Document Type : Original Article
Authors
1 Associate Professor, Department of Pediatric Diseases, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
2 Assistant Professor, Department of Pediatric Diseases, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
3 Medical student, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
Abstract
Background and Objective: SARS-CoV-2 infection can lead to a wide spectrum of neurological complications in children besides respiratory manifestations. Despite growing global evidence, data regarding the neurological manifestations of COVID-19 among Iranian pediatric patients remain limited. This study aimed to investigate the frequency of neurological manifestations and their association with clinical outcomes among hospitalized children with COVID-19 at Motahari Hospital in Urmia, Iran.
Materials and Methods: This retrospective cross-sectional analytical study was conducted on 460 children (age <18 years) with PCR-confirmed COVID-19 who were hospitalized between March 2020 and March 2022. Census sampling was performed. Demographic variables, central and peripheral neurological manifestations, D-dimer levels, and clinical outcomes were extracted from medical records. Data analysis was performed using SPSS version 25, using multiple logistic regression modeling.
Results: Among the 460 enrolled children (mean age 4.17 ± 3.62 years; 59.78% male), the most prevalent neurological manifestations were seizure (14.13%), headache (7.39%), and dizziness (1.52%). Patients presenting with headache and dizziness were significantly older (P<0.001). The overall in-hospital mortality rate was 4.78%. Multivariate logistic regression analysis revealed that severe neurological manifestations (AOR = 2.45; 95% CI: 1.12 - 5.36; P = 0.024) and elevated D-dimer levels >1000 µg/L (AOR = 3.12; 95% CI: 1.41 - 6.88; P = 0.005) were the significant independent predictors of mortality.
Conclusion: Neurological manifestations are relatively common among hospitalized children with COVID-19. Since severe neurological complications and coagulopathy (elevated D-dimer) independently increase the risk of in-hospital mortality, careful and early neurological evaluation of pediatric patients is crucial for improving clinical outcomes.
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