Associated Press photo

For hospitalized children who tested or were presumed positive for COVID-19, 44% developed neurological symptoms, a new study led by a pediatrician-scientist at UPMC and the University of Pittsburgh School of Medicine found.

Published in the journal Pediatric Neurology, the preliminary findings from the study indicated that the most common neurological symptoms were headache and altered mental status, known as acute encephalopathy.

The study was a first finding from the pediatric arm of GCS-NeuroCOVID, an international, multi-center consortium studying how COVID-19 affects the nervous system and the brain.

Impacts of COVID

Lead author Ericka Fink, M.D., pediatric intensivist at UPMC Children’s Hospital of Pittsburgh and associate professor of critical care medicine and pediatrics at Pitt, explained that the COVID-19 virus can affect children in different ways.

COVID-19 can cause acute disease, where symptomatic illness comes on soon after infection, and it can result in an inflammatory condition called MIS-C, or multisystem inflammatory syndrome in children, weeks after clearing the virus.

MIS-C is separate from post-COVID-19, or “long COVID” symptoms, and is characterized by fever, inflammation and organ dysfunction.

“One of the consortium’s big questions was whether neurological manifestations are similar or different in pediatric patients, depending on which of these two conditions they have,” Fink said.

Study results

Researchers recruited 30 pediatric critical care centers around the world. Of 1,493 hospitalized children, 1,278, or 86%, were diagnosed with acute COVID-19, and 215 children, or 14%, were diagnosed with MIS-C, a condition that typically appears several weeks after clearing the virus.

The most common neurologic symptoms linked with acute COVID-19 were headache, acute encephalopathy and seizures, while children with MIS-C most often had headache, acute encephalopathy and dizziness. Rarer symptoms of both conditions included loss of smell, vision impairment, stroke and psychosis.

The analysis showed that neurological symptoms were more common in children with MIS-C compared to those with acute COVID-19. Children who had neurological symptoms were also more likely to require intensive care than their peers who didn’t experience such symptoms.

“Any child with a neurologic symptom would be more concerning to me as a pediatrician,” Fink said. “While we don’t exactly know from this study just yet how important a headache is to deterioration of a child, we do know that children presenting with altered mental status or seizures are certainly children that we need to observe more closely or, perhaps, perform more testing on.”

Raising awareness of complications

Fink emphasized that she did not want to “sound an alarm bell” that every child is at risk for neurological symptoms, as the study was conducted specifically in children who were already hospitalized with COVID-19, which represents a small percentage of children who get COVID-19 overall.

The data, which was gathered from the beginning of the pandemic until April 2021, also reflects a pre-vaccine state, and Fink said that less severe COVID-19 disease and MIS-C are being found in adults and children who are vaccinated.

“If a parent is concerned about a child having a change in mental status, or a change in their neurologic status, like one-sided weakness, unexplained psychological changes, seizures or abnormal movements, those are the types of symptoms that would bring a child to the hospital, regardless of it being COVID or not,” she said. “We are just trying to bring to light that these kinds of symptoms and complications can occur in children, and what to look out for.”

The team also recently launched a follow-up 15-center study to look at post-hospital discharge and examine the length of time for which children are having symptoms.

“Another long-term goal of this study is to build a database that tracks neurological manifestations over time — not just for SARS-CoV-2, but for other types of infections as well,” Fink added. “Some countries have excellent databases that allow them to easily track and compare children who are hospitalized, but we don’t have such a resource in the U.S.”