Abstract
BackgroundPresently, it is known that, even if less frequently than in adults, children can develop a severe new coronavirus disease 2019 (COVID-19). Children with the SARS-CoV-2 infection can have neurological signs and symptoms of disease more frequently than previously thought, revealing the involvement of the central nervous system, the peripheral nervous system, or both. Aim of this manuscript is to highlight the neurologic complications associated with SARS-CoV-2 among pediatric patients with COVID-19, suggesting when to monitor carefully neurologic development.Main findingsChildren with a severe chronic underlying disease, infants and toddlers and those who develop the so-called multisystem inflammatory syndrome (MIS-C) are those with the highest incidence of neurological complications. Fortunately, in most of the cases, neurological manifestations, mainly represented by headache and anosmia, are mild and transient and do not significantly complicate the COVID-19 course. However, in some cases, very severe clinical problems associated with relevant alterations of neuroimaging, electroencephalography, nerve conduction studies and electromyography findings can develop. Generally, almost all the children with COVID-19 and neurological manifestations till now described have made a complete recovery, although in some cases this has occurred after several weeks of treatment. Moreover, COVID-19 infection during pregnancy has been found associated with an increased risk of obstetric complications that can lead to neurological acute and long-term manifestations in neonates.ConclusionsBased on data showing the neurologic impact of COVID-19 in pediatric age, we suggest monitoring neurological development a few months after healing in pediatric patients who have presented MIS-C, seizures or other neurological manifestations and in children of pregnant women with COVID-19 in order to detect overt and subtle deficits.
Highlights
It is known that, even if less frequently than in adults, children can develop a severe new coronavirus disease 2019 (COVID-19)
Based on data showing the neurologic impact of COVID-19 in pediatric age, we suggest monitoring neurological development a few months after healing in pediatric patients who have presented multisystem inflammatory syndrome in children (MIS-C), seizures or other neurological manifestations and in children of pregnant women with COVID-19 in order to detect overt and subtle deficits
In the first months of new coronavirus disease 2019 (COVID-19) pandemic, results of several epidemiological studies had led to the conclusion that, compared to adults, children were less susceptible to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and that, when infected, they remained more frequently asymptomatic or developed a mild disease [1,2,3]
Summary
Based on data on neurological involvement in SARSCoV-2 positive pediatric patients and on neonatal complications observed in children of pregnant women with COVID-19, we suggest monitoring neurological development a few months after healing in pediatric patients who have presented MIS-C, seizures or other neurological manifestations and in children of pregnant women with COVID-19 in order to detect overt and subtle deficits. As the focus of healthcare shifts from the ‘crisis’, diligence, attention and multicentric collaborations will be required to ensure ongoing international collaboration in maintaining registries to monitor for possible later behavioral complications of COVID-19 in children who have being infected, even without clinical evidence of neurological signs and symptoms. It will be important to evaluate subtle neurobehavioral impairment which can be evident only many years later because of the known SARS-CoV- 2 localization in certain cerebral areas linked to neurobehavioral development skills (i.e., orbito-frontal and pre-frontal areas). During the pandemic, the chronicrelapsing neurological pathology (i.e., epilepsy) was neglected by many families due to the fear of being infected by SARS-CoV-2 with access to the Emergency Room and being subjected to diagnostic delays related to COVID-19 before hospitalization (which often meant strict isolation and estrangement from the family).
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