COVID and children: Headaches, mental state related to the disease

New research in the United States has revealed 44 percent of hospitalized children with COVID-19 have developed a neurological symptom, the most common being headaches and altered mental status.

The study, led by a pediatrician scientist at the University of Pittsburgh Medical Center and the University of Pittsburgh School of Medicine, found that these children were also more likely to require intensive care than those who did not present. not the same symptoms.

The research looked at how SARS-CoV-2, the virus that causes COVID-19, can affect young patients, including through acute illness, where symptomatic illness occurs soon after infection, and an inflammatory condition called MIS. -C or multisystem inflammatory syndrome in children. , which can occur weeks after clearing the virus.

Preliminary results have been published in the journal Pediatric neurology and are the first to come from the pediatric arm of the Global Consortium Study of Neurologic Dysfunction in COVID-19, or GCS-NeuroCOVID, an international group working to understand how COVID-19 affects the brain and nervous system.

“Fortunately, mortality rates in children are low for both acute SARS-CoV-2 and MIS-C,” said lead author Dr. Ericka Fink, a pediatric intensivist and associate professor of medicine at intensive care and pediatrics, in a press release.

“But this study shows that the frequency of neurological manifestations is high – and it may in fact be higher than what we found because these symptoms are not always documented in the medical record or evaluable. For example, we cannot not know if a baby is having a headache.”

The research paper does not point to any specific variant as the cause. And despite the timing, the researchers note that Delta’s impact is largely absent from the study.

CHILDREN

The study involved children under the age of 18 who were hospitalized with a positive test or clinical diagnosis of a COVID-related condition between January 2020 and April 2021.

With the help of 30 pediatric intensive care centers around the world, mostly in North America, researchers examined the symptoms of 1,493 children.

Their median age was eight years and 47% were female. Forty-two percent were white, 28% black, and 37% Latino or Hispanic.

Most patients were admitted between July and December 2020 and 58% had a pre-existing condition. Of these, the most common were respiratory and neurological at 20% each.

SYMPTOMS

Of all the children in the study, 44% had at least one neurological sign or symptom.

Headache and acute encephalopathy, or altered mental status, were most common among children overall, at 21% and 16% respectively.

Other less common symptoms include seizures (8%), anosmia or loss of smell (4%), ageusia or loss of taste (3.6%), meningitis or encephalitis (1.3%) and stroke (0.9%).

A total of 86% of children were diagnosed with acute illness, while 14% were diagnosed with MIS-C.

Ultimately, neurological disorders were more common in children with MIS-C than in those with acute disease. Children with MIS-C were also more likely to have two or more neurological symptoms.

Children with SARS-CoV-2-related illness and pre-existing neurological conditions were almost three and a half times more likely to develop neurological symptoms than those without pre-existing neurological conditions.

Children with MIS-C were also more than twice as likely to have a neurological symptom as those with acute illness – the researchers say that while more research is needed, this may be partly due to a hyperinflammation.

Metabolic diseases such as type 1 diabetes were also associated with neurological disorders in children who presented with acute COVID-19.

The most frequently reported non-neurological symptoms were fever (64%), cough (36%) and anorexia (29%).

MONITORING OF WORKS

The researchers note that neurological conditions were only recorded if they appeared in the medical record.

Additionally, symptoms such as encephalopathy may present differently depending on age or developmental stage, meaning they may be overstated or understated in the results.

Some patients in the acute illness group were admitted for other reasons and tested positive for COVID-19 due to testing policies. Asymptomatic children with neurological disorders may also not have been tested for SARS-CoV-2.

The researchers add that they were unable to determine in children who already had an acute neurological disease, whether the neurological symptoms presented were due to this disease or to COVID-19.

“Another long-term goal of this study is to create a database that tracks neurological manifestations over time – not just for SARS-CoV-2, but also for other types of infections,” said Fink said.

“Some countries have excellent databases that allow them to easily track and compare hospitalized children, but we don’t have such a resource in the United States”