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

• Published in: Journal of Tropical Pediatrics 2021-07, Vol.67 (3)
• Main Authors: Panda, Prateek Kumar, Sharawat, Indar Kumar, Panda, Pragnya, Natarajan, Vivekanand, Bhakat, Rahul, Dawman, Lesa
• Format: Article
• Language: English
• Subjects: Brain Diseases; Child; Clinical Review; COVID-19; Headache; Humans; Nervous System Diseases - epidemiology; Nervous System Diseases - etiology; SARS-CoV-2
• ISSN: 0142-6338; 1465-3664
• DOI: 10.1093/tropej/fmaa070

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.