Acute necrotizing encephalopathy in children with COVID-19: a retrospective study of 12 cases

Frontiers in Neurology

Neurology

Chunhua Dong¹  Qin Jiang¹  Fan Zhang¹  Xia Lin¹  Weifeng Lu¹  Jian Zhang¹  Kang Ma¹  Xiang Ma²  Xiaoying Li³  Ying Wang⁴  Mohnad Abdalla⁴  Xia Liu⁵ 

[1] PICU, Children’s Hospital Affiliated to Shandong University, Jinan, China;PICU, Jinan Children’s Hospital, Jinan, China;Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China;Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China;Department of Respiratory Disease, Children’s Hospital Affiliated to Shandong University, Jinan, China;Department of Respiratory Disease, Jinan Children’s Hospital, Jinan, China;Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China;NICU, Children’s Hospital Affiliated to Shandong University, Jinan, China;NICU, Jinan Children’s Hospital, Jinan, China;Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China;Research Institute of Pediatrics, Children’s Hospital Affiliated to Shandong University, Jinan, China;Research Institute of Pediatrics, Jinan Children’s Hospital, Jinan, China;Shandong Provincial Clinical Research Center for Children’s Health and Disease, Jinan, China;Respiratory Interventional Department, Children’s Hospital Affiliated to Shandong University, Jinan, China;Respiratory Interventional Department, Jinan Children’s Hospital, Jinan, China;

关键词: acute necrotizing encephalopathy;    COVID-19;    children;    SARS-CoV-2;    clinical features;   

DOI  :  10.3389/fneur.2023.1184864

 received in 2023-03-12, accepted in 2023-07-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundAcute necrotizing encephalopathy (ANE) is a devastating neurologic condition that can arise following a variety of systemic infections, including influenza and SARS-Cov-2. The clinical features of COVID-19-associated ANE in pediatric patients based on multi-case data have not yet been described and remain obscure. We reviewed 12 pediatric patients to better describe the clinical features of ANE with COVID-19.MethodsWe retrospectively collected and summarized the clinical features of ANE in children with COVID-19. Clinical data were collected from 12 children, including their general status, clinical symptoms, laboratory tests, and neuroimaging features.ResultsAmong the subjects, 10 were over 5 years old and they accounted for 83.33%. A large percentage of those affected (66.67%) were females. The major manifestations included fever (100%), impaired consciousness (100%), and convulsions (75%). We determined that increased interleukin (IL)-6 and IL-10, and tumor necrosis factor-α and interferon gamma were not predictive of severe ANE and mortality in children with COVID-19 in this study. All children presented with abnormal neuroimaging with multiple and symmetrically distributed lesions, involving the thalamus, basal ganglia, cerebellum, and brain hemispheres. Eight of the 12 children died, resulting in a mortality rate of 66.67%, and 75% of these children were females. Importantly, we found the timely administration of mannitol after an acute onset of convulsions or disturbance of consciousness may be decreased the high mortality induced by ANE children with COVID-19.ConclusionCOVID-19 associated with ANE in children is characterized by sudden symptom onset, rapid disease progression, and high mortality.

【 授权许可】

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Copyright © 2023 Lin, Wang, Li, Abdalla, Zhang, Dong, Lu, Liu, Zhang, Ma, Ma and Jiang.