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Mar, 2024;95 (4): 1088-1094.

Children with severe neurological symptoms associated with SARS-CoV-2 infection during Omicron pandemic in China.

Tao Zhang, Qiao-Feng Zhang, Hong-Mei Yang, Pin Liu, Peng Sun, Yu-Mei Li, Zhen Zhang, Yan-Zhi Huang, Xin-Yan Yu, Qi-Qi-Ge Chao-Lu-Men, Qin Su, Chun-Feng Liu
Author Information
  1. Tao Zhang: Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
  2. Qiao-Feng Zhang: Department of Pediatric Intensive Care Unit, Dalian Women and Children's Medical Group, Dalian, China.
  3. Hong-Mei Yang: Department of Pediatric Intensive Care Unit, Dalian Women and Children's Medical Group, Dalian, China.
  4. Pin Liu: Department of Pediatric Intensive Care Unit, Shenyang Children's Hospital, Shenyang, China.
  5. Peng Sun: Department of Pediatric Intensive Care Unit, Shenyang Children's Hospital, Shenyang, China.
  6. Yu-Mei Li: Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, China.
  7. Zhen Zhang: Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, China.
  8. Yan-Zhi Huang: Changchun Children's Hospital, Changchun, China.
  9. Xin-Yan Yu: Department of Critical Medicine, Jiangnan Hospital of the Sixth Affiliated Hospital of Harbin Medical University (Harbin Children's Hospital), Harbin, China.
  10. Qi-Qi-Ge Chao-Lu-Men: Department of Intensive Care Unit, Inner Mongolia Medical University Affiliated Hospital, Hohhot, China.
  11. Qin Su: Department of Intensive Care Unit, Inner Mongolia Medical University Affiliated Hospital, Hohhot, China.
  12. Chun-Feng Liu: Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China. zhliu258@hotmail.com.
PMID: 37990079 DOI: 10.1038/s41390-023-02904-8

Abstract

BACKGROUND: To analyze the clinical characteristics and outcomes of children with severe neurological symptoms associated with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the Omicron pandemic in China.
METHODS: This study used a questionnaire to obtain data from pediatric intensive care unit (PICU) centers in seven tertiary hospitals in Northeast China from December 1, 2022, to January 31, 2023.
RESULTS: A total of 255 patients were confirmed to have SARS-CoV-2 infection, and 45 patients (17.65 %) were included in this study. Of these, seven (15.6%) patients died, and the median time from admission to death was 35 h (IQR, 14-120 h). Twenty (52.6%) survivors experienced neurological sequelae. Patients with platelet counts lower than 100 × 10/L had a higher incidence of complications such as multiple organ dysfunction, mechanical ventilation rate, and mortality. Cranial magnetic resonance imaging (MRI) always reveals cerebral tissue edema, with some severe lesions forming a softening site.
CONCLUSION: Children infected with SARS-CoV-2 often exhibit severe neurological symptoms, and in some cases, they may rapidly develop malignant cerebral edema or herniation, leading to a fatal outcome. An early decrease in platelet count may associated with an unfavorable prognosis.
IMPACT: Since early December 2022, China has gradually adjusted its prevention and control policy of SARS-CoV-2; Omicron outbreaks have occurred in some areas for a relatively short period. Due to the differences in ethnicity, endemic strains and vaccination status, there was a little difference from what has been reported about children with SARS-CoV-2 infection with severe neurological symptoms in abroad. This is the first multicenter clinical study in children with nervous system involvement after acute SARS-CoV-2 infection in China, and helpful for pediatricians to have a more comprehensive understanding of the clinical symptoms and prognosis of such disease.

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MeSH Term

Child
Humans
COVID-19
SARS-CoV-2
Pandemics
Brain Edema
China
Retrospective Studies
Multicenter Study Journal Article
Article has an altmetric score of 10

Word Cloud

Created with Highcharts 10.0.0SARS-CoV-2severeneurologicalsymptomsinfectionChinaclinicalchildrenassociatedOmicronstudypatientsacutepandemicsevenDecember20226%plateletcerebraledemaChildrenmayearlyprognosisBACKGROUND:analyzecharacteristicsoutcomesrespiratorysyndromecoronavirus-2METHODS:usedquestionnaireobtaindatapediatricintensivecareunitPICUcenterstertiaryhospitalsNortheast1January312023RESULTS:total255confirmed451765%included15diedmediantimeadmissiondeath35 hIQR14-120 hTwenty52survivorsexperiencedsequelaePatientscountslower100 × 10/LhigherincidencecomplicationsmultipleorgandysfunctionmechanicalventilationratemortalityCranialmagneticresonanceimagingMRIalwaysrevealstissuelesionsformingsofteningsiteCONCLUSION:infectedoftenexhibitcasesrapidlydevelopmalignantherniationleadingfataloutcomedecreasecountunfavorableIMPACT:SincegraduallyadjustedpreventioncontrolpolicyoutbreaksoccurredareasrelativelyshortperiodDuedifferencesethnicityendemicstrainsvaccinationstatuslittledifferencereportedabroadfirstmulticenternervoussysteminvolvementhelpfulpediatricianscomprehensiveunderstandingdisease

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