Serum neurofilament light chain (sNfL) values in a large cross-sectional population of children with asymptomatic to moderate COVID-19

J Neurol. 2021 Nov;268(11):3969-3974. doi: 10.1007/s00415-021-10554-1. Epub 2021 Apr 23.


Background: Serum neurofilament light chain (sNfL) is an established biomarker of neuro-axonal damage in multiple neurological disorders. Raised sNfL levels have been reported in adults infected with pandemic coronavirus disease 2019 (COVID-19). Levels in children infected with COVID-19 have not as yet been reported.

Objective: To evaluate whether sNfL is elevated in children contracting COVID-19.

Methods: Between May 22 and July 22, 2020, a network of outpatient pediatricians in Bavaria, Germany, the Coronavirus antibody screening in children from Bavaria study network (CoKiBa), recruited healthy children into a cross-sectional study from two sources: an ongoing prevention program for 1-14 years, and referrals of 1-17 years consulting a pediatrician for possible infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We determined sNfL levels by single molecule array immunoassay and SARS-CoV-2 antibody status by two independent quantitative methods.

Results: Of the 2652 included children, 148 (5.6%) were SARS-CoV-2 antibody positive with asymptomatic to moderate COVID-19 infection. Neurological symptoms-headache, dizziness, muscle aches, or loss of smell and taste-were present in 47/148 cases (31.8%). Mean sNfL levels were 5.5 pg/ml (SD 2.9) in the total cohort, 5.1 (SD 2.1) pg/ml in the children with SARS-CoV-2 antibodies, and 5.5 (SD 3.0) pg/ml in those without. Multivariate regression analysis revealed age-but neither antibody status, antibody levels, nor clinical severity-as an independent predictor of sNfL. Follow-up of children with pediatric multisystem inflammatory syndrome (n = 14) showed no association with sNfL.

Conclusions: In this population study, children with asymptomatic to moderate COVID-19 showed no neurochemical evidence of neuronal damage.

Keywords: Brain; COVID-19; Children; Neurofilament; Neurology.

MeSH terms

  • Adult
  • COVID-19*
  • Child
  • Cross-Sectional Studies
  • Humans
  • Intermediate Filaments*
  • Neurofilament Proteins
  • SARS-CoV-2
  • Systemic Inflammatory Response Syndrome


  • Neurofilament Proteins

Supplementary concepts

  • pediatric multisystem inflammatory disease, COVID-19 related