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Browsing by Author "Rollins, Caitlin K."
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Item Neurological and Psychological Sequelae Associated With Multisystem Inflammatory Syndrome in Children(American Medical Association, 2023-07-03) Rollins, Caitlin K.; Calderon, Johanna; Wypij, David; Taylor, Alex M.; Kanjiker, Tahera Sultana Davalji; Rohde, Julia S.; Maiman, Moshe; Zambrano, Laura D.; Newhams, Margaret M.; Rodriguez, Susan; Hart, Nicholas; Worhach, Jennifer; Kucukak, Suden; Poussaint, Tina Y.; Son, Mary Beth F.; Friedman, Matthew L.; Gertz, Shira J.; Hobbs, Charlotte V.; Kong, Michele; Maddux, Aline B.; McGuire, Jennifer L.; Licht, Paul A.; Allen Staat, Mary; Yonker, Lael M.; Mazumdar, Maitreyi; Randolph, Adrienne G.; Campbell, Angela P.; Newburger, Jane W.; Overcoming COVID-19 Investigators; Pediatrics, School of MedicineImportance: Acute neurological involvement occurs in some patients with multisystem inflammatory syndrome in children (MIS-C), but few data report neurological and psychological sequelae, and no investigations include direct assessments of cognitive function 6 to 12 months after discharge. Objective: To characterize neurological, psychological, and quality of life sequelae after MIS-C. Design, setting, and participants: This cross-sectional cohort study was conducted in the US and Canada. Participants included children with MIS-C diagnosed from November 2020 through November 2021, 6 to 12 months after hospital discharge, and their sibling or community controls, when available. Data analysis was performed from August 2022 to May 2023. Exposure: Diagnosis of MIS-C. Main outcomes and measures: A central study site remotely administered a onetime neurological examination and in-depth neuropsychological assessment including measures of cognition, behavior, quality of life, and daily function. Generalized estimating equations, accounting for matching, assessed for group differences. Results: Sixty-four patients with MIS-C (mean [SD] age, 11.5 [3.9] years; 20 girls [31%]) and 44 control participants (mean [SD] age, 12.6 [3.7] years; 20 girls [45%]) were enrolled. The MIS-C group exhibited abnormalities on neurological examination more frequently than controls (15 of 61 children [25%] vs 3 of 43 children [7%]; odds ratio, 4.7; 95% CI, 1.3-16.7). Although the 2 groups performed similarly on most cognitive measures, the MIS-C group scored lower on the National Institutes of Health Cognition Toolbox List Sort Working Memory Test, a measure of executive functioning (mean [SD] scores, 96.1 [14.3] vs 103.1 [10.5]). Parents reported worse psychological outcomes in cases compared with controls, particularly higher scores for depression symptoms (mean [SD] scores, 52.6 [13.1] vs 47.8 [9.4]) and somatization (mean [SD] scores, 55.5 [15.5] vs 47.0 [7.6]). Self-reported (mean [SD] scores, 79.6 [13.1] vs 85.5 [12.3]) and parent-reported (mean [SD] scores, 80.3 [15.5] vs 88.6 [13.0]) quality of life scores were also lower in cases than controls. Conclusions and relevance: In this cohort study, compared with contemporaneous sibling or community controls, patients with MIS-C had more abnormal neurologic examinations, worse working memory scores, more somatization and depression symptoms, and lower quality of life 6 to 12 months after hospital discharge. Although these findings need to be confirmed in larger studies, enhanced monitoring may be warranted for early identification and treatment of neurological and psychological symptoms.Item Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C(Frontiers Media, 2023-10-18) Maddux, Aline B.; Young, Cameron C.; Kucukak, Suden; Zambrano, Laura D.; Newhams, Margaret M.; Rollins, Caitlin K.; Halasa, Natasha B.; Gertz, Shira J.; Mack, Elizabeth H.; Schwartz, Stephanie; Kong, Michele; Loftis, Laura L.; Irby, Katherine; Rowan, Courtney M.; Tarquinio, Keiko M.; Zinter, Matt S.; Crandall, Hillary; Cvijanovich, Natalie Z.; Schuster, Jennifer E.; Fitzgerald, Julie C.; Staat, Mary A.; Hobbs, Charlotte V.; Nofziger, Ryan A.; Shein, Steven; Flori, Heidi; Cullimore, Melissa L.; Chatani, Brandon M.; Levy, Emily R.; Typpo, Katri V.; Hume, Janet R.; Campbell, Angela P.; Randolph, Adrienne G.; Overcoming COVID-19 Investigators; Pediatrics, School of MedicineObjective: To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic. Methods: Across 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results: Of 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n = 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments. Discussion: Among patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.