Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov 1;150(5):e2022058167.
doi: 10.1542/peds.2022-058167.

COVID-19 and Acute Neurologic Complications in Children

James W Antoon  1   2 , Matt Hall  3 , Leigh M Howard  4 , Alison Herndon  1   2 , Katherine L Freundlich  1   2 , Carlos G Grijalva  5 , Derek J Williams  1   2
Affiliations

COVID-19 and Acute Neurologic Complications in Children

James W Antoon et al. Pediatrics. .

Abstract

Background: Little is known about the epidemiology and outcomes of neurologic complications associated with coronavirus disease 2019 (COVID-19) in children.

Methods: We performed a cross-sectional study of children 2 months to <18 years of age with COVID-19 discharged from 52 children's hospitals from March 2020 to March 2022. Neurologic complications were defined as encephalopathy, encephalitis, aseptic meningitis, febrile seizure, nonfebrile seizure, brain abscess and bacterial meningitis, Reye's syndrome, and cerebral infarction. We assessed length of stay (LOS), ICU admission, 30 day readmissions, deaths, and hospital costs. We used multivariable logistic regression to identify factors associated with neurologic complications.

Results: 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%), nonfebrile 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 with those without complications. Factors associated with lower odds of neurologic complications included: younger age (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.96-0.98), occurrence during delta variant predominant time period (aOR: 0.71; 95% CI: 0.57-0.87), presence of a nonneurologic complex chronic condition (aOR: 0.80; 95% CI: 0.69-0.94). The presence of a neurologic complex chronic condition was associated with higher odds of neurologic complication (aOR 4.14, 95% CI 3.48-4.92).

Conclusions: 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 comorbidity.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Grijalva has received consulting fees from Pfizer, Sanofi, and Merck. The remaining authors have indicated they have no potential conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Forest plot of odds of COVID-19-associated neurologic complications in hospitalized children. aORs were derived by using multivariable logistic regression including the following covariates: age, sex, race/ethnicity, payer, nonneurologic CCC, neurologic CCC, remdesivir or dexamethasone treatment, and SARS-CoV-2 strain or variant. Reference categories for each risk factor include SARS-CoV-2 strain or variant (wildtype), remdesivir or dexamethasone treatment (no remdesivir or dexamethasone treatment), nonneurologic CCC (no nonneurologic CCC), neurologic CCC (no neurologic CCC), race/ethnicity (non-Hispanic white).
FIGURE 2
FIGURE 2
Forest plot of risk factors for COVID-19-associated neurologic complications stratified by age. aORs were derived by using multivariable logistic regression including the following covariates: age, sex, race/ethnicity, payer, nonneurologic CCC, neurologic CCC, remdesivir or dexamethasone treatment, and SARS-CoV-2 strain or variant. Reference categories for each risk factor include SARS-CoV-2 strain or variant (wildtype), remdesivir or dexamethasone treatment (no remdesivir or dexamethasone treatment), nonneurologic CCC (no nonneurologic CCC), neurologic CCC (no neurologic CCC), race/ethnicity (non-Hispanic white).
See this image and copyright information in PMC

References

    1. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533–534 - PMC - PubMed
    1. American Academy of Pediatrics . Children and COVID-19: state-level data report. Available at: https://www.aap.org/en/pages/2019-novel-coronavirus- covid-19-infections.... Accessed April 28, 2022
    1. Antoon JW, Grijalva CG, Thurm C, et al. . Factors associated with COVID-19 disease severity in US children and adolescents. J Hosp Med. 2021;16(10):603–610 - PMC - PubMed
    1. Antoon JW, Hall M, Herndon A, et al. . Prevalence, risk factors, and outcomes of influenza-associated neurologic complications in children. J Pediatr. 2021;239:32–38.e5 - PMC - PubMed
    1. Saravanos GL, King CL, Deng L, et al. . Respiratory syncytial virus-associated neurologic complications in children: a systematic review and aggregated case series. J Pediatr. 2021;239:39–49.e9 - PubMed

Publication types

Supplementary concepts