Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis

Abstract

Background Knowledge about neurological complications of COVID-19 in children is limited due to the paucity of data in the existing literature. Some systematic reviews are available describing overall clinical features of COVID-19 in children and neurological complications of COVID-19 in adults. But to the best of our knowledge, no systematic review has been performed to determine neurological manifestations of COVID-19. Methods Six different electronic databases (MEDLINE, EMBASE, Web of Science, CENTRAL, medRxiv and bioRxiv) were searched for articles related to COVID-19 and neurological complications in children. Studies/case series reporting neurological manifestations of COVID-19 in patients aged ≤18 years, as well as case reports, as neurological complications appear to be rare. The pooled estimate of various non-specific and specific neurological manifestations was performed using a random effect meta-analysis. Results Twenty-one studies/case series and five case reports (3707 patients) fulfilled the eligibility criteria and were included in this systematic review, from a total of 460 records. Headache, myalgia and fatigue were predominant non-specific neurological manifestations, presenting altogether in 16.7% cases. Total of 42 children (1%) were found to have been reported with definite neurological complications, more in those suffering from a severe illness (encephalopathy—25, seizure—12, meningeal signs—17). Rare neurological complications were intracranial hemorrhage, cranial nerve palsy, Guillain–Barré syndrome and vision problems. All children with acute symptomatic seizures survived suggesting a favorable short-term prognosis. Conclusion Neurological complications are rare in children suffering from COVID-19. Still, these children are at risk of developing seizures and encephalopathy, more in those suffering from severe illness.

Psychological and Behavioral Impact of Lockdown and Quarantine Measures for COVID-19 Pandemic on Children, Adolescents and Caregivers: A Systematic Review and Meta-Analysis

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SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders

“…However, the incidence has since increased as recent studies have reported rates ranging from 9.4% to 37.7% in neurological patients [ 133 , 134 ]. Interestingly, less than 1% of children reported definite neurological complications such as encephalopathy, seizure, or meningeal signs [ 135 ], indicating that encephalopathy is more common in adult than pediatric COVID-19 patients.…”

Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome

“…[36][37][38][39][40] The frequency of neurologic involvement in children hospitalized with acute COVID-19 is unclear with 150 of 4190 patients reported across 9 international case series. [41][42][43][44][45][46] Using the Overcoming COVID-19 US public health surveillance registry of children and adolescents hospitalized with COVID-19-related complications, 36 we aimed to describe the type and severity of neurologic involvement and documented hospital outcomes.…”