Severe neurological manifestation associated with COVID-19 in children during the Omicron variant-predominant period

Background The Omicron variant of SARS-CoV-2 is known to be more infectious and less severe than other variants. Despite the increasing number of symptomatic patients, severe neurological complications in children with the Omicron variant have been reported rarely, unlike with wild-type or delta variants of the virus. This study aimed to investigate severe neurological complications in children with Omicron variant infection. Methods We conducted a retrospective study of 17 pediatric patients with severe neurological manifestations associated with COVID-19 in Korea during the period of Omicron variant prevalence, from January 1 to April 30, 2022. Results The results showed that 11 patients had preexisting neurological disabilities, and 9 met the criteria for multisystem inflammatory syndrome in children (MIS-C). Four of the 5 vaccine-eligible patients (12 years and older) were unvaccinated. Severe neurological manifestations included acute necrotizing encephalopathy, acute fulminant cerebral edema, acute disseminated encephalomyelitis, basal ganglia encephalitis, unclassified severe encephalopathy/encephalitis, and refractory status dystonicus. Patients with MIS-C and underlying neurological disabilities had longer median hospital stays and ICU stays compared with those without these conditions. Five of the 17 patients survived with new neurological deficits at the 1-year follow-up, and three died, all of whom had underlying neurological disabilities. Conclusion This study shows that severe neurological complications in pediatric patients with the Omicron variant of SARS-CoV-2 occur infrequently but may lead to significant morbidity and mortality, especially among those with preexisting neurological disabilities and unvaccinated individuals. Continued efforts are necessary to prevent and manage such complications in these vulnerable populations.