Predicting factors for acute encephalopathy in febrile seizure children with SARS-CoV-2 omicron variant: a retrospective study

Abstract

Background: SARS-CoV-2 posed a threat to children during the early phase of Omicron wave because many patients presented with febrile seizures. The study aimed to investigate predicting factors for acute encephalopathy of children infected by SARS-CoV-2 Omicron variant presenting with febrile seizures.

Methods: The retrospective study analyzed data from pediatric patients who visited the emergency department of Chang Gung Memorial Hospital in Taiwan between April and July 2022. We specifically focused on children with COVID-19 who presented with febrile seizures, collecting demographic, clinical, and laboratory data at the pediatric emergency department, as well as final discharge diagnoses. Subsequently, we conducted a comparative analysis of the clinical and laboratory characteristics between patients diagnosed with acute encephalopathy and those with other causes of febrile seizures.

Results: Overall, 10,878 children were included, of which 260 patients presented with febrile seizures. Among them, 116 individuals tested positive for SARS-CoV-2 and of them, 14 subsequently developed acute encephalopathy (12%). Those with acute encephalopathy displayed distinctive features, including older age (5.1 vs. 2.6 years old), longer fever duration preceding the first seizure (1.6 vs. 0.9 days), cluster seizure (50% vs. 16.7%), status epilepticus (50% vs. 13.7%) and occurrences of bradycardia (26.8% vs. 0%) and hypotension (14.3% vs. 0%) in the encephalopathy group. Besides, the laboratory findings in the encephalopathy group are characterized by hyperglycemia (mean (95% CI) 146 mg/dL (95% CI 109-157) vs. 108 mg/dL (95% CI 103-114) and metabolic acidosis (mean (95% CI) pH 7.29(95% CI 7.22-7.36) vs. 7.39 (95%CI 7.37-7.41)).

Conclusions: In pediatric patients with COVID-19-related febrile seizures, the occurrence of seizures beyond the first day of fever, bradycardia, clustered seizures, status epilepticus, hyperglycemia, and metabolic acidosis should raise concerns about acute encephalitis/encephalopathy. However, the highest body temperature and the severity of leukocytosis or C-reactive protein levels were not associated with poor outcomes.

Keywords: COVID-19; Encephalopathy; Febrile seizures; Pediatric; Predictive factor; SARS-CoV-2.

Fig. 1

Flow chart of the study. The overall number of the entire cohort of children is given first. Patients were included and excluded according to the selection criteria. The gray background represents the tentative diagnosis at the pediatric emergency department, and the blue background represents the final diagnosis of the population. †AAD, Against Advice Discharge. Numbers in the round brackets in the box of exclusion criteria represent patient numbers

Fig. 2

Incidence of fever with seizures in the children with COVID-19 at the pediatric emergency department. A After excluded 58 cases with underlying etiology and comorbidity (see exclusion criteria), the prevalence rate of the children with febrile seizures due to SARS-CoV-2 infection at the pediatric emergency department was 1.1% (116/10878). B The etiologies were simple febrile seizures (56.9%), myoclonic jerk (13.8%), complex febrile seizures (12.9%), febrile seizures plus (4.3%), and acute encephalopathy (12.1%)