Severe Neurological Manifestation Associated With Coronavirus Disease 2019 in Children During the Omicron Variant-Predominant Period

Minhye Kim; Younghun Choi; Soo Yeon Kim; Anna Cho; Hunmin Kim; Jong Hee Chae; Ki Joong Kim; Dasom Park; Young Se Kwon; Min-Jee Kim; Mi-Sun Yum; Ju Hyun Kong; Yoon Jin Lee; Byung Chan Lim

doi:10.1016/j.pediatrneurol.2024.04.004

Severe Neurological Manifestation Associated With Coronavirus Disease 2019 in Children During the Omicron Variant-Predominant Period

Pediatr Neurol. 2024 Apr 7:156:17-25. doi: 10.1016/j.pediatrneurol.2024.04.004. Online ahead of print.

Authors

Minhye Kim¹, Younghun Choi², Soo Yeon Kim¹, Anna Cho³, Hunmin Kim³, Jong Hee Chae¹, Ki Joong Kim¹, Dasom Park⁴, Young Se Kwon⁴, Min-Jee Kim⁵, Mi-Sun Yum⁵, Ju Hyun Kong⁶, Yoon Jin Lee⁶, Byung Chan Lim⁷

Affiliations

¹ Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea.
² Department of Radiology, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea.
³ Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Seoul National University College of Medicine, Seoul, Korea.
⁴ Department of Pediatrics, Inha University Hospital, Inha University, College of Medicine, Incheon, Korea.
⁵ Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
⁶ Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea.
⁷ Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea. Electronic address: prabbit7@snu.ac.kr.

PMID: 38692086
DOI: 10.1016/j.pediatrneurol.2024.04.004

Abstract

Background: The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be more infectious and less severe than the other variants. Despite the increasing number of symptomatic patients, severe neurological complications in children with the Omicron variant have been reported rarely, unlike with wild-type or Delta variants. This study aimed to investigate severe neurological complications in children with Omicron variant infection.

Methods: We conducted a retrospective study of 17 pediatric patients with severe neurological manifestations associated with coronavirus disease 2019 in Korea during the Omicron variant prevalence, from January 1 to April 30, 2022.

Results: Among the 17 patients, 11 had pre-existing neurological disabilities and nine met the criteria for multisystem inflammatory syndrome in children (MIS-C). Four of the five vaccine-eligible patients (12 years and older) were unvaccinated. Severe neurological manifestations included acute necrotizing encephalopathy, acute fulminant cerebral edema, acute disseminated encephalomyelitis, basal ganglia encephalitis, unclassified severe encephalopathy/encephalitis, and refractory status dystonicus. Patients with MIS-C and underlying neurological disabilities had longer median hospital and intensive care unit stays compared with those without these conditions. Five patients survived with new neurological deficits at the one-year follow-up, and three died, all of whom had underlying neurological disabilities.

Conclusions: This study shows that severe neurological complications in pediatric patients with the Omicron variant of SARS-CoV-2 occur infrequently but may lead to significant morbidity and mortality, especially among those with pre-existing neurological disabilities and unvaccinated individuals. Continued efforts are necessary to prevent and manage such complications in these vulnerable populations.

Keywords: COVID-19; Children; Neurology; Neuroradiologic manifestations; Omicron; SARS-CoV-2.