Citations 2
Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity
Francoeur, Conall , Robertson, Courtney , Wainwright, Mark S. , Roa, Juan D. , Lovett, Marlina E. , Stulce, Casey , Yacoub, M, Potera, Renee M. , Zivick, Elizabeth, Holloway, Adrian , Nagpal, Ashish, Even, Katelyn , Rodriguez, Isadora Souza , Walker, Tracie C. , Campos-Miño, Santiago , Sewell, Taylor B. , Pryce, Patrice , Silver, Wendy G. , Lin, Jieru E. , Vargas, Wendy , McGuire, Jennifer L. , Tasayco-Muñoz, Jaime , Hong, Sue J. , Doerfler, Matthew , Williams, Cydni N. , Drury, Kurt , Bhagat, Dhristie, Price, Dana C. , Santos, Laura Jurema dos , Kahoud, Robert J., Agner, Shannon C. , Walson, Karen, Rasmussen, Lindsey , Pal, Ria , Janas, Anna , Ferrazzano, Peter , Farias‐Moeller, Raquel , Snooks, Kellie , Chang, Chung‐Chou H. , Iolster, Tomás, Erklauer, Jennifer , Yoong, Michael , Jardine, Michelle, Mohammad, Zoha, Deep, Akash , Kendirli, Tanıl , Lidsky, Karen , Dallefeld, Samantha , Flockton, Helen, Agrawal, Shruti , Siruguppa, K., Gutiérrez-Mata, Alfonso, Bogantes-Ledezma, Sixto , Sevilla-Acosta, Fabricio , Umaña-Calderón, Andrés , Ulate-Campos, Adriana , Talisa, Victor B. , Kanthimathinathan, Hari Krishnan , Schober, Michelle E. , Kahoud, Robert, Wainwright, Mark S , Alcamo, Alicia M. , Yacoub, Mais, Wellnitz, Kari , Carvalho, Werther Brunow de , Schwartz, Stephanie P. , Dervan, Leslie A. , Geneslaw, Andrew S. , Topjian, Alexis , Domínguez-Rojas, Jesús , Muller, William J. , Nelson, Aaron L.A. , Price, Dana, Dapul, Heda , Appavu, Brian , Guilliams, Kristin P. , Barón, Facundo Jorro , Wassmer, Evangeline , Waak, Michaela , Butt, Warwick W. , Yock‐Corrales, Adriana , Fink, Ericka L.
JAMA Network Open | June 10, 2024 | Volume: 7 | Issue: 6 | Pages: e2414122
10.1001/jamanetworkopen.2024.14122
Importance Neurological manifestations during acute SARS-CoV-2–related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective To assess the association of severe neurological manifestations during a SARS-CoV-2–related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2–related condition. Results Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P < .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations ( P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. Conclusions and Relevance The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.
Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children
Nadiger, Meghana , McGarvey, Jeremy , Harthan, Aaron A. , Lombardo, Mónica, Perkins, Nicholas , Sayed, Imran A., Bhalala, Utpal , Raju, Umamaheswara, Miller, Aaron S., Boman, Karen , Arteaga, Grace M. , Bansal, Vikas , Tekin, Aysun , Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Kovačević, Tanja , Markić, Joško , Ardalic, Tatjana Capitovic , Polić, Branka , Ivić, Ivo, Carev, Dominko , Glavinić, Robert, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Kasumalla, Phani Sreeharsha, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja , Chaitanya, Sheetal, Papani, Sridhar, Kamuram, Mahesh, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Petrolwala, Mukur, Ladva, Bharat, Kodate, Akira, Suzuki, Reina , Moriki, Koyo, Hassan-Hanga, Fatimah , Gezawa, Abubakar Shehu, Kabara, Halima M. S., Amole, Taiwo Gboluwaga , Kabir, Halima , Haliru, Dalha Gwarzo, Ibrahim, Abdullahi S., Asghar, Muhammad Sohaib , Syed, Mashaal , Naqvi, Syed Anosh Ali, Yasmin, Farah , Ahmed, Iftekhar , Ishaque, Sidra , Saleem, Ali Faisal , Alarifi, Mohammed I, Macarambon, Jara Mia, Bukhari, Ahmad Abdullah, Albahrani, Hussain A., Aldossary, Kaltham M., Malki, Walid, Kouzoukas, Brenna, Jacobs, Nekaiya, Ganbote, Tejashree, Valentine, Beryl, Sreerama, Pavan, Havalad, Vinod, Barry, Suzanne, Woll, Christopher , Wu, Gregory F. , Carrole, Erin, Burke, Kathryn , Irby, Katherine , Sanders, Ronald C., Hefley, Glenda, Christie, Amy B. , Adiga, Rajani, Campbell, Beth Salvagio , Wilson, Cathleen, Rivers, Patrick , Brinks, Jonathan, Mongoh, Mokenge Ndiva, Gilson, Boris, Danesh, Valerie , Dubrocq, Gueorgui , Davis, Amber, Hammers, Marissa J, McGahey, Ill M, Farris, Amanda C., Priest, Elisa L. , Korsmo, Robyn, Fares, Lorie, Skiles, Kathy, Shor, Susan M, Burns, Kenya, Dowell, Corrie A., Gonzales, Gabriela “ Hope”, Flores, Melody, Newman, Lindsay, Wilk, Debora A., Ettlinger, Jason, Bomar, Jaccallene, Darji, Himani, Arroliga, Alejandro C. , Khandhar, Paras B., Kring, Elizabeth, Anderson, Edwin L., Nagy, Rosemary, Inja, Ravali R., Nawathe, Pooja , Tsing, Jennifer, Carr, Karen, Chaudhary, Anila , Guglielmino, Kathleen, Strom, Larisa, Chiotos, Kathleen, Lee, Giyoung , Burnett, Ryan H., Sydney, Guy I. , Traynor, Danielle M., Ahmed, Farzin, Deonarine, Christopher, Jones, Ashley, Shaikh, Mohammad-Ali , Preston, David A. , Chin, Jeanette, Milligan, Patrick S., Koglin, Joy M., Gibson, Regina, Johnson, Lana, Preston, Felicia, Scott, Crimson, Nungester, Bethany, Menter, Sarah, Wasilewski, A., Kaul, Viren , Austin, Praise, Rogner, Jaimie, Russo, Anthony J. , Ontai, Sidney , Contreras, Brian, Obinwanko, Uzoma, Amamasi, Nneka, Sharafi, Amir, Kaufman, Margit, Lobel, G, Gandhi, Nisha, AbdelAty, Amr M. , Shaji, Elizabeth, Lim, Kiana, Marte, Juan M., Sosa, Dani Ashley, Roth, Prerana , Litwin, Alain H. , Pariyadath, Anand, Moschella, Phillip , Llano, Trayson, Salas, Alan, Daube, Ariel , Korn, Michelle, Rajagopalan, Logi, Santos, Laura Jurema dos , Crandall, Christine , Stojanovski, Sasko, Michienzi, Kelly, Amer, Marwa , Dahhan, Talal, Kseibi, Eiad, Butt, Abid, Khurshid, Syed Moazzum, Rabee, Muath, Abujazar, Mohammed, Alghunaim, Razan, Abualkhair, Maal, AlFirm, Abeer Turki, Oulds, Franscene, Nandavar, Akshay, Wen, Andy , DaCar, Allie, Reilkoff, Ronald A., Eichen, Sarah, Goertzen, Lexie, Rajala, Scott, Feussom, Ghislaine, Domecq, Juan Pablo , Sharma, Mayank , Qamar, Shahraz , Morales, Diana J. Valencia , Khan, Syed Anjum , Jain, Nitesh , Wang, Christine, Kotekal, Dhatri, Sendi, Prithvi , Aulakh, Bhagat , Bandy, Jennifer A., Kreps, Lisa M., Bollinger, Dawn R., Nadiger, Meghana, Schauf, Victoria, Rich, Deana, Anderson, Harry L., Rajkumar, Dixy, Abunayla, Ali, Heiter, Jerrilyn, Zaren, Howard A. , Smith, Stephanie J., Lewis, Grant C., Seames, Lauren, Farlow, Cheryl, Miller, Judy, Broadstreet, Gloria, Terrill, Cindy, Montgomery, Brock, Reyes, Sydney A, Reyes, Summer M, Plattner, Alex, Martinez, Anthony , Allison, Micheal, Mittal, Aniket, Ruíz, Rafael Azuar , Skaanland, Aleta, Amzuta, Ioana, Shah, Amish , Modi, Ritu, Al-Khalisy, Hassan, Masuta, Pardeep , Schafer, Melissa , Wratney, Angela, Jones, Tracy L., Ayers, Shonda C., Harrell, Amy B., Brown, Brent R., Malone, Kassidy, Sinko, Lauren A, Hrarrell, Amy B, Settle, Lisa, Sears, Taylor J., Kuehne, Joshua, Garcia, Melinda, Beebe, Morgan, Herrera, Heather , Belden, Katherine A. , Baram, Michael , Weber, Devin , DePaola, Rosalie, Xia, Yuwei , Carter, Hudson, Tolley, A. E., Ferranti, Mary, House, Scott, Aldana, Isabella, Stulce, Casey , Chong, Grace , Ghavam, Ahmeneh , Baslanti, Tezcan Ozrazgat, Omalay, George, Hashemighouchani, Haleh , Cupka, Julie S , Hubbard, Janice, Nazir, Usman, Rampon, Garrett , Riggle, Jake, Dismang, Nathan, Sullivan, Janice, Morris, Sarah, Nason, Jennifer, Rahman, Rania Abdul, Mulrow, Mary, Gál, Tamás, Mahashabde, Manasi, Vagonis, Alexandra , Uber, Rebecca, Mahmud, Haseeb , Leightle, Stefan, Zhang, Zoe, Vissichelli, Nicole C. , O'Meara, A M Iqbal, Rocawich, Katie, Harris, Lynnette , Cusson, Bruce, Reeves, Brandon, Fanelli, Jessica, Disher, Nataya, Samant, Anusha, DeGroot, Chritian, Youshock, Evan, Ligon, R. Miller, McCartney, Katherine, Garcia, Julio, Iloabachie, Chidi, Flores, Kelsey, VanEenenaam, David P., Sands, Lauren , Sweatt, Nia, Fowler, Jacob , Fram, Madeline, Howard, Easton, Johnson, Kathleen N. , Udoh, Imoh, Nosow, Lillian, Howard, Lucy Winesett, Pham, Quan Duc Minh, Irfanullah, Aman, Ong, Tiffany, Enwezor, Chukwunyelu Henry, Dabagian, Hannah, Bansal, Vikas , Asghar, Muhammad S , Tekin, Aysun , Tripathi, Sandeep , Lombardo, Monica, Gharpure, Varsha , Chiotos, Kathleen , Bjornstad, Erica C. , Dapul, Heda , Montgomery, Vicki , Deo, Neha , Gajic, Ognjen , Kashyap, Rahul , Walkey, Allan J. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Itagaki, Yuki , Galadanci, Hadiza , Kabara, Halima Salisu, Syed, Mashaal, Almazyad, Mohammed , Asfina, Kazi Nur , Cooper, Paul R. , Burke, Kathryn, Mohammed, Mustafa, Ashley, Dennis W. , Mosier, Jarrod , Lutrick, Karen , Dubrocq, Gueorgui , Nagy, Rosemary, Inja, Ravali R., Pedraza, Isabel , Carr, Karen, Gist, Katja M. , Chiotos, Kathleen, Blatz, Allison M. , Cheruku, Sreekanth , Preston, David, Gupta, Sandeep , Abdelaty, Amr, Rennert, Lior , Ramírez, Michelle , Verma, Sourabh , Stojanovski, Sasko D., Johnson, Kristin, Bawazeer, Mohammed Abdullah , Gupta, Manoj , Heneghan, Julia A. , Tang, Ben, Lal, Amos , O’Horo, John C. , Singh, Romil , Koritala, Thoyaja , Tarabichi, Yasir , Perzynski, Adam T. , Wang, Christine, Totapally, Balagangadhar , Nadiger, Meghana, Wall, Chris, Menon, Shina , McGuire, John K. , Anderson, Harry L., Miller, Judy, Lin, John C. H. , Montgomery, Brock, Ruiz, Rafael, Ross, Robert, Gupta, Neha , Brown, Brent , Tolley, Aaron, Tofil, Nancy M. , Mayampurath, Anoop , Bihorac, Azra , Ruppert, Matthew M. , McGonagill, Patrick W. , Galet, Colette , Wang, David , Allan, Lauren , Badheka, Aditya V. , Chegondi, Madhuradhar , Sullivan, Janice, Nason, Jennifer, Akhter, Murtaza , Kashiouris, Markos , Gal, Tamas, Karam, Oliver , Carvalho, Heloisa De, Khanna, Ashish K. , Garcia, Julio, Robinson, Samuel, Enwezor, Chukwunyelu Henry , Mendoza, Rafael
JAMA Pediatrics | October 3, 2022 | Volume: 176 | Issue: 12 | Pages: 1208
10.1001/jamapediatrics.2022.3611
ImportanceThere is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).ObjectiveTo determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.Design, Setting, and ParticipantsThis cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.ExposureAdministration of steroids within 2 days of admission.Main Outcomes and MeasuresLength of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.ResultsA total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.Conclusions and RelevanceSteroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.