COVID-19 and Acute Neurologic Complications in Children.
COVID-19 and Acute Neurologic Complications in Children.
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DOI：
10.1542/peds.2022-058167
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发表时间：
2022-11-01
期刊：
影响因子：
8
通讯作者：
Williams, Derek J.
中科院分区：
文献类型：
--
作者：
Antoon, James W.;Hall, Matt;Howard, Leigh M.;Herndon, Alison;Freundlich, Katherine L.;Grijalva, Carlos G.;Williams, Derek J.
关于儿童中与COVID-19相关的神经系统并发症的流行病学和结果知之甚少。我们对2020年3月至2022年3月期间从52家儿童医院出院的2个月至18岁以下的COVID-19患儿进行了横断面研究。神经系统并发症定义为脑病、脑炎、无菌性脑膜炎、热性癫痫发作、非热性癫痫发作、脑脓肿和细菌性脑膜炎、雷氏综合征和脑梗死。我们评估了住院时间（LOS）、重症监护病房（ICU）入院、30天再入院、死亡和住院费用。我们使用多变量逻辑回归来确定与神经系统并发症相关的因素。在15137名因COVID-19住院的儿童中，1060名（7.0%）同时诊断为神经系统并发症。最常见的神经系统并发症是热性惊厥（3.9%）、非热性惊厥（2.3%）和脑病（2.2%）。与无并发症的儿童相比，有神经系统并发症的儿童的住院时间、ICU入院时间、ICU住院时间、30天再入院时间、死亡和住院费用更高。与神经系统并发症发生率较低相关的因素包括：年龄较小（aOR 0.97, 95% CI 0.96, 0.98），发生在δ变异主要时间段（aOR 0.71, 95% CI 0.57, 0.87），存在非神经系统复杂慢性疾病（CCC） （aOR 0.80, 95% CI 0.69, 0.94）。神经系统CCC的存在与神经系统并发症的高发生率相关（aOR 4.14, 95% CI 3.48, 4.92）。神经系统并发症在因COVID-19住院的儿童中很常见，并与较差的医院预后相关。我们的研究结果强调了COVID-19免疫接种在儿童中的重要性，特别是在高危人群中，如神经系统合并症患者。这项针对52家儿童医院的横断面研究调查了COVID-19儿童的患病率、结局和相关因素、神经系统并发症
Little is known about the epidemiology and outcomes of neurologic complications associated with COVID-19 in children. We performed a cross-sectional study of children 2 months to <18 years with COVID-19 discharged from 52 children’s hospitals from March 2020-March 2022. Neurologic complications were defined as encephalopathy, encephalitis, aseptic meningitis, febrile seizure, non-febrile seizure, brain abscess and bacterial meningitis, Reye’s syndrome, and cerebral infarction. We assessed length of stay (LOS), intensive care unit (ICU) admission, 30-day readmissions, deaths, and hospital costs. We used multivariable logistic regression to identify factors associated with neurologic complications. Of 15,137 children hospitalized with COVID-19, 1060 (7.0%) had a concurrent diagnosis of a neurologic complication. The most frequent neurologic complications were febrile seizures (3.9%), non-febrile seizures (2.3%) and encephalopathy (2.2%). Hospital LOS, ICU admission, ICU LOS, 30-day readmissions, deaths, and hospital costs were higher in children with neurologic complications compared to those without complications. Factors associated with lower odds of neurologic complications included: younger age (aOR 0.97, 95% CI 0.96, 0.98), occurrence during Delta variant predominant time period (aOR 0.71, 95% CI 0.57, 0.87), presence of a non-neurologic complex chronic condition (CCC) (aOR 0.80, 95% CI 0.69, 0.94). Presence of a neurologic CCC was associated with a higher odds of neurologic complication (aOR 4.14, 95% CI 3.48, 4.92). Neurologic complications are common in children hospitalized with COVID-19 and are associated with worse hospital outcomes. Our findings emphasize the importance of COVID-19 immunization in children, especially in high-risk populations, such as those with neurologic co-morbidity. This cross-sectional study of 52 children’s hospitals examined the prevalence, outcomes and factors associated, neurologic complications in children with COVID-19
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