Browsing by Author "Harvey, Helen"

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    Changes in Distribution of Severe Neurologic Involvement in US Pediatric Inpatients With COVID-19 or Multisystem Inflammatory Syndrome in Children in 2021 vs 2020
    (American Medical Association, 2023) LaRovere, Kerri L.; Poussaint, Tina Y.; Young, Cameron C.; Newhams, Margaret M.; Kucukak, Suden; Irby, Katherine; Kong, Michele; Schwartz, Stephanie P.; Walker, Tracie C.; Bembea, Melania M.; Wellnitz, Kari; Havlin, Kevin M.; Cvijanovich, Natalie Z.; Hall, Mark W.; Fitzgerald, Julie C.; Schuster, Jennifer E.; Hobbs, Charlotte V.; Halasa, Natasha B.; Singh, Aalok R.; Mack, Elizabeth H.; Bradford, Tamara T.; Gertz, Shira J.; Schwarz, Adam J.; Typpo, Katri V.; Loftis, Laura L.; Giuliano, John S., Jr.; Horwitz, Steven M.; Biagas, Katherine V.; Clouser, Katharine N.; Rowan, Courtney M.; Maddux, Aline B.; Soma, Vijaya L.; Babbitt, Christopher J.; Aguiar, Cassyanne L.; Kolmar, Amanda R.; Heidemann, Sabrina M.; Harvey, Helen; Zambrano, Laura D.; Campbell, Angela P.; Randolph, Adrienne G.; Overcoming COVID-19 Investigators; Pediatrics, School of Medicine
    Importance: In 2020 during the COVID-19 pandemic, neurologic involvement was common in children and adolescents hospitalized in the United States for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related complications. Objective: To provide an update on the spectrum of SARS-CoV-2-related neurologic involvement among children and adolescents in 2021. Design, setting, and participants: Case series investigation of patients reported to public health surveillance hospitalized with SARS-CoV-2-related illness between December 15, 2020, and December 31, 2021, in 55 US hospitals in 31 states with follow-up at hospital discharge. A total of 2253 patients were enrolled during the investigation period. Patients suspected of having multisystem inflammatory syndrome in children (MIS-C) who did not meet criteria (n = 85) were excluded. Patients (<21 years) with positive SARS-CoV-2 test results (reverse transcriptase-polymerase chain reaction and/or antibody) meeting criteria for MIS-C or acute COVID-19 were included in the analysis. Exposure: SARS-CoV-2 infection. Main outcomes and measures: Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening neurologic involvement was adjudicated by experts based on clinical and/or neuroradiological features. Type and severity of neurologic involvement, laboratory and imaging data, vaccination status, and hospital discharge outcomes (death or survival with new neurologic deficits). Results: Of 2168 patients included (58% male; median age, 10.3 years), 1435 (66%) met criteria for MIS-C, and 476 (22%) had documented neurologic involvement. Patients with neurologic involvement vs without were older (median age, 12 vs 10 years) and more frequently had underlying neurologic disorders (107 of 476 [22%] vs 240 of 1692 [14%]). Among those with neurologic involvement, 42 (9%) developed acute SARS-CoV-2-related life-threatening conditions, including central nervous system infection/demyelination (n = 23; 15 with possible/confirmed encephalitis, 6 meningitis, 1 transverse myelitis, 1 nonhemorrhagic leukoencephalopathy), stroke (n = 11), severe encephalopathy (n = 5), acute fulminant cerebral edema (n = 2), and Guillain-Barré syndrome (n = 1). Ten of 42 (24%) survived with new neurologic deficits at discharge and 8 (19%) died. Among patients with life-threatening neurologic conditions, 15 of 16 vaccine-eligible patients (94%) were unvaccinated. Conclusions and relevance: SARS-CoV-2-related neurologic involvement persisted in US children and adolescents hospitalized for COVID-19 or MIS-C in 2021 and was again mostly transient. Central nervous system infection/demyelination accounted for a higher proportion of life-threatening conditions, and most vaccine-eligible patients were unvaccinated. COVID-19 vaccination may prevent some SARS-CoV-2-related neurologic complications and merits further study.
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    Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak
    (American Medical Association, 2023-08-01) Halasa, Natasha; Zambrano, Laura D.; Amarin, Justin Z.; Stewart, Laura S.; Newhams, Margaret M.; Levy, Emily R.; Shein, Steven L.; Carroll, Christopher L.; Fitzgerald, Julie C.; Michaels, Marian G.; Bline, Katherine; Cullimore, Melissa L.; Loftis, Laura; Montgomery, Vicki L.; Jeyapalan, Asumthia S.; Pannaraj, Pia S.; Schwarz, Adam J.; Cvijanovich, Natalie Z.; Zinter, Matt S.; Maddux, Aline B.; Bembea, Melania M.; Irby, Katherine; Zerr, Danielle M.; Kuebler, Joseph D.; Babbitt, Christopher J.; Glas Gaspers, Mary; Nofziger, Ryan A.; Kong, Michele; Coates, Bria M.; Schuster, Jennifer E.; Gertz, Shira J.; Mack, Elizabeth H.; White, Benjamin R.; Harvey, Helen; Hobbs, Charlotte V.; Dapul, Heda; Butler, Andrew D.; Bradford, Tamara T.; Rowan, Courtney M.; Wellnitz, Kari; Allen Staat, Mary; Aguiar, Cassyanne L.; Hymes, Saul R.; Randolph, Adrienne G.; Campbell, Angela P.; RSV-PIC Investigators; Pediatrics, School of Medicine
    Importance: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide. Objective: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission. Design, setting, and participants: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection. Exposure: Respiratory syncytial virus. Main outcomes and measures: Data were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity. Results: The first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age <37 weeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days. Conclusions and relevance: In this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness.
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    Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome
    (AMA, 2021-03) LaRovere, Kerri L.; Riggs, Becky J.; Poussaint, Tina Y.; Young, Cameron C.; Newhams, Margaret M.; Maamari, Mia; Walker, Tracie C.; Singh, Aalok R.; Dapul, Heda; Hobbs, Charlotte V.; McLaughlin, Gwenn E.; Son, Mary Beth F.; Maddux, Aline B.; Clouser, Katharine N.; Rowan, Courtney M.; McGuire, John K.; Fitzgerald, Julie C.; Gertz, Shira J.; Shein, Steven L.; Munoz, Alvaro Coronado; Thomas, Neal J.; Irby, Katherine; Levy, Emily R.; Staat, Mary A.; Tenforde, Mark W.; Feldstein, Leora R.; Halasa, Natasha B.; Giuliano, John S.; Hall, Mark W.; Kong, Michele; Carroll, Christopher L.; Schuster, Jennifer E.; Doymaz, Sule; Loftis, Laura L.; Tarquinio, Keiko M.; Babbitt, Christopher J.; Nofziger, Ryan A.; Kleinman, Lawrence C.; Keenaghan, Michael A.; Cvijanovich, Natalie Z.; Spinella, Philip C.; Hume, Janet R.; Wellnitz, Kari; Mack, Elizabeth H.; Michelson, Kelly N.; Flori, Heidi R.; Patel, Manish M.; Randolph, Adrienne G.; Overcoming COVID-19 Investigators; Gaspers, Mary G; Typpo, Katri V; Sanders, Ronald C; Schwarz, Adam J; Harvey, Helen; Zinter, Matt S; Mourani, Peter M; Coates, Bria M; Bhoojhawon, Guru; Havlin, Kevin M; Montgomery, Vicki L; Sullivan, Janice E; Bradford, Tamara T; Bembea, Melania M; Lipton, Susan V; Graciano, Ana Lia; Chen, Sabrina R; Kucukak, Suden; Newburger, Jane W; Carroll, Ryan W; Fernandes, Neil D; Yager, Phoebe H; Marohn, Kimberly L; Heidemann, Sabrina M; Cullimore, Melissa L; McCulloh, Russell J; Horwitz, Steven M; Li, Simon; Walsh, Rowan F; Ratner, Adam J; Soma, Vijaya L; Gillen, Jennifer K; Zackai, Sheemon P; Ackerman, Kate G; Cholette, Jill M; Harwayne-Gidansky, Ilana; Hymes, Saul R; Overby, Philip J; Schwartz, Stephanie P; Lansell, Amanda N; Koncicki, Monica L; Carcillo, Joseph; Fink, Ericka; Kimura, Dai; Bowens, Cindy; Crandall, Hillary; Smith, Lincoln S; Cengiz, Pelin; Pediatrics, School of Medicine
    Importance Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. Objective To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. Setting, Design, and Participants Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. Exposures Severe acute respiratory syndrome coronavirus 2. Main Outcomes and Measures Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. Results Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19–related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. Conclusions and Relevance In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown.