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