Factors associated with neurological outcomes in pediatric patients with coronavirus disease 2019 during the Omicron wave: A single-center experience in Taiwan.

BACKGROUND

Beginning in April 2022, a rapid surge in the Omicron variant of severe acute respiratory syndrome coronavirus 2 occurred throughout Taiwan. During this period, infected children might present with neurological complications of varying severity. We aimed to investigate the neurological complications in pediatric patients with coronavirus disease 2019 (COVID-19).

METHODS

This single-center study analyzed the clinical and laboratory data of pediatric patients with COVID-19 who were admitted to a tertiary hospital in Taiwan between May 2022 and October 2023. COVID-19 was diagnosed via rapid antigen and real-time polymerase chain reaction testing.

RESULTS

In total, 160 patients with COVID-19 were enrolled (women: 45.6 %, n = 73; average age, 4.10 ± 4.07 years). Among them, 21.3 % (n = 34) had neurological findings and 78.8 % (n = 126) did not. The most common neurological symptoms were altered awareness (28/34, 82.4 %) and seizures (26/34, 76.5 %), and 12 patients (35.3 %) presented with intracranial hypertension. Neurological manifestations were prevalent in preschool-aged children (1-5 years). Fever was highly prevalent in all patients and was seen in 100 % of those with neurological symptoms. Higher serum procalcitonin levels, absolute neutrophil counts, and lower platelet counts were observed in pediatric patients with COVID-19 and neurological symptoms.

CONCLUSIONS

Recognizing the severe neurological manifestations of COVID-19 is essential for optimal patient management. Elevated serum procalcitonin levels may be an early biomarker of neurological complications. Moreover, early identification of status epilepticus and intracranial hypertension during the disease's acute phase facilitates risk stratification for adverse outcomes. Thus, we provide a novel approach for predicting critical pediatric COVID-19 cases.