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Background

Neurological complications associated with COVID-19 are reported in adults. We undertook an observational study to examine the neurological manifestations of COVID-19 infection in children across the United Kingdom

Methods

The CoroNerve Study Group (www.coronerve.com) developed an online network of secure rapid-response notification portals via major UK neuroscience & psychiatry bodies. Cases were included if they met the case definitions and reported prospectively onto a standardised online case report form.

Results

Fifty two cases were included: 25 (48%) had PIMS-TS; the remaining 27 (52%) were termed the COVID neurology group. The median age was 9 years (range 1-17); the majority were non-caucasian [36 (69%)]. In the COVID neurology group, 14 had encephalopathy: 6 encephalitis (4 ADEM, 2 encephalitis), 7 status epilepticus and 1 encephalopathy; 5 had Guillain-Barré syndrome, three demyelinating disorders; two acute psychosis, two chorea, one TIA. The PIMS-TS group had overlapping neurological manifestations including 21 (84%) with encephalopathy [two strokes] and nine (36%) with peripheral nervous system involvement (table 1).

Twenty-eight had CSF analysis; 8 (29%) had a pleocytosis (median 20 white cell count/mm, range 6-6075). All had negative molecular screening (including 3 tested for SARS-CoV-2). Central nervous system imaging was abnormal in 24/46 (52%). Patients in the PIMS-TS group were more likely to be admitted to ICU [20/25 (80%) vs 8/27 (30%)] and require immunomodulation [22/25 (88%) vs 6/27 (22%)]. Thirty-five children (67%) had apparent full recovery (Modified Rankin Score 0-1) and one child (2%) died (PIMS-TS stroke).

Conclusions

Neurological manifestations associated with COVID-19 infection in children are uncommon but include a wide spectrum of phenotypes (often overlapping in PIMS-TS). Stroke and psychiatric presentations are less common than in adults and short-term outcome appears good.

Clinical Trial Registration

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Background

There is increasing evidence that adult patients diagnosed with acute COVID-19 suffer from persisting symptoms (defined as Long Covid). To date, there is no data about Long Covid in children. We assessed persistent symptoms in pediatric patients with a previous diagnosis of COVID-19.

Methods

We did an ambidirectional cohort study of children diagnosed with microbiologically-confirmed COVID-19 in our Institution between March and November, 2020. All caregiver’s were interviewed about their child’s health with a questionnaire developed by an international panel of experts of the Long Covid ISARIC study group, for evaluation of persisting symptoms. Children aged 12 years or more were actively involved in the interview with their caregivers. Participants were categorised into groups according to severity of COVID-19 (symptomatic/asymptomatic and hospitalized/not-hospitalized) and length of follow-up (<60, 60-120, > 120 days).

Results

129 children were enrolled (mean age 11 years, 48.1% female), assessed a mean of 162.5 (SD, 113.7) days after COVID-19 diagnosis. 41.8% completely recovered, 35.7% had 1 or 2 symptoms and 22.5% had 3 or more. 52.7% had at least one symptom 120 days or more after diagnosis.

Fatigue, nasal congestion, muscle and joint pain, respiratory symptoms, palpitations, sleep/concentration problems, weight loss and skin rashes were the most frequently reported symptoms. Symptoms were described also in asymptomatics. 42.6% children assessed > 120 days from diagnosis were still distressed by these symptoms.

Conclusions

This study provides the first providing evidence of Long Covid in children, half of them reporting at least one symptom more than 120 days after COVID-19, 42.6% of them being impaired by these symptoms during daily activities.

Background

Multisystem Inflammatory Syndrome in Children (MIS-C) is the most severe pediatric disease associated with SARS-CoV-2 infection, potentially life threatening, but optimal therapeutic strategy remains unknown. We aimed to compare the efficacy of intravenous immunoglobulins (IVIG) plus methylprednisolone versus IVIG alone as first-line therapy.

Methods

We conducted a quasi-randomized propensity score analysis, using a 1:2 matching algorithm, based on a national surveillance system. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the WHO definition were included. The primary outcome was the persistence of fever 2 days after the introduction of first-line therapy or recrudescence of fever within 7 days after the first-line therapy, which defined treatment failure. Secondary outcomes included a requirement for second-line therapy, hemodynamic support, and acute left ventricular dysfunction after first-line therapy.

Results

Among 181 children with suspected MIS-C, 111 fulfilled WHO definition. 37/72 (51%) children in the IVIG alone group and 3/34 (9%) in the IVIG+methylprednisolone group showed treatment failure. In the propensity-score analysis, treatment failure was significantly reduced in the IVIG+methylprednisolone versus IVIG alone group (OR 0.25, 95% CI 0.09 to 0.70], p=0.009). Second-line therapy, hemodynamic support and acute left-ventricular dysfunction occurring after first-line therapy were also significantly reduced in the IVIG+methylprednisolone group (OR 0.19, 95%CI [0.06; 0.61]; OR 0.21, 95%CI [0.06; 0.76]; and OR 0.20, 95%CI [0.06; 0.66], respectively).

Conclusions

IVIG plus methylprednisolone was superior to IVIG alone as first-line therapy in MIS-C.