The risk of a child being hospitalized for COVID-19 is small, however a new study in UK found that about one in 20 children hospitalized with COVID-19 developed brain or nerve complications related to the viral infection.
The results of the study have already been published in the The Lancet Child and Adolescent Health. The study, led by the University of Liverpool, identifies a wide spectrum of neurological complications in children and suggests that they may be more common than in adults hospitalized with COVID-19.
Although neurological problems have been reported in children with the newly described post-COVID condition, pediatric multisystem inflammatory syndrome temporarily associated with SARS-CoV-2, the ability of COVID-19 to cause a wide range of nervous system complications in children has been poorly recognized.
To solve this low recognition, the CoroNerve Studies Group, a collaboration between the universities of Liverpool, Newcastle, Southampton and UCL, has developed a UK-wide real-time reporting system in partnership with British Pediatric Neurology Association.
Between April 2020 and January 2021, 52 cases of children under 18 years of age with neurological complications were identified among 1,334 children hospitalized with COVID-19, which gives an estimated prevalence of 3.8%. This compares to an estimated prevalence of 0.9% in adults hospitalized with COVID-19.
Eight children, corresponding to 15%, with neurological characteristics did not show symptoms of COVID-19, although the virus was detected by PCR, which highlights the importance of screening for the virus in children with acute neurological disorders.
For the first time, the study identified important differences between those with pediatric multisystem inflammatory syndrome and those with neurological complications not pediatric multisystem inflammatory syndrome. The 25 children or 48% diagnosed with pediatric multisystem inflammatory syndrome exhibited multiple neurological features, including encephalopathy, stroke, behavior change and hallucinations. These children were more likely to need intensive care.
On the other hand, the 27 children without pediatric multisystem inflammatory syndrome, or 52%, had a primary neurological disorder such as prolonged seizures, encephalitis (brain inflammation), Guillain-Barré syndrome and psychosis. In almost half of these cases, this was a recognized post-infectious neuroimmune disorder, compared with just one child in the pediatric multisystem inflammatory syndrome group, suggesting that different immunological mechanisms are at work.
Short-term results were apparently good in two-thirds, or 65%, although one-third, or 33%, had some degree of disability and one child died at follow-up. However, the impacts on the developing brain and the long-term consequences are not yet known.
The study’s first author, Stephen Ray, a clinical investigator for the Wellcome Trust and a pediatrician at the University of Liverpool, said: “The risk of a child being admitted to hospital for COVID-19 is small, but among hospitalized children, cerebral complications and nerves occur in almost 4%”.
The investigator added: “The national study confirms that children with the new post-infection hyperinflammatory syndrome with pediatric multisystem inflammatory syndrome may have brain and nerve problems; but a broad spectrum of neurological disorders in children due to COVID-19 who did not have pediatric multisystem inflammatory syndrome have also been identified. Often, they were due to the child’s immune response after the COVID-19 infection.”
Senior co-author Rachel Kneen, a pediatric neurologist consultant at Alder Hey Children’s NHS Foundation Trust, University of Liverpool, said: “Many of the children identified were not doing well. Although they had a low risk of death, half needed intensive care support and a third had an identified neurological disability. Many received complex medications and treatments, often designed to control their own immune system. We need to track these kids to understand the long-term impact. ”
Another of the study’s authors, Benedict Michael, a senior clinical scientist and MRC member at the University of Liverpool, said: “We now appreciate COVID-19’s ability to cause a wide range of brain complications in children hospitalized with this disease, with the potential to cause lifelong disabilities, we desperately need research to understand the immune mechanisms that drive this. More importantly, how do we identify children at risk and how should we treat them to prevent lasting brain damage? We are delighted that the UK government funded our COVID-CNS study to understand exactly these issues so that we can help inform doctors to better recognize and treat these children.”