Manifestaciones neurológicas asociadas a COVID-19 en el Hospital de Niños Dr. Roberto Gilbert, en el periodo marzo 2020 a marzo 2025.

Abstract

Introduction: SARS-CoV-2 infection can cause neurological involvement in the pediatric population, affecting both the central and peripheral nervous systems, with manifestations ranging from mild to severe. Objective: To describe the neurological manifestations found in children hospitalized with COVID-19 at the Dr. Roberto Gilbert Children's Hospital during the period from March 2020 to March 2025. Methods: An observational, retrospective, cross-sectional, and descriptive study. Results: 117 patients were included, treated at the Dr. Roberto Gilbert Children's Hospital over a 5-year period (March 2020 to March 2025), ranging in age from 0 days to 17 years 11 months, diagnosed with SARS-CoV-2 by RT-PCR (39%; n=46), antigen (37%; n=43), and/or positive IgM (9%; n=10) and IgG (21%; n=25) antibodies. The majority of the population was infants aged 0 to 2 years (54%, n=63), and females (58%, n=68). The majority had no comorbidities (80%; n=94), and only 17% had received COVID-19 vaccination (n=20). The most frequent neurological manifestation was seizures (74%; n=98), followed by headache (8%; n=10), altered consciousness and sensorimotor manifestations (6%; n=8), ataxia (4%; n=5), visual disturbances (2%; n=3), and psychiatric disturbances (1%; n=1). The following phases of COVID-19 were present: acute (48%; n=56), Pediatric Multisystem Inflammatory Syndrome (MIS-C, 42%; n=49), and post-infectious (10%; n=12). Neurological complications in 19% of cases (n=22): encephalitis (n=10), status epilepticus (n=7), cerebral hemorrhage (n=2), optic neuritis (n=1), acute disseminated encephalomyelitis (n=1) and non-epileptic seizures of psychogenic origin (n=1). Pathological neurological studies: CT scan of the head (7%;n=8), brain MRI (9%;n=10), EEG (19%;n=22), Electromyography (2%;n=2), CSF (15%;n=18). Paraclinical Pathology: Leukocytes (32%;n=37), neutrophils (65%;n=76), lymphocytes (68%;n=80), platelets (20%;n=24), Anemia for age (40%;n=47), PCR (13%;n=15), procalcitonin (22%;n=26), ESR (18%;n=21), ferritin (25%;n=29), fibrinogen (15%;n=18), D-dimer (40%;n=47), interleukin-6 (20%;n=23). Treatment: anticonvulsants (48%;n=56), antibiotic therapy (42%;n=49), corticosteroids (16%;n=19), immunoglobulin (2%;n=2), rituximab (0%). The average hospital stay was 8 days, distributed as follows: inpatient (53%; n=62), emergency (21%; n=24), pediatric intensive care unit (9%; n=11), and pediatric intensive care unit (17%; n=20), the latter demonstrates the severity of the disease in the pediatric population by requiring admission to critical care areas. Mortality was 3% (n=3). Conclusions: Neurological manifestations in the pediatric population are more frequent with younger age, with seizures being the most common and encephalitis the most frequent complication. Mortality in the pediatric population is low at 3%, even though nearly half presented with MIS-C.