. 29%), and longer hospital length of stay (9 [2-9] vs. 5 [2-6] days), all p< .001; mortality was similar (1.5% vs. 0.5%, p=.067). The most common comorbidities were neurologic and respiratory (20% each). Children with comorbidity more frequently had any neurologic manifestation (61% vs. 39%), and seizures/status epilepticus (11% vs. 4%), p< .001). There were no differences between comorbidity vs no comorbidity groups for the most common neurologic manifestations including headache (21% vs. 20%) and acute encephalopathy (17% vs. 15%). Older age (odds ratio 1.1 [95% confidence interval 1.1-1.1]), ICU stay (2.6 [1.9-3.4]), MIS-C (2.2 [1.5-3.2]), and neurologic (2.8 [1.9-4.1]) comorbidity were associated with neurologic manifestation while cardiovascular morbidity was protective for neurologic manifestation (.5 [.3-.8]), all p< .05.
Conclusions: Children with comorbidity, especially neurologic, who are hospitalized with COVID-19 related conditions are at increased risk of neurologic manifestations. Assessment of post-hospital neurodevelopmental outcomes to determine the impact of neurologic manifestations in children with comorbidity and COVID-19 related conditions is critically needed.