Analysis of Neurological Clinical Manifestations and Diagnostic Workups in Pediatric COVID-19: A Systematic Review

Abstract

Background While numerous studies report neurological manifestations of COVID-19, there are fewer reviews in the pediatric population, focusing solely on the manifestations.Aim This systematic review aims to describe the clinical manifestations and laboratory findings of pediatric patients with neurological manifestations of COVID-19.Methods We searched Pubmed, Science Direct, Medline, Scielo, Medrxiv, Research Square, SSRN, and Biorxiv with the appropriate keywords. Inclusion criteria include new-onset neurological manifestations with a time correlation to the confirmed COVID-19 with a further diagnostic work-up. We use The Joanna Briggs Institute's (JBI) essential evaluation checklist and Newcastle Ottawa Quality Assessment Scale (NOS) to evaluate the quality of the studies. The protocol for this systematic review has been registered in The international Prospective Register of Systematic Review (PROSPERO) database (CRD42021228671).Results 31 articles were ultimately chosen with 42 patients (26 male) included in this systematic review. The neurological diagnosis was mostly of the CNS classification (38/42) with a predomination of brain disorders (22/38). Most patients had lymphopenia, elevated C-reactive protein, procalcitonin, ferritin, creatinine kinase, blood urea nitrogen, D-dimer, and erythrocyte sedimentation rate. In the CNS group, CSF monocytes (55%; 11–80%), CSF polymorphonuclear (PMN) cells (15%; 0–96%), CSF red blood cells (282 cells/mm3; 2-4000 cells/mm3), and opening pressure (34.5 cm/H2O; 25–100 cm/H2O) were elevated.Conclusions Our systematic review found that neurological manifestations in COVID-19 occurred more often in males, with a majority being CNS disorders. A majority had a favorable outcome. More studies are needed in order to elucidate the viral mechanisms of SARS-CoV-2 in CSF.