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      Has the Incidence of Febrile Convulsions in Childhood Changed During the SARS-CoV-2 Pandemic?

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          Abstract

          Introduction: SARS-CoV-2 infection in children is usually asymptomatic or only mild symptoms are typical. The aim of our study was to assess the incidence of febrile convulsions in our own patients with COVID-19. Patients and Methods: In our retrospective study, we reviewed the data of children who presented at our University Hospital from March 2020 to March 2022 with febrile convulsion. The control group were children admitted to the hospital because of febrile convulsions from January 2018 to January 2020. Results: During the coronavirus pandemic, 51 patients were examined with febrile convulsions. The majority (86.3%) of children had their first febrile convulsion during this period. We diagnosed simple febrile convulsions in 40 cases and complicated ones in 11 cases. The family history of febrile convulsion or epilepsy was present in 12 (23.5%) patients. In addition to febrile convulsion, SARS-CoV-2 infection was confirmed by laboratory testing in 4 cases (7.8%). Three of them had febrile convulsion during the Omicron variant period. Conclusions: During the coronavirus pandemic, the number of children examined because of having febrile convulsions was not higher than in the control period. The coronavirus is unlikely to increase the risk of febrile convulsions.

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          SARS-CoV-2 Infection in Children

          Xiaoxia Lu, Liqiong Zhang, Hui Du … (2020)
          To the Editor: As of March 10, 2020, the 2019 novel coronavirus (SARS-CoV-2) has been responsible for more than 110,000 infections and 4000 deaths worldwide, but data regarding the epidemiologic characteristics and clinical features of infected children are limited. 1-3 A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age. 2 In order to determine the spectrum of disease in children, we evaluated children infected with SARS-CoV-2 and treated at the Wuhan Children’s Hospital, the only center assigned by the central government for treating infected children under 16 years of age in Wuhan. Both symptomatic and asymptomatic children with known contact with persons having confirmed or suspected SARS-CoV-2 infection were evaluated. Nasopharyngeal or throat swabs were obtained for detection of SARS-CoV-2 RNA by established methods. 4 The clinical outcomes were monitored up to March 8, 2020. Of the 1391 children assessed and tested from January 28 through February 26, 2020, a total of 171 (12.3%) were confirmed to have SARS-CoV-2 infection. Demographic data and clinical features are summarized in Table 1. (Details of the laboratory and radiologic findings are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.) The median age of the infected children was 6.7 years. Fever was present in 41.5% of the children at any time during the illness. Other common signs and symptoms included cough and pharyngeal erythema. A total of 27 patients (15.8%) did not have any symptoms of infection or radiologic features of pneumonia. A total of 12 patients had radiologic features of pneumonia but did not have any symptoms of infection. During the course of hospitalization, 3 patients required intensive care support and invasive mechanical ventilation; all had coexisting conditions (hydronephrosis, leukemia [for which the patient was receiving maintenance chemotherapy], and intussusception). Lymphopenia (lymphocyte count, <1.2×109 per liter) was present in 6 patients (3.5%). The most common radiologic finding was bilateral ground-glass opacity (32.7%). As of March 8, 2020, there was one death. A 10-month-old child with intussusception had multiorgan failure and died 4 weeks after admission. A total of 21 patients were in stable condition in the general wards, and 149 have been discharged from the hospital. This report describes a spectrum of illness from SARS-CoV-2 infection in children. In contrast with infected adults, most infected children appear to have a milder clinical course. Asymptomatic infections were not uncommon. 2 Determination of the transmission potential of these asymptomatic patients is important for guiding the development of measures to control the ongoing pandemic.
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            Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020

            Silvia Garazzino, Carlotta Montagnani, Daniele Dona … (2020)
            Data on features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents are scarce. We report preliminary results of an Italian multicentre study comprising 168 laboratory-confirmed paediatric cases (median: 2.3 years, range: 1 day–17.7 years, 55.9% males), of which 67.9% were hospitalised and 19.6% had comorbidities. Fever was the most common symptom, gastrointestinal manifestations were frequent; two children required intensive care, five had seizures, 49 received experimental treatments and all recovered.
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              COVID-19 and Acute Neurologic Complications in Children

              James Antoon, Matt Hall, Leigh Howard … (2022)
              Little is known about the epidemiology and outcomes of neurologic complications associated with COVID-19 in children. We performed a cross-sectional study of children 2 months to <18 years with COVID-19 discharged from 52 children's hospitals from March 2020-March 2022. Neurologic complications were defined as encephalopathy, encephalitis, aseptic meningitis, febrile seizure, non-febrile seizure, brain abscess and bacterial meningitis, Reye’s syndrome, and cerebral infarction. We assessed length of stay (LOS), intensive care unit (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%), non-febrile 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 to those without complications. Factors associated with lower odds of neurologic complications included: younger age (aOR 0.97, 95% CI 0.96, 0.98), occurrence during Delta variant predominant time period (aOR 0.71, 95% CI 0.57, 0.87), presence of a non-neurologic complex chronic condition (CCC) (aOR 0.80, 95% CI 0.69, 0.94). Presence of a neurologic CCC was associated with a 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 co-morbidity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Child Neurol
                Journal ID (iso-abbrev): J Child Neurol
                Journal ID (publisher-id): JCN
                Journal ID (hwp): spjcn
                Title: Journal of Child Neurology
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 0883-0738
                ISSN (Electronic): 1708-8283
                Publication date (Electronic): 2 May 2024
                Publication date (Print): May 2024
                Volume: 39
                Issue: 5-6
                Pages: 190-194
                Affiliations
                [1 ]Faculty of Medicine, Department of Pediatrics, Ringgold 37656, universityUniversity of Pecs; , Pecs, Hungary
                [2 ]Faculty of Medicine, Institute of Bioanalysis, Ringgold 37656, universityUniversity of Pecs; , Pecs, Hungary
                Author notes
                [*]Monika Kovacs, MD, Faculty of Medicine, Department of Pediatrics, University of Pecs, 7 Jozsef Attila Street, H-7623 Pécs, Hungary. Email: kovacs.monika2@ 123456pte.hu
                Author information
                https://orcid.org/0009-0005-3140-2779
                Article
                Publisher ID: 10.1177_08830738241249630
                DOI: 10.1177/08830738241249630
                PMC ID: 11179305
                PubMed ID: 38698642
                SO-VID: 107d9c60-a55c-4909-91a0-371861ed9373
                Copyright © © The Author(s) 2024
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 29 August 2023
                Date revision received : 8 March 2024
                Date accepted : 5 April 2024
                Categories
                Subject: Original Articles
                Custom metadata
                typesetter ts19

                Keywords: child sars-cov-2 (severe acute respiratory syndrome coronavirus 2),covid-19 infection,covid-19 (coronavirus disease 2019),febrile seizure,sars-cov-2
                Data availability:
                Keywords: child sars-cov-2 (severe acute respiratory syndrome coronavirus 2), covid-19 infection, covid-19 (coronavirus disease 2019), febrile seizure, sars-cov-2

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