Acute Neurological Presentation in Children With SARS-CoV-2 Infection

Antonella Riva; Gianluca Piccolo; Federica Balletti; Maria Binelli; Noemi Brolatti; Alberto Verrotti; Elisabetta Amadori; Alberto Spalice; Thea Giacomini; Maria Margherita Mancardi; Paola Iannetti; Maria Stella Vari; Emanuela Piccotti; Pasquale Striano; Giacomo Brisca

doi:10.3389/fped.2022.909849

Acute Neurological Presentation in Children With SARS-CoV-2 Infection

Front Pediatr. 2022 Jul 11:10:909849. doi: 10.3389/fped.2022.909849. eCollection 2022.

Authors

Antonella Riva^{1

2}, Gianluca Piccolo^{1

2}, Federica Balletti¹, Maria Binelli¹, Noemi Brolatti^{1

2}, Alberto Verrotti³, Elisabetta Amadori^{1

2}, Alberto Spalice⁴, Thea Giacomini^{1

5}, Maria Margherita Mancardi^{1

5}, Paola Iannetti⁶, Maria Stella Vari², Emanuela Piccotti⁷, Pasquale Striano^{1

2}, Giacomo Brisca⁸

Affiliations

¹ Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.
² Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
³ Department of Pediatrics, University of Perugia, Perugia, Italy.
⁴ Department of Pediatrics, Child Neurology Division, Sapienza University Rome, Rome, Italy.
⁵ Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁶ Department of Paediatrics, University of Rome, Rome, Italy.
⁷ Pediatric Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
⁸ Subintensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.

Abstract

Background: In the pediatric population, the knowledge of the acute presentation of SARS-CoV-2 infection is mainly limited to small series and case reports, particularly when dealing with neurological symptoms. We describe a large cohort of children with acute SARS-CoV-2 infection, focusing on the neurological manifestations and investigating correlations between disease severity and population demographics.

Methods: Patients aged 0-18 years with a positive molecular swab were recruited between April 2020 and March 2021 from a tertiary Italian pediatric centre. Clinical data, imaging, and laboratory test results were retrieved from our local dataset and statistically analyzed.

Results: A total of 237 patients with a median age of 3.2 years were eligible; thirty-two (13.5%) presented with neurological symptoms, including headache (65.6%), altered awareness (18.8%), ageusia/anosmia (12.5%), seizures (6.3%), and vertigo (6.3%), combined in 7 (21.9%) cases. Respiratory (59.5%) and gastrointestinal (25.3%) symptoms were the most common among the 205 (86.5%) patients without neurological involvement. Neurological symptoms did not significantly influence the severity of the triage access codes. Moreover, pre-existing medical conditions were not higher in the group with neurological manifestations. Overall, fifty-nine patients (25%, 14/59 with neurological symptoms) required treatment, being antibiotics, systemic steroids, and heparin those most prescribed.

Conclusion: Our study supports the overall benign course of the SARS-CoV-2 infection in children. Neurological manifestations, except for headache, remain a rare presenting symptom, and disease severity seems unrelated to pre-existing medical conditions.

Keywords: COVID-19; SARS-CoV-2; acute; children; neurological symptoms.