Stephen T J Ray
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study
Ray, Stephen T J; Abdel-Mannan, Omar; Sa, Mario; Fuller, Charlotte; Wood, Greta K; Pysden, Karen; Yoong, Michael; McCullagh, Helen; Scott, David; McMahon, Martin; Thomas, Naomi; Taylor, Micheal; Illingworth, Marjorie; McCrea, Nadine; Davies, Victoria; Whitehouse, William; Zuberi, Sameer; Guthrie, Keira; Wassmer, Evangeline; Shah, Nikit; Baker, Mark R; Tiwary, Sangeeta; Tan, Hui Jeen; Varma, Uma; Ram, Dipak; Avula, Shivaram; Enright, Noelle; Hassell, Jane; Ross Russell, Amy L; Kumar, Ram; Mulholland, Rachel E; Pett, Sarah; Galea, Ian; Thomas, Rhys H; Benjamin, Laura A; Lim, Ming; Hacohen, Yael; Solomon, Tom; Griffiths, Michael J; Michael, Benedict D; Kneen, Rachel; Breen, Gerome; Castell, Hannah; Collie, Ceryce; George, Lilly; Hartmann, Monika; Henrion, Marc; Kinali, Maria; Petropoulos, Christina; Ramdas, Sithara; Vlachou, Victoria; Vollmer, Brigitte; Facer, Bethany; Dunai, Cordelia; Benjamin, Laura
Authors
Omar Abdel-Mannan
Mario Sa
Charlotte Fuller
Greta K Wood
Karen Pysden
Michael Yoong
Helen McCullagh
David Scott
Martin McMahon
Naomi Thomas
Micheal Taylor
Marjorie Illingworth
Nadine McCrea
Victoria Davies
William Whitehouse
Sameer Zuberi
Keira Guthrie
Evangeline Wassmer
Nikit Shah
Mark R Baker
Sangeeta Tiwary
Hui Jeen Tan
Uma Varma
Dipak Ram
Shivaram Avula
Noelle Enright
Jane Hassell
Amy L Ross Russell
Ram Kumar
Rachel E Mulholland
Sarah Pett
Ian Galea
Rhys H Thomas
Laura A Benjamin
Ming Lim
Yael Hacohen
Tom Solomon
Michael J Griffiths
Benedict D Michael
Rachel Kneen
Gerome Breen
Hannah Castell
Ceryce Collie
Lilly George
Monika Hartmann
Marc Henrion
Maria Kinali
Christina Petropoulos
Sithara Ramdas
Victoria Vlachou
Brigitte Vollmer
Bethany Facer
Cordelia Dunai
Laura Benjamin
Abstract
Background: The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. We aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. Methods: We did a prospective national cohort study in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Paediatric neurologists were invited to notify any children and adolescents (age <18 years) admitted to hospital with neurological or psychiatric disorders in whom they considered SARS-CoV-2 infection to be relevant to the presentation. Patients were excluded if they did not have a neurological consultation or neurological investigations or both, or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR of respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both), or the Royal College of Paediatrics and Child Health criteria for paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. Findings: Between April 2, 2020, and Feb 1, 2021, 52 cases were identified; in England, there were 51 cases among 1334 children and adolescents hospitalised with COVID-19, giving an estimated prevalence of 3·8 (95% CI 2·9–5·0) cases per 100 paediatric patients. 22 (42%) patients were female and 30 (58%) were male; the median age was 9 years (range 1–17). 36 (69%) patients were Black or Asian, 16 (31%) were White. 27 (52%) of 52 patients were classified into the COVID-19 neurology group and 25 (48%) were classified into the PIMS-TS neurology group. In the COVID-19 neurology group, diagnoses included status epilepticus (n=7), encephalitis (n=5), Guillain-Barré syndrome (n=5), acute demyelinating syndrome (n=3), chorea (n=2), psychosis (n=2), isolated encephalopathy (n=2), and transient ischaemic attack (n=1). The PIMS-TS neurology group more often had multiple features, which included encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioural change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Recognised neuroimmune disorders were more common in the COVID-19 neurology group than in the PIMS-TS neurology group (13 [48%] of 27 patients vs 1 [<1%] of 25 patients, p=0·0003). Compared with the COVID-19 neurology group, more patients in the PIMS-TS neurology group were admitted to intensive care (20 [80%] of 25 patients vs six [22%] of 27 patients, p=0·0001) and received immunomodulatory treatment (22 [88%] patients vs 12 [44%] patients, p=0·045). 17 (33%) patients (10 [37%] in the COVID-19 neurology group and 7 [28%] in the PIMS-TS neurology group) were discharged with disability; one (2%) died (who had stroke, in the PIMS-TS neurology group). Interpretation: This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall. Further studies should investigate underlying mechanisms for neurological involvement in COVID-19 and the longer-term outcomes. Funding: UK Research and Innovation, Medical Research Council, Wellcome Trust, National Institute for Health Research.
Citation
Ray, S. T. J., Abdel-Mannan, O., Sa, M., Fuller, C., Wood, G. K., Pysden, K., …Benjamin, L. (2021). Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study. Lancet Child and Adolescent Health, 5(9), 631-641. https://doi.org/10.1016/S2352-4642%2821%2900193-0
Journal Article Type | Article |
---|---|
Acceptance Date | Jul 14, 2021 |
Online Publication Date | Jul 21, 2021 |
Publication Date | Sep 1, 2021 |
Deposit Date | Mar 23, 2022 |
Publicly Available Date | Mar 24, 2022 |
Journal | The Lancet Child and Adolescent Health |
Electronic ISSN | 2352-4642 |
Publisher | Elsevier |
Peer Reviewed | Peer Reviewed |
Volume | 5 |
Issue | 9 |
Pages | 631-641 |
DOI | https://doi.org/10.1016/S2352-4642%2821%2900193-0 |
Keywords | Neurological manifestations, SARS-CoV-2 infection, hospitalised, children, adolescents |
Public URL | https://nottingham-repository.worktribe.com/output/7642798 |
Publisher URL | https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00193-0/fulltext |
Files
Ray Lancet Child Adol Health 2022 AAM
(472 Kb)
PDF
Downloadable Citations
About Repository@Nottingham
Administrator e-mail: discovery-access-systems@nottingham.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search