BACKGROUND

Little is known about the epidemiology and outcomes of neurologic complications associated with COVID-19 in children.

METHODS

We performed a cross-sectional study of children 2 months to <18 years with COVID-19 discharged from 52 children's hospitals from March 2020-March 2022. Neurologic complications were defined as encephalopathy, encephalitis, aseptic meningitis, febrile seizure, non-febrile seizure, brain abscess and bacterial meningitis, Reye’s syndrome, and cerebral infarction. We assessed length of stay (LOS), intensive care unit (ICU) admission, 30-day readmissions, deaths, and hospital costs. We used multivariable logistic regression to identify factors associated with neurologic complications.

RESULTS

Of 15,137 children hospitalized with COVID-19, 1060 (7.0%) had a concurrent diagnosis of a neurologic complication. The most frequent neurologic complications were febrile seizures (3.9%), non-febrile seizures (2.3%) and encephalopathy (2.2%). Hospital LOS, ICU admission, ICU LOS, 30-day readmissions, deaths, and hospital costs were higher in children with neurologic complications compared to those without complications. Factors associated with lower odds of neurologic complications included: younger age (aOR 0.97, 95% CI 0.96, 0.98), occurrence during Delta variant predominant time period (aOR 0.71, 95% CI 0.57, 0.87), presence of a non-neurologic complex chronic condition (CCC) (aOR 0.80, 95% CI 0.69, 0.94). Presence of a neurologic CCC was associated with a higher odds of neurologic complication (aOR 4.14, 95% CI 3.48, 4.92).

CONCLUSIONS

Neurologic complications are common in children hospitalized with COVID-19 and are associated with worse hospital outcomes. Our findings emphasize the importance of COVID-19 immunization in children, especially in high-risk populations, such as those with neurologic co-morbidity.

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Competing Interests

CONFLICT OF INTEREST DISCLOSURES: Dr. Grijalva has received consulting fees from Pfizer, Sanofi and Merck. The remaining authors have no conflicts of interest relevant to this article to disclose.