Neurological Complications In Children Research Articles

Neurological complications in children and adolescent with Inflammatory Bowel diseases

Neurological complications in children and adolescent with Inflammatory Bowel diseases

Severe Neurological Manifestation Associated With Coronavirus Disease 2019 in Children During the Omicron Variant-Predominant Period

BackgroundThe Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be more infectious and less severe than the other variants. Despite the increasing number of symptomatic patients, severe neurological complications in children with the Omicron variant have been reported rarely, unlike with wild-type or Delta variants. This study aimed to investigate severe neurological complications in children with Omicron variant infection. MethodsWe conducted a retrospective study of 17 pediatric patients with severe neurological manifestations associated with coronavirus disease 2019 in Korea during the Omicron variant prevalence, from January 1 to April 30, 2022. ResultsAmong the 17 patients, 11 had pre-existing neurological disabilities and nine met the criteria for multisystem inflammatory syndrome in children (MIS-C). Four of the five vaccine-eligible patients (12 years and older) were unvaccinated. Severe neurological manifestations included acute necrotizing encephalopathy, acute fulminant cerebral edema, acute disseminated encephalomyelitis, basal ganglia encephalitis, unclassified severe encephalopathy/encephalitis, and refractory status dystonicus. Patients with MIS-C and underlying neurological disabilities had longer median hospital and intensive care unit stays compared with those without these conditions. Five patients survived with new neurological deficits at the one-year follow-up, and three died, all of whom had underlying neurological disabilities. ConclusionsThis study shows that severe neurological complications in pediatric patients with the Omicron variant of SARS-CoV-2 occur infrequently but may lead to significant morbidity and mortality, especially among those with pre-existing neurological disabilities and unvaccinated individuals. Continued efforts are necessary to prevent and manage such complications in these vulnerable populations.

THE IMPORTANCE OF VACCINATION AGAINST MEASLES, RUBELLA AND MUMPS IN PREVENTING NEUROLOGICAL COMPLICATIONS IN CHILDREN

Childhood vaccination against measles, rubella and mumps has been a crucial measure in preventing neurological complications. These potentially debilitating and, in extreme cases, fatal diseases have significant impacts on public health. Among the most serious complications, the neurological consequences that can affect the cognitive and motor development of children stand out. With the introduction of large-scale immunization programs, there has been a substantial reduction in the incidence of these diseases, providing not only individual protection, but also contributing to the eradication of outbreaks in communities. Objective: To analyze scientific literature from the last 10 years to comprehensively understand how vaccination against measles, rubella and mumps impacts the prevention of neurological complications in children. Methodology: The review was conducted following the PRISMA checklist guidelines. We used the PubMed, Scielo and Web of Science databases to search for relevant articles. The descriptors were "vaccination", "measles", "rubella", "mumps" and "neurological complications". Inclusion criteria covered studies published in the last 10 years, focused on children and addressing post-vaccination neurological effects. Exclusion criteria included studies with unrepresentative samples and lack of detailed information on neurological outcomes. Results: The analysis revealed a significant reduction in neurological complications associated with measles, rubella and mumps after the implementation of vaccination programs. Studies have highlighted the effectiveness of vaccines in preventing encephalitis and other neurological sequelae. Additionally, a decline in hospitalizations related to these complications was observed. Conclusion: This systematic review reinforces the importance of vaccination in preventing neurological complications in children resulting from measles, rubella and mumps. Analysis of the last 10 years reinforces the effectiveness of vaccines, highlighting not only the individual benefits, but also the public health gains in preventing outbreaks and reducing the serious consequences associated with these diseases.

Surgical revascularization as a procedure to prevent neurological complications in children with moyamoya syndrome associated with neurofibromatosis I: a single institution case series.

The optimal timing and surgical approach for surgical revascularization in patients with moyamoya syndrome (MMS) associated with neurofibromatosis type I (NF1) remain so far elusive. We aimed to compare the long-term clinical, radiological, and cognitive effects of different revascularization procedures in a pediatric cohort of NF1-associated MMS. We reviewed the clinical, radiological, and surgical data of 26 patients with NF1-associated MMS diagnosed at our institution between 2012 and 2022, at the clinical onset and last follow-up. Indirect bypasses were performed in 12/26 patients (57.1%), while combined direct and indirect procedures in 9/26 subjects (42.9%); 5 patients did not undergo surgery. Through logistic regression analysis, pathological Wechsler Intelligence Scale for Children (WISC) at onset was found to be associated with symptom improvement at 1-year follow up (p = 0.006). No significant differences were found in long-term neurocognitive outcome and stroke rate in patients receiving combined or indirect bypass (p > 0.05). Currently, whether combined or indirect bypass should be considered the treatment of choice in pediatric patients with NF1-associated MMS remains unclear, as well as the optimal time approach. In our series, no significant differences were found in long-term neurocognitive outcome and stroke rate between patients treated with either of these two approaches. Clinical evidence supports the crucial role of early diagnosis and surgical revascularization in subjects with MMS-associated NF1, even in case of mildly symptomatic vasculopathy. This allows to achieve a good long-term outcome with improved intellectual function and prevention of stroke and seizure in these patients.

NEUROLOGICAL COMPLICATIONS FOLLOWING PEDIATRIC CONGENITAL CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives: The study was designed to ascertain the incidence of neurological complications in children following cardiac surgery for congenital heart defects (CHD). Methods: An extensive search was conducted using Medical Subject Headings in the Cochrane Controlled Trials databases, PubMed, and Embase in July 2023. Data extraction was done using a customized data extraction sheet, adhering to Cochrane’s standard methodological procedures. As the heterogeneity was high among the included studies, random-effect models were employed during the meta-analysis. Results: Seventeen articles were included in our analysis, encompassing a total sample size of 23,930 pediatric patients who underwent congenital cardiac surgeries. The calculated incidence of neurological complications following these procedures was found to be 0.21 (95% confidence interval: 0.14–0.28). A random-effects model employing the DerSimonian-Laird estimator was utilized for the meta-analysis. The assessment of heterogeneity revealed Tau of 0.134, an I2 value of 99.63%, and an H2 value of 267.078, indicating heterogeneity (p<0.001). Conclusion: The study highlights the substantial incidence of neurological complications following congenital cardiac surgery, with infants <1 year old being at a higher risk.

Clinical characteristics of SARS-CoV-2-associated encephalopathy in children: Nationwide epidemiological study

ObjectiveSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sometimes triggers acute encephalopathy as a serious neurological complication in children. We previously reported the clinico-radiological findings of SARS-CoV-2-associated encephalopathy. The advent of the SARS-CoV-2 omicron variant led to a marked increase in pediatric patients with coronavirus disease 2019 (COVID-19); however, epidemiological changes with acute encephalopathy according to the emergence of SARS-CoV-2 have not yet been documented. Therefore, the present study investigated epidemiological differences in SARS-CoV-2-associated encephalopathy during the BA.1/BA.2 and BA.5 predominant periods and also between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy. MethodsWe conducted a nationwide survey of SARS-CoV-2-associated encephalopathy in Japanese children between June and November 2022. We compared the present results during the BA.5 predominant period and previous findings during the BA.1/BA.2 predominant period. We also compared the clinico-radiological syndromes of encephalopathy between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy. ResultsAlthough many patients with SARS-CoV-2-associated encephalopathy in the BA.5 predominant period had seizures as their initial symptoms, no significant differences were observed in the clinical features. Patients with SARS-CoV-2-associated encephalopathy had worse outcomes than those with non-SARS-CoV-2-associated encephalopathy (p-value = 0.003). Among 103 patients with SARS-CoV-2-associated encephalopathy, 14 (13.6%) had severe types of acute encephalopathy, namely, encephalopathy with acute fulminant cerebral edema (AFCE) and hemorrhagic shock and encephalopathy syndrome (HSES). Also, 28 (27.2%) patients with SARS-CoV-2-associated encephalopathy had poor outcome: severe neurological sequelae or death. Ninety-five patients (92.2%) were not vaccinated against SARS-CoV-2. ConclusionsIn SARS-CoV-2-associated encephalopathy, high percentages of AFCE and HSES can result in poor outcomes.

Neurological Complications in Children With Cancer: Experience From a Single Center in Türkiye

Neurological Complications in Children With Cancer: Experience From a Single Center in Türkiye

Neurologic Complications in Patients With Lymphoreticular Malignancy: A Descriptive Cohort Study.

The objectives of this study were to study the spectrum of neurologic complications in children with lymphoreticular malignancy (acute lymphoblastic leukemia, Hodgkin, and non-Hodgkin lymphoma) at diagnosis and during treatment and to determine the etiology of these complications. In this descriptive cohort study, conducted between November 2018 and March 2020, 204 children with a diagnosis of lymphoreticular malignancy were enrolled. The baseline investigations were done in all the cases. Those who developed neurological symptoms were evaluated with cerebrospinal fluid examination and radiologic and electrophysiologic studies as per indication and were managed according to standard management guidelines. Of the 204 patients, 30 (14.7%) developed neurological complications. The majority of these complications (n=20/30; 87%) occurred during the intensive chemotherapy period. Common complications included acute methotrexate neurotoxicity (n=7), vincristine-induced neurotoxicity (n=7), central nervous system (CNS) relapse (n=4), and posterior reversible encephalopathy syndrome (n=2). L-asparaginase-induced thrombosis (n=1), intramedullary compression syndrome (n=1), CNS infection (n=2), CNS hemophagocytic lymphohistiocytosis (n=1), and steroid-induced myopathy (n=1) were also observed. The complications resolved in 21/30 (70%) patients after receiving appropriate treatment while the neurological complication persisted in 2/30 (6.7%) patients. Three patients (10%) abandoned the treatment, and 4 (13.3%) patients expired. Neurologic complications in patients with lymphoreticular malignancy are quite variable, having common presenting symptoms but varying imaging abnormalities. By close follow-up and effective treatment, the morbidity and mortality of these complications can be minimized.

Influenza-associated neurologic complications in children from an H3N2 outbreak in Shenzhen, China during COVID-19 lockdown

ObjectivesTo identify the characteristics of influenza-associated neurologic complications (INCs) in children from a recent H3N2 outbreak in Shenzhen, China during COVID-19 lockdown. MethodsA retrospective cohort study of INCs in children hospitalized with H3N2 infection was conducted. ResultsFrom June 01, 2022 to July 01, 2022, 513 children with H3N2 infection were hospitalized and 97 developed INCs. Of the 18 patients with encephalopathy/encephalitis, 13 were previously healthy. Three developed acute necrotizing encephalopathy and two died. Of the 63 patients with febrile seizures, 55 (87%) had simple febrile seizures. Of the 14 patients with an exacerbation of seizure with underlying epilepsy, the seizure symptoms occurred mostly within 24 hours of disease onset (13/14). The comparison of the three groups (encephalopathy/encephalitis, febrile seizure and exacerbation of seizure with underlying epilepsy) reported no significant differences in sex, pre-existing neurologic diseases, vaccination rate, white blood cell count, C-reactive protein, procalcitonin, blood glucose, lactic acid, or duration of fever. The influenza vaccination rates were generally low (22% vs 32% vs 21%). Patients with encephalopathy/encephalitis had a higher rate of elevated alanine aminotransferase (28% vs 3% vs 0, P = 0.005). ConclusionH3N2-related neurologic complications in children mainly occur early in the disease course. Most patients were previously healthy and unvaccinated against influenza. Elevated alanine aminotransferase is more common in encephalopathy/encephalitis.

CLINICAL PROFILE OF NEUROLOGICAL INVOLVEMENT IN DENGUE IN CHILDREN ADMITTED TO A TERTIARY CARE CENTER

Background: Dengue is the second most common mosquito-borne disease affecting human beings after malaria. Transmitted by mosquitoes of the genus Aedes, clinical manifestations range from an asymptomatic state to a severe haemorrhagic fever. A change in the spectrum of clinical manifestations has been recently noted with neurological manifestations being recognized frequently 12.The incidence of encephalopathy and encephalitis, the most common neurological complications of dengue,has been estimated to be between 0.5 and 6.2%12 Aims And Objectives: 1.To study the clinical profile of Neurological involvement in children with dengue. 2.To study the Neurological complication in children with dengue infections. Study Design: prospective observational study Participants: The data was collected from 50 patients who had neurological manifestations and serologically proven dengue antibodies admitted in hospitals attached to M.R. Medical college Kalaburagi Results: Neurological manifestation and complications in dengue fever observed in 50 cases (13%).female preponderance is seen (ratio of 0.9:1).common symptoms were fever with seizures (60%), headache (56%), vomiting (70%), altered sensorium (40%) and blurring of vision (20%). clinical signs elicited were hepatomegaly (68%), splenomegaly (52%), oedema (52%), lymphadenopathy (20%). Mean GCS found to be 11.2. complications observed in study subjects were encephalitis (56%) followed by encephalopathy (36%), meningitis (4%), meningoencephalitis (4%), cranial nerve palsy (4%), intracranial bleed (2%). mortality observed in 4 cases (8%). Conclusion: Neurological manifestations in dengue fever is widespread and it may progress to life threatening complications like encephalopathy, encephalitis, Intracranial bleed etc through various diverse mechanisms. However, awareness is required for prevention, early recognition, and timely therapeutic intervention to prevent complications and mortality.

Postoperative Neurological Deficits with Incidence and the Various Arterial Territories Involved in Patients Undergoing Congenital Cardiac Surgery: A Single-center Analysis

Introduction: The incidence and pattern of neurological complications after congenital cardiac surgery have been changing over the years due to improvement in surgical technique and perioperative management. The aim of this study was to evaluate the incidence and pattern of neurological injury in our institute. Materials and Methods: We retrospectively reviewed all pediatric patients who underwent noncontrast computed tomography of the brain for suspected postoperative neurological injury occurring during the 1st week after pediatric cardiac surgery between April 2016 and February 2020. We identified neurological injury as patients having ischemic infarct and intracranial hemorrhage. Results: A total of 2971 pediatric cardiac surgeries were performed at our institute. Sixty-seven patients (2.25%) developed neurological injury. Fifty-five patients (82%) developed ischemic infarct while 12 patients (18%) had intracranial hemorrhagic. Pattern of ischemic infarct included global hypoxic injury in 30 patients (54.5%), posterior cerebral artery territory in 9 patients (16.3%), middle cerebral artery territory in 8 patients (14.5%), multiterritory involvement in 5 patients (9.0%), and anterior cerebral artery territory in 3 patients (5.4%). In patients with intracranial hemorrhage, 5 patients (7.4%) developed subarachnoid hemorrhage (SAH), 4 patients (5.9%) developed subdural hemorrhage, and 3 patients (4.4%) developed intraparenchymal hemorrhage. Conclusions: Neurological complication accounts for significant morbidity and mortality after congenital cardiac surgery. In our study, ischemic infarct accounted for 82% cases. In ischemic infarct, global ischemia was the most common type and carried high risk of mortality. In hemorrhage group, SAH was the most common finding. Nevertheless, the aim of this study was to characterize the current incidence of acute clinically evident neurologic complications in children undergoing congenital cardiac surgery in a tertiary hospital, although acute neurologic morbidity appears to be appreciably lower than in the past at our institution.

Neurological Complications in Children with Sickle Cell Disease at Qatif Central Hospital in Saudi Arabia

Neurological Complications in Children with Sickle Cell Disease at Qatif Central Hospital in Saudi Arabia

Detection of HSV-1, HSV-2 and VZV Isolated from Cerebrospinal Fluid Samples of Children Suspected to Encephalitis.

Encephalitis is an uncommon, serious brain infection that can cause fatality among children. The cause of most encephalitis remained unknown, yet viruses are the most well-known infectious agents that cause encephalitis. This study aimed to determine varicella-zoster virus (VZV) and herpes simplex virus type 1, 2 (HSV1/2) among individuals who are under 5 years of age in Iran. In this study, 149 cerebrospinal fluid samples of suspected patients of encephalitis were analyzed with some symptoms, such as seizure, fever, nausea loss of consciousness, and dizziness from Mofid Children's Hospital in Tehran, Iran. Then, the molecular evaluation of samples was performed using multiplex Polymerase Chain Reaction (PCR) for detecting HSV1/2 and VZV. The mean age of the patients was 1.8 years. Also, 63.4% of children were male and 36.6% were female. Out of 149 tested samples, 11 (7.3%) showed the viral DNA for one of the herpes viruses (7.3%). Nine samples were HSV1 positive (6.0%) and two samples were VZV positive (1.3%). Fever and vomiting were the most frequent symptoms. The mean ± standard deviation (SD) WBC and counts in cerebrospinal fluid (CSF)-positive samples, and all included samples were 298.8 ± 552.7 cells/μL and 131.1 ± 474.6 cells/μL, respectively. Although viral encephalitis is considered a threat to children's health, with accurate diagnosis and appropriate antiviral drugs, death and neurological complications in children can be prevented.

Neurological complications of COVID-19 in children and its effect on the quality of life

Coronavirus disease 2019, a pandemic that recently enveloped the world is a highly transmissible respiratory disease leading to 2,409,011 deaths in 2021. The most prevalent clinical symptoms in coronavirus disease 2019 patients are fever, cough, shortness of breath, and other respiratory issues. Coronavirus disease 2019 exhibits various neurological manifestations and complications which are quite rare in children. The purpose of this research is to review the available information about neurological complications of Coronavirus disease 2019 in children. Coronavirus disease 2019 is linked to neurological complications in children, including headaches, encephalopathy, and certain other neurological disorders. Involvement of the nervous system in coronavirus infection is either immediate, during the progression of the disease, after recovery, or as part of multisystem inflammatory syndrome in children. The clinical manifestations of coronavirus disease in new-borns and infants with neurological complications vary and can affect the whole neuraxis, affecting the central nervous system, peripheral nervous system, or both. In addition, children with multisystem inflammatory syndrome and coronavirus had severe neurological complications such as encephalitis, epilepsy, coma, dementia, dysgeusia or ageusia, aseptic meningitis, stroke, dysarthria, dysphagia, cerebellar ataxia, axial hypotonia, and drowsiness. Seizures in children are normally reported when they are suffering from fever due to viral infection. Neurological complications in children are rare and limited literature is available in this regard. More comprehensive, clinical follow-up studies can significantly contribute to understanding the relationship among coronavirus disease effects and neurological complications among children.

Proteomic and metabonomic analysis uncovering Enterovirus A71 reprogramming host cell metabolic pathway.

Enterovirus A71 (EV71) infection can cause hand, foot, and mouth disease (HFMD) and severe neurological complications in children. However, the biological processes regulated by EV71 remain poorly understood. Herein, proteomics and metabonomics studies were conducted to uncover the mechanism of EV71 infection in rhabdomyosarcoma (RD) cells and identify potential drug targets. Differential expressed proteins from enriched membrane were analyzed by isobaric tags for relative and absolute quantitation (iTRAQ)-based proteomics technology. Twenty-six differential proteins with 1.5-fold (p<0.05) change were detected, including 14 upregulated proteins and 12 downregulated proteins. The upregulated proteins are mainly involved in metabolic process, especially in the glycolysis pathway. Alpha-enolase (ENO1) protein was found to increase with temporal dependence following EV71 infection. The targeted metabolomics analysis revealed that glucose absorption and glycolysis metabolites were increased after EV71 infection. The glycolysis pathway was inhibited by knocking down ENO1 or the use of a glycolysis inhibitor (dichloroacetic acid [DCA]); and we found that EV71 infection was inhibited by depleting ENO1 or using DCA. Our study indicates that EV71 may reprogram glucose metabolism by activating glycolysis, and EV71 infection can be inhibited by interrupting the glycolysis pathway. ENO1 may be a potential target against EV71, and DCA could act as an inhibitor of EV71.

COVID-19 and Acute Neurologic Complications in Children.

Little is known about the epidemiology and outcomes of neurologic complications associated with coronavirus disease 2019 (COVID-19) in children. We performed a cross-sectional study of children 2 months to &lt;18 years of age with COVID-19 discharged from 52 children's hospitals from March 2020 to March 2022. Neurologic complications were defined as encephalopathy, encephalitis, aseptic meningitis, febrile seizure, nonfebrile seizure, brain abscess and bacterial meningitis, Reye's syndrome, and cerebral infarction. We assessed length of stay (LOS), ICU admission, 30 day readmissions, deaths, and hospital costs. We used multivariable logistic regression to identify factors associated with neurologic complications. Of 15 137 children hospitalized with COVID-19, 1060 (7.0%) had a concurrent diagnosis of a neurologic complication. The most frequent neurologic complications were febrile seizures (3.9%), nonfebrile seizures (2.3%), and encephalopathy (2.2%). Hospital LOS, ICU admission, ICU LOS, 30 day readmissions, deaths, and hospital costs were higher in children with neurologic complications compared with those without complications. Factors associated with lower odds of neurologic complications included: younger age (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.96-0.98), occurrence during delta variant predominant time period (aOR: 0.71; 95% CI: 0.57-0.87), presence of a nonneurologic complex chronic condition (aOR: 0.80; 95% CI: 0.69-0.94). The presence of a neurologic complex chronic condition was associated with higher odds of neurologic complication (aOR 4.14, 95% CI 3.48-4.92). Neurologic complications are common in children hospitalized with COVID-19 and are associated with worse hospital outcomes. Our findings emphasize the importance of COVID-19 immunization in children, especially in high-risk populations, such as those with neurologic comorbidity.

Neurological Complications in Children Hospitalized With Seizures and Respiratory Infections: A Comparison Between SARS-CoV-2 and Other Respiratory Infections

BackgroundChildren with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can experience neurological symptoms, but limited data are available on neurological symptoms associated with other respiratory infections. We compared proportions of neurological symptoms in children hospitalized with seizures and respiratory infections, including SARS-CoV-2, influenza, and endemic coronaviruses. MethodsA retrospective cohort study was performed on children admitted for seizures who had positive respiratory polymerase chain reactions for SARS-CoV-2, coronavirus NL63, coronavirus OC34, influenza (A and B), adenovirus, Mycoplasma pneumoniae, or parainfluenza 3 or 4. Primary outcomes were rates of new neurological diagnoses and mortality. ResultsA total of 883 children were included. Mortality rates ranged from 0% with M. pneumoniae to 4.9% with parainfluenza 4. Strokes were observed with all infections except for coronavirus OC43 and M. pneumoniae, with the highest rates in parainfluenza 4 (4.9%) and SARS-CoV-2 (5.9%). Compared with other infections, children with SARS-CoV-2 were older, had higher rates of stroke, and lower rates of intubation. The most common brain magnetic resonance imaging (MRI) abnormality was diffusion restriction. Abnormal MRI rates were lower in SARS-CoV-2, compared with patients with other coronavirus (OC). However, rates of stroke, encephalopathy, hypoxic-ischemic encephalopathy, and meningoencephalitis were similar between SARS-CoV-2 and influenza cohorts. ConclusionsIn children hospitalized with seizures, higher rates of stroke were observed in SARS-CoV-2 versus OC. Similar rates of neurological symptoms were observed in patients with SARS-CoV-2 and those with influenza. Strokes can occur in children with these viral infections, particularly SARS-CoV-2.

Post-COVID-19 Immune-Mediated Neurological Complications in Children: An Ambispective Study

BackgroundThe neurological manifestation following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is varied, and till now, only a few studies have reported the same. MethodsWe used retrospective data from May to July 2021 and prospective study data from August to September 2021, including that from children aged between one month and 18 years who presented to a tertiary care referral center with the neurological manifestation and had a history of coronavirus disease 2019 (COVID-19) infection or exposure and positive SARS-CoV-2 serology. The neuroradiological manifestations were further categorized as in a predesigned proforma. ResultsCase records of the 18 children who fulfilled the criteria were included in the study; among them, seven (38.8%) were male and 11 (61.1%) were female. Predominant presentation in our study group was status epilepticus (six of 18) and Guillain-Barré syndrome (five of 18). Other manifestations included stroke (two of 18), demyelinating syndromes (three of 18), and autoimmune encephalitis (two of 18). Most of the children had favorable outcomes except for one mortality in our cohort. ConclusionsDelayed complications following SARS-CoV-2 infection are seen in children. A temporal correlation was noted between the COVID-19 infection and the increasing number of neurological cases after the second wave. Steroids could be beneficial while treating such patients, especially in the presence of high inflammatory markers. Testing for SARS-CoV-2 serology during the pandemic can give a clue to the underlying etiology. Further multicentric studies are required to understand the varied neurological manifestations following SARS-CoV-2 infection in children.

Neurologic complications of infective endocarditis in children.

To define the frequency and characteristics of acute neurologic complications in children hospitalised with infective endocarditis and to identify risk factors for neurologic complications. Retrospective cohort study of children aged 0-18years hospitalised at a tertiary children's hospital from 1 January, 2008 to 31 December, 2017 with infective endocarditis. Sixty-eight children met Duke criteria for infective endocarditis (43 definite and 25 possible). Twenty-three (34%) had identified neurologic complications, including intracranial haemorrhage (25%, 17/68) and ischaemic stroke (25%, 17/68). Neurologic symptoms began a median of 4.5days after infective endocarditis symptom onset (interquartile range 1, 25days), though five children were asymptomatic and diagnosed on screening neuroimaging only. Overall, only 56% (38/68) underwent neuroimaging during acute hospitalisation, so additional asymptomatic neurologic complications may have been missed. Children with identified neurologic complications compared to those without were older (48 versus 22% ≥ 13years old, p = 0.031), more often had definite rather than possible infective endocarditis (96 versus 47%, p < 0.001), mobile vegetations >10mm (30 versus 11%, p = 0.048), and vegetations with the potential for systemic embolisation (65 versus 29%, p = 0.004). Six children died (9%), all of whom had neurologic complications. Neurologic complications of infective endocarditis were common (34%) and associated with mortality. The true frequency of neurologic complications was likely higher because asymptomatic cases may have been missed without screening neuroimaging. Moving forward, we advocate that all children with infective endocarditis have neurologic consultation, examination, and screening neuroimaging. Additional prospective studies are needed to determine whether early identification of neurologic abnormalities may direct management and ultimately reduce neurologic morbidity and overall mortality.

240 Neurologic complications in children with seizures and respiratory illness: A comparison between SARS-CoV-2 and other respiratory viruses

OBJECTIVES/GOALS: To compare rates and types of neurological symptoms in children hospitalized with seizures and respiratory infections, including SARS-CoV-2, influenza, and endemic coronaviruses. METHODS/STUDY POPULATION: Retrospective cohort study of children between 0-21 years of age admitted to a single pediatric free-standing quaternary referral center from January 1, 2014 to June 1, 2021 for seizures who had positive respiratory infection PCR for SARS-CoV-2, other coronaviruses (Coronavirus NL63 and Coronavirus OC34), influenza (A and B), adenovirus, Mycoplasma pneumoniae, and parainfluenza 3 or 4 infections. Patient characteristics including age, race, sex, ethnicity, hospital length of stay, intensive care unit admission, intubation, chest x-ray, and MRI results were included. The primary outcomes were rates of neurological diagnoses and mortality. RESULTS/ANTICIPATED RESULTS: A total of 883 children were included: 68 SARS-CoV-2, 232 influenza, and 187 with other coronaviruses (OC), 214 adenovirus, 20 M. pneumoniae, 121 parainfluenza 3, and 41 parainfluenza 4. Mortality rates were 0% M pneumoniae to 4.9% in parainfluenza 4, with 2.9% in SARS-CoV-2. Encephalopathy was noted in 5-15.6% and strokes were seen in all infections except for coronavirus OC43 and M. pneumoniae, with 4.9% in parainfluenza 4 and 5.9% in SARS-CoV-2. The most common brain MRI abnormality was diffusion restriction. Differences between SARS-CoV-2 and OC were observed in stroke (5.9% vs. 0.5%, p-value=0.019), ICU admission (50% vs. 69%, p-value=0.008), and intubation (19.1% vs. 34.8%, p-value=0.021, respectively). However, the rates of neurological symptoms were similar between SARS-CoV-2 and influenza. DISCUSSION/SIGNIFICANCE: We found higher rates of stroke, but lower rates of ICU admission and intubation in SARS-CoV-2 versus OC. Strokes were observed in many infections. Rates of neurological symptoms were similar in SARS-CoV-2 versus influenza patients. Vigilance should be undertaken in treatment of children presenting with all respiratory illnesses.