Publication date: Sep 24, 2025
The Omicron variant has become the predominant strain globally, yet pediatric data on COVID-19-associated acute encephalopathy (AE) remain scarce. This study aimed to characterize the clinical features and outcomes of Omicron-related AE in a PICU cohort. We prospectively analyzed 10 pediatric patients (aged ≤ 18 years) diagnosed with COVID-19-associated AE at Capital Center of Children’s health Capital Medical University from December 2022 to January 2023. AE diagnosis followed the Japanese Society of Child Neurology criteria. Demographic, clinical, laboratory, radiological, and outcome data were collected. Median page was 35 months (IQR 17. 0-62. 5), with 80% ≤4 years old. All patients presented with fever and altered mental status; 40% had seizures. Cranial MRI revealed symmetric brain lesions in all cases: 70% acute necrotizing encephalopathy (ANE), 10% encephalitis with splenial lesions (MERS), and 10% acute encephalopathy with subcortical demyelination (AESD). Elevated inflammatory markers (procalcitonin 31. 27 ng/mL [IQR 23. 8-38. 7], IL-6 21. 6 pg/mL [IQR 12. 3-34. 9]) and CSF pleocytosis were common. Six patients (60%) died within 48 h of PICU admission, all unvaccinated and ≤ 4 years old. Survivors exhibited long-term neurological sequelae (quadriparesis, hypotonia). Omicron-associated AE in young children is characterized by rapidly progressive neurological deterioration, with 60% mortality in this cohort and persistent deficits in survivors. Symmetric MRI lesions, elevated procalcitonin, and CSF cytokine elevation may serve as early diagnostic indicators. Vaccination gaps and innate immune dysregulation likely contribute to severe outcomes.
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Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | COVID-19 |
| disease | MESH | seizures |
| disease | MESH | encephalopathy |
| disease | MESH | encephalitis |
| disease | MESH | demyelination |
| disease | MESH | pleocytosis |
| disease | MESH | sequelae |
| disease | MESH | quadriparesis |
| disease | MESH | hypotonia |
| pathway | REACTOME | Reproduction |
| drug | DRUGBANK | Coenzyme M |
| disease | MESH | emergencies |
| disease | MESH | infection |
| disease | MESH | syndromes |
| disease | MESH | bacterial meningitis |
| disease | MESH | herpes simplex encephalitis |
| disease | IDO | history |
| disease | MESH | neurological disorders |
| disease | MESH | intractable epilepsy |
| disease | IDO | blood |
| drug | DRUGBANK | Methylprednisolone |
| drug | DRUGBANK | Immune Globulin Human |
| drug | DRUGBANK | Tocilizumab |
| disease | MESH | infectious diseases |
| drug | DRUGBANK | Methionine |
| disease | MESH | Neuroinflammation |
| disease | MESH | abnormalities |