Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study.
Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study.
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DOI：
10.1016/s2352-4642(21)00193-0
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发表时间：
2021-09
期刊：
影响因子：
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通讯作者：
CoroNerve study group
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作者：
Ray STJ;Abdel-Mannan O;Sa M;Fuller C;Wood GK;Pysden K;Yoong M;McCullagh H;Scott D;McMahon M;Thomas N;Taylor M;Illingworth M;McCrea N;Davies V;Whitehouse W;Zuberi S;Guthrie K;Wassmer E;Shah N;Baker MR;Tiwary S;Tan HJ;Varma U;Ram D;Avula S;Enright N;Hassell J;Ross Russell AL;Kumar R;Mulholland RE;Pett S;Galea I;Thomas RH;Lim M;Hacohen Y;Solomon T;Griffiths MJ;Michael BD;Kneen R;CoroNerve study group
与儿科SARS-CoV-2感染相关的神经和精神并发症谱知之甚少。我们的目的是分析住院儿童和青少年这些并发症的范围和患病率。我们使用CoroNerve研究小组建立的安全快速响应通知门户网站在线网络在英国进行了一项前瞻性国家队列研究。儿科神经科医生被邀请通知任何儿童和青少年（年龄<18岁）因神经系统或精神疾病住院，他们认为SARS-CoV-2感染与介绍有关。如果患者没有进行神经科会诊或神经科检查或两者都没有，或不符合确诊的SARS-CoV-2感染的定义，则将其排除在外（呼吸道或脊髓液样本的PCR阳性、抗SARS-CoV-2 IgG的血清学阳性或两者兼有），或皇家学院和儿童健康标准，用于与SARS-CoV-2暂时相关的儿科炎性多系统综合征（PIMS-TS）。个体被分类为患有与COVID-19相关的原发性神经系统疾病（COVID-19神经病学组）或具有神经系统特征的PIMS-TS（PIMS-TS神经病学组）。所有因COVID-19住院的儿童和青少年的分母来自英国国家卫生服务局的数据。在2020年4月2日至2021年2月1日期间，发现了52例病例;在英格兰，1334名儿童和青少年因COVID-19住院治疗，其中51例，估计患病率为每100名儿科患者3.8例（9 - 5%CI 2.9 - 5.0）。22例（42%）患者为女性，30例（58%）为男性;中位年龄为9岁（范围1-17岁）。36例（69%）患者为黑人或亚洲人，16例（31%）为白色人。52名患者中有27名（52%）被归类为COVID-19神经病学组，25名（48%）被归类为PIMS-TS神经病学组。在COVID-19神经病学组中，诊断包括癫痫持续状态（n=7）、脑炎（n=5）、格林-巴利综合征（n=5）、急性脱髓鞘综合征（n=3）、舞蹈病（n =2）、精神病（n = 2）、孤立性脑病（n=2）和短暂性脑缺血发作（n=1）。PIMS-TS神经病学组更常见多种特征，包括脑病（n=22 [88%]）、周围神经系统受累（n=10 [40%]）、行为改变（n=9 [36%]）和就诊时幻觉（n=6 [24%]）。COVID-19神经病学组中识别出的神经免疫疾病比PIMS-TS神经病学组更常见（27例患者中的13例[48%] vs 25例患者中的1例[<1%]，p= 0.0003）。与COVID-19神经病学组相比，PIMS-TS神经病学组中更多的患者入院接受重症监护（25例患者中的20例[80%] vs 27例患者中的6例[22%]，p= 0.0001）并接受免疫调节治疗（22例[88%] vs 12例[44%]，p= 0.045）。17例（33%）患者（COVID-19神经病学组10例[37%]，PIMS-TS神经病学组7例[28%]）因残疾出院; 1例（2%）死亡（PIMS-TS神经病学组发生卒中）。这项研究确定了原发性神经系统疾病患者与PIMS-TS患者之间的关键差异。与原发性神经系统疾病患者相比，更多PIMS-TS患者需要重症监护，但总体结局相似。进一步的研究应该调查COVID-19神经系统受累的潜在机制和长期结果。英国研究和创新，医学研究理事会，惠康信托基金，国家健康研究所。
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. 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. 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). 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. UK Research and Innovation, Medical Research Council, Wellcome Trust, National Institute for Health Research.