eprintid: 10131933 rev_number: 21 eprint_status: archive userid: 608 dir: disk0/10/13/19/33 datestamp: 2021-07-29 10:59:32 lastmod: 2024-11-04 15:18:17 status_changed: 2021-07-29 10:59:32 type: article metadata_visibility: show creators_name: Ray, STJ creators_name: Abdel-Mannan, O creators_name: Sa, M creators_name: Fuller, C creators_name: Wood, GK creators_name: Pysden, K creators_name: Yoong, M creators_name: McCullagh, H creators_name: Scott, D creators_name: McMahon, M creators_name: Thomas, N creators_name: Taylor, M creators_name: Illingworth, M creators_name: McCrea, N creators_name: Davies, V creators_name: Whitehouse, W creators_name: Zuberi, S creators_name: Guthrie, K creators_name: Wassmer, E creators_name: Shah, N creators_name: Baker, MR creators_name: Tiwary, S creators_name: Tan, HJ creators_name: Varma, U creators_name: Ram, D creators_name: Avula, S creators_name: Enright, N creators_name: Hassell, J creators_name: Ross Russell, AL creators_name: Kumar, R creators_name: Mulholland, RE creators_name: Pett, S creators_name: Galea, I creators_name: Thomas, RH creators_name: Lim, M creators_name: Hacohen, Y creators_name: Solomon, T creators_name: Griffiths, MJ creators_name: Michael, BD creators_name: Kneen, R creators_name: CoroNerve study group, title: Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study ispublished: inpress subjects: GOSH divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F87 divisions: C08 divisions: D77 divisions: D01 divisions: G16 note: This version is the version of record. For information on re-use, please refer to the publisher’s terms and conditions. abstract: BACKGROUND: The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. We aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. METHODS: We did a prospective national cohort study in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Paediatric neurologists were invited to notify any children and adolescents (age <18 years) admitted to hospital with neurological or psychiatric disorders in whom they considered SARS-CoV-2 infection to be relevant to the presentation. Patients were excluded if they did not have a neurological consultation or neurological investigations or both, or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR of respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both), or the Royal College of Paediatrics and Child Health criteria for paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. FINDINGS: Between April 2, 2020, and Feb 1, 2021, 52 cases were identified; in England, there were 51 cases among 1334 children and adolescents hospitalised with COVID-19, giving an estimated prevalence of 3·8 (95% CI 2·9-5·0) cases per 100 paediatric patients. 22 (42%) patients were female and 30 (58%) were male; the median age was 9 years (range 1-17). 36 (69%) patients were Black or Asian, 16 (31%) were White. 27 (52%) of 52 patients were classified into the COVID-19 neurology group and 25 (48%) were classified into the PIMS-TS neurology group. In the COVID-19 neurology group, diagnoses included status epilepticus (n=7), encephalitis (n=5), Guillain-Barré syndrome (n=5), acute demyelinating syndrome (n=3), chorea (n=2), psychosis (n=2), isolated encephalopathy (n=2), and transient ischaemic attack (n=1). The PIMS-TS neurology group more often had multiple features, which included encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioural change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Recognised neuroimmune disorders were more common in the COVID-19 neurology group than in the PIMS-TS neurology group (13 [48%] of 27 patients vs 1 [<1%] of 25 patients, p=0·0003). Compared with the COVID-19 neurology group, more patients in the PIMS-TS neurology group were admitted to intensive care (20 [80%] of 25 patients vs six [22%] of 27 patients, p=0·0001) and received immunomodulatory treatment (22 [88%] patients vs 12 [44%] patients, p=0·045). 17 (33%) patients (10 [37%] in the COVID-19 neurology group and 7 [28%] in the PIMS-TS neurology group) were discharged with disability; one (2%) died (who had stroke, in the PIMS-TS neurology group). INTERPRETATION: This study identified key differences between those with a primary neurological disorder versus those with PIMS-TS. Compared with patients with a primary neurological disorder, more patients with PIMS-TS needed intensive care, but outcomes were similar overall. Further studies should investigate underlying mechanisms for neurological involvement in COVID-19 and the longer-term outcomes. FUNDING: UK Research and Innovation, Medical Research Council, Wellcome Trust, National Institute for Health Research. date: 2021-07-15 date_type: published official_url: https://doi.org/10.1016/S2352-4642(21)00193-0 oa_status: green full_text_type: pub pmcid: PMC8279959 language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1877969 doi: 10.1016/S2352-4642(21)00193-0 pii: S2352-4642(21)00193-0 lyricists_name: Abdel-Mannan, Omar lyricists_name: Benjamin, Laura lyricists_name: Hacohen, Yael lyricists_name: Pett, Sarah lyricists_id: OABDE15 lyricists_id: LABEN07 lyricists_id: YHACO24 lyricists_id: SPETT58 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: The Lancet Child & Adolescent Health event_location: England citation: Ray, STJ; Abdel-Mannan, O; Sa, M; Fuller, C; Wood, GK; Pysden, K; Yoong, M; ... CoroNerve study group; + view all <#> Ray, STJ; Abdel-Mannan, O; Sa, M; Fuller, C; Wood, GK; Pysden, K; Yoong, M; McCullagh, H; Scott, D; McMahon, M; Thomas, N; Taylor, M; Illingworth, M; McCrea, N; Davies, V; Whitehouse, W; Zuberi, S; Guthrie, K; Wassmer, E; Shah, N; Baker, MR; Tiwary, S; Tan, HJ; Varma, U; Ram, D; Avula, S; Enright, N; Hassell, J; Ross Russell, AL; Kumar, R; Mulholland, RE; Pett, S; Galea, I; Thomas, RH; Lim, M; Hacohen, Y; Solomon, T; Griffiths, MJ; Michael, BD; Kneen, R; CoroNerve study group; - view fewer <#> (2021) Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study. The Lancet Child & Adolescent Health 10.1016/S2352-4642(21)00193-0 <https://doi.org/10.1016/S2352-4642%2821%2900193-0>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10131933/1/main%20%282%29.pdf