PDF(Pubmed)
Abstract：
The COVID-19 pandemic has impacted individuals differently, and there\'s been a growing body of evidence pointing to neurological complications caused by the virus. However, our understanding of the range of neurological issues linked to SARS-CoV-2 infection in children is limited. This systematic review and meta-analysis aimed to assess the abnormal neuroimaging findings in pediatric COVID-19 patients, shedding light on this crucial aspect of the disease\'s impact on children. We conducted an extensive search in the PubMed, Medline, and ScienceDirect databases for observational studies reporting neuroimaging findings of the brain and spinal cord in children with COVID-19 between December 1, 2019, and October 30, 2021. Grey literature sources, including medRxiv and Google Scholar, were also explored. Pooled proportions of abnormal neuroimaging findings, categorized into neurovascular findings, ADEM-like lesions, encephalitic pattern, myelitis, transient splenial lesions, and other anomalies, were calculated using a random-effects model. Between-study heterogeneity was assessed using the χ2 statistic for pooled proportions and the inconsistency index I2. The Quality of the studies was evaluated using the NIH Quality Assessment Tool and the adapted Newcastle-Ottawa Scale. Our search yielded 9,605 articles, with 96 studies (involving 327 pediatric patients) included in the qualitative analysis. Of these, five reports (encompassing 111 patients) underwent quantitative analysis. The pooled proportion of pediatric COVID-19 patients with neurological symptoms and exhibiting abnormal neuroimaging findings was 43.74%. These findings were further categorized into neurovascular findings (8.22%), ADEM-like lesions (7.69%), encephalitic pattern (13.95%), myelitis (4.60%), transient splenial lesions (16.26%), and other abnormalities (12.03%). Insignificant between-study heterogeneity was observed in all categories, and our analysis did not reveal significant publication bias. In conclusion, a substantial proportion of pediatric COVID-19 patients with neurological symptoms have abnormal neuroimaging findings, underscoring the need for vigilant monitoring of neurological complications in this vulnerable population. Standardized reporting and long-term follow-up studies are essential to fully understand the implications of these findings. Collaborative research efforts will deepen our understanding of COVID-19\'s neurological dimensions in children and enhance clinical care for this population.
摘要：
COVID-19大流行对个人的影响不同，越来越多的证据表明病毒引起的神经系统并发症。然而,我们对与儿童SARS-CoV-2感染相关的神经系统问题的了解有限.这项系统评价和荟萃分析旨在评估儿童COVID-19患者的异常神经影像学表现，阐明了这种疾病对儿童影响的这一关键方面。我们在PubMed进行了广泛的搜索，Medline,和ScienceDirect数据库，用于观察性研究，报告2019年12月1日至2021年10月30日期间COVID-19儿童大脑和脊髓的神经影像学发现。灰色文献来源，包括medRxiv和谷歌学者，也被探索过。合并比例的异常神经影像学发现，分类为神经血管发现，ADEM样病变,脑炎模式，脊髓炎,一过性脾病变,和其他异常现象,使用随机效应模型计算。使用χ2统计量对合并比例和不一致指数I2评估研究之间的异质性。使用NIH质量评估工具和适应的纽卡斯尔-渥太华量表评估研究质量。我们的搜索产生了9605篇文章，96项研究(涉及327例儿科患者)纳入定性分析。其中,对5例报告(包括111例患者)进行了定量分析.出现神经系统症状并表现出异常神经影像学表现的儿童COVID-19患者的合并比例为43.74%。这些发现被进一步归类为神经血管发现（8.22％），ADEM样病变(7.69%),脑炎模式（13.95%），脊髓炎（4.60%），短暂性脾病变（16.26%），和其他异常（12.03%）。在所有类别中观察到不显著的研究间异质性，我们的分析没有发现显著的发表偏倚.总之,相当比例的有神经症状的儿童COVID-19患者有异常的神经影像学表现，强调需要警惕监测这一脆弱人群的神经系统并发症。标准化报告和长期随访研究对于充分理解这些发现的含义至关重要。合作研究工作将加深我们对COVID-19儿童神经系统的理解，并加强对这一人群的临床护理。
