Headache, change in mental status linked to COVID-19 hospitalization in children, study finds

New research out of the United States has found 44 per cent of children in hospital with COVID-19 developed a neurological symptom, the most common being headaches and altered mental status.

The study, led by a pediatrician scientist at the University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine, found those children were also more likely to require intensive care than those who didn't experience the same symptoms.

The research looked at how SARS-CoV-2, the virus that causes COVID-19, can affect young patients namely through acute disease, where symptomatic illness comes soon after infection, and an inflammatory condition called MIS-C or multisystem inflammatory syndrome in children, which can occur weeks after clearing the virus.

The preliminary findings were published in the journal Pediatric Neurology and are the first to come from the pediatric arm of the Global Consortium Study of Neurologic Dysfunction in COVID-19, or GCS-NeuroCOVID, an international group working to understand how COVID-19 affects the brain and nervous system.

"Thankfully, mortality rates in children are low for both acute SARS-CoV-2 and MIS-C," lead author Dr. Ericka Fink, a pediatric intensivist and associate professor of critical care medicine and pediatrics, said in a news release.

"But this study shows that the frequency of neurological manifestations is high — and it may actually be higher than what we found because these symptoms are not always documented in the medical record or assessable. For example, we can't know if a baby is having a headache."

The research paper doesn't point to any specific variant as a cause. And despite the timeline, the researchers note that the impact of Delta is largely absent from the study.

THE CHILDREN

The study involved children under the age of 18 who were hospitalized with a positive test or clinical diagnosis of a COVID-related condition between January 2020 and April 2021.

With the help of 30 pediatric critical care centres around the world, mostly in North America, the researchers looked at the symptoms of 1,493 children.

Their median age was eight and 47 per cent were female. Forty-two per cent were white, 28 per cent Black, and 37 per cent Latino or Hispanic.

Most patients were admitted between July and December 2020 and 58 per cent had a pre-existing condition. Of those, the most common were respiratory and neurological at 20 per cent each.

THE SYMPTOMS

Of all the children in the study, 44 per cent had at least one neurological sign or symptom.

Headache and acute encephalopathy, or altered mental status, were most common among children overall at 21 per cent and 16 per cent respectively.

Other less common symptoms include seizures (eight per cent), anosmia or loss of smell (four per cent), ageusia or loss of taste (3.6 per cent), meningitis or encephalitis (1.3 per cent) and stroke (0.9 per cent).

In total, 86 per cent of kids were diagnosed with acute disease, while 14 per cent were diagnosed with MIS-C.

Ultimately, neurological conditions were more common in children with MIS-C than those with acute disease. Children with MIS-C also were more likely to have two or more neurological symptoms.

Children with SARS-CoV-2 related illness and pre-existing neurological conditions were almost three-and-a-half times more likely to develop neurologic symptoms than those without pre-existing neurological conditions.

Kids with MIS-C also were more than two times more likely to have a neurological symptom than those with acute disease — the researchers say while more research is needed, this may be due in part to hyperinflammation.

Metabolic diseases such as Type 1 diabetes also were associated with neurological conditions in children who presented with acute COVID-19.

The most common non-neurological symptoms reported were fever (64 per cent), cough (36 per cent) and anorexia (29 per cent).

FOLLOW-UP WORK

The researchers note that neurological conditions were only recorded if they were in the medical record.

As well, symptoms such as encephalopathy may present differently depending on age or developmental stage, meaning they may be over or underreported in the results.

Some patients in the acute disease group were admitted for other reasons and found to be positive for COVID-19 due to testing policies. Asymptomatic children with neurological conditions also may not have been tested for SARS-CoV-2.

The researchers add they were unable to determine in children who already had an acute neurological disease, whether the neurological symptoms presented were due to that disease or COVID-19.

"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 said.

"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."