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  • Clinical Research Article
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Children with severe neurological symptoms associated with SARS-CoV-2 infection during Omicron pandemic in China

Pediatric Research volume 95, pages 1088–1094 (2024)Cite this article

Abstract

Background

To analyze the clinical characteristics and outcomes of children with severe neurological symptoms associated with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the Omicron pandemic in China.

Methods

This study used a questionnaire to obtain data from pediatric intensive care unit (PICU) centers in seven tertiary hospitals in Northeast China from December 1, 2022, to January 31, 2023.

Results

A total of 255 patients were confirmed to have SARS-CoV-2 infection, and 45 patients (17.65 %) were included in this study. Of these, seven (15.6%) patients died, and the median time from admission to death was 35 h (IQR, 14–120 h). Twenty (52.6%) survivors experienced neurological sequelae. Patients with platelet counts lower than 100 × 109/L had a higher incidence of complications such as multiple organ dysfunction, mechanical ventilation rate, and mortality. Cranial magnetic resonance imaging (MRI) always reveals cerebral tissue edema, with some severe lesions forming a softening site.

Conclusion

Children infected with SARS-CoV-2 often exhibit severe neurological symptoms, and in some cases, they may rapidly develop malignant cerebral edema or herniation, leading to a fatal outcome. An early decrease in platelet count may associated with an unfavorable prognosis.

Impact

  • Since early December 2022, China has gradually adjusted its prevention and control policy of SARS-CoV-2; Omicron outbreaks have occurred in some areas for a relatively short period. Due to the differences in ethnicity, endemic strains and vaccination status, there was a little difference from what has been reported about children with SARS-CoV-2 infection with severe neurological symptoms in abroad. This is the first multicenter clinical study in children with nervous system involvement after acute SARS-CoV-2 infection in China, and helpful for pediatricians to have a more comprehensive understanding of the clinical symptoms and prognosis of such disease.

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Fig. 1: Patient screening process.
Fig. 2: Neurological imaging of the patients.

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Data availability

All authors agreed that the data and materials mentioned in this article are true and availability. The datasets used and/or analyzed during the current study available from the appendix.

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Funding

This work was supported by the Major science and technology Project of Liaoning Province (No. 2020JH1/10300001 to Chun-Feng Liu); the Natural Science Foundation of Liaoning Province (No. 2023-MS-191 to T.Z.), and 345 Talent Project of Shengjing Hospital of China Medical University (C.-F.L. and T.Z.).

Author information

Authors and Affiliations

  1. Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China

    Tao Zhang & Chun-Feng Liu

  2. Department of Pediatric Intensive Care Unit, Dalian Women and Children’s Medical Group, Dalian, China

    Qiao-Feng Zhang & Hong-Mei Yang

  3. Department of Pediatric Intensive Care Unit, Shenyang Children’s Hospital, Shenyang, China

    Pin Liu & Peng Sun

  4. Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Changchun, China

    Yu-Mei Li & Zhen Zhang

  5. Changchun Children’s Hospital, Changchun, China

    Yan-Zhi Huang

  6. Department of Critical Medicine, Jiangnan Hospital of the Sixth Affiliated Hospital of Harbin Medical University (Harbin Children’s Hospital), Harbin, China

    Xin-Yan Yu

  7. Department of Intensive Care Unit, Inner Mongolia Medical University Affiliated Hospital, Hohhot, China

    Qi-Qi-Ge Chao-Lu-Men & Qin Su

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  1. Tao Zhang
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Contributions

T.Z., and C.F.L, conceived and designed the study. T.Z., Q.F.Z., H.M.Y., P.L., P.S., Y.M.L., Z.Z., Y.Z.H., X.Y.Y., Q.Q.G.C.L.M. and Q.S., collected all the data. T.Z. analyzed the data. All authors participated in drafting or revising of the manuscript, and approved the final manuscript.

Corresponding author

Correspondence to Chun-Feng Liu.

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Competing interests

The authors declare no competing interests.

Ethical approval and consent to participate

This study was approved by the Ethics Committee of Shengjing Hospital of China Medical University (2023PS434K), and the patient consent was not required in this study.

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Zhang, T., Zhang, QF., Yang, HM. et al. Children with severe neurological symptoms associated with SARS-CoV-2 infection during Omicron pandemic in China. Pediatr Res 95, 1088–1094 (2024). https://doi.org/10.1038/s41390-023-02904-8

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