Neurological manifestations in children with SARS-CoV-2 infection: a French multicentric cohort

Abstract

Objectives: This study aimed to assess neurological manifestations in French children hospitalized with SARS-CoV-2 infection. Secondary objectives were to evaluate the severity of these presentations and estimate the frequency of long-term neurological sequelae.

Methods: A multicenter observational study was conducted, including 71 children hospitalized for neurological manifestations of SARS-CoV-2 infection from January 2020 to March 2022.

Results: The median age was 8.7 years (range 4.2-13), with 49 % being girls. The most common neurological manifestations were encephalitis and meningoencephalitis (32 %). Brain imaging was abnormal in 68 % of cases. Half of the children required admission in intensive care unit (ICU). Nearly one-third of the children had neurological symptoms at the end of the follow-up, with cognitive difficulties being the most reported complaints. No significant associations were made between sex, age, neurological comorbidities, and the severity nor presence of sequelae. However, abnormal brain imaging was significantly associated with a higher risk of ICU stay (OR = 8.01 [95 % CI 2.37-27.1], p < 0.01) and with the presence of sequelae at discharge (OR = 4.65 [1.45-14.9], p = 0.011) and last follow-up (OR = 5.14 [1.40-18.9], p = 0.015).

Conclusion: Although rare, neurological manifestations in children with SARS-CoV-2 infection can be severe, with encephalitis as the most common clinical presentation. Abnormal brain imaging is a strong prognostic marker of acute severity and long-term neurological and cognitive sequelae. Objective assessment tools and longer follow-up are necessary to evaluate the long-term outcomes in these children.

Keywords: Neuro-Covid; SARS-CoV-2; neuro-immunology; pediatric encephalitis; pediatric neurology.