COVID-19-associated during the Omicron wave was severe and often fatal in this small pediatric PICU cohort.
Evidence
This single-center prospective study followed 10 children with COVID-19-associated acute encephalopathy in Beijing from December 2022 to January 2023, reporting symmetric MRI lesions, 60% mortality within 48 hours, and neurological sequelae in survivors.
Caveat
The evidence comes from only 10 PICU patients at one center, so risk factors such as vaccination status and immune dysregulation remain preliminary.
Simplified
BACKGROUND: The Omicron variant has become the predominant strain globally, yet pediatric data on COVID-19-associated (AE) remain scarce. This study aimed to characterize the clinical features and outcomes of Omicron-related AE in a PICU cohort.
METHODS: We prospectively analyzed 10 pediatric patients (aged ≤ 18 years) diagnosed with COVID-19-associated AE at Capital Center of Children's health Capital Medical University from December 2022 to January 2023. AE diagnosis followed the Japanese Society of Child Neurology criteria. Demographic, clinical, laboratory, radiological, and outcome data were collected.
RESULTS: Median page was 35 months (IQR 17.0-62.5), with 80% ≤4 years old. All patients presented with fever and altered mental status; 40% had seizures. Cranial MRI revealed symmetric brain lesions in all cases: 70% (ANE), 10% encephalitis with splenial lesions (MERS), and 10% acute encephalopathy with subcortical demyelination (AESD). Elevated inflammatory markers (procalcitonin 31.27 ng/mL [IQR 23.8-38.7], IL-6 21.6 pg/mL [IQR 12.3-34.9]) and CSF pleocytosis were common. Six patients (60%) died within 48 h of PICU admission, all unvaccinated and ≤ 4 years old. Survivors exhibited long-term neurological sequelae (quadriparesis, hypotonia).
CONCLUSIONS: Omicron-associated AE in young children is characterized by rapidly progressive neurological deterioration, with 60% mortality in this cohort and persistent deficits in survivors. Symmetric MRI lesions, elevated procalcitonin, and CSF cytokine elevation may serve as early diagnostic indicators. Vaccination gaps and innate immune dysregulation likely contribute to severe outcomes.
Key numbers
60%
Mortality Rate
6 of 10 patients died within 48 hours of PICU admission.
20%
Incidence of
10 of 50 hospitalized pediatric COVID-19 cases developed .
80%
Age Group Affected
80% of cases occurred in children ≤ 4 years old.
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