The Spectrum and Burden of COVID-19–Associated Neurologic Disease in Australian Children 2020–2023

<h3><b>Background: </b>We aimed to describe the clinical spectrum and burden of COVID-19–associated neurologic disease in Australian children.</h3><h3><b>Methods: </b>We extracted Australian national sentinel site surveillance data on COVID-19–associated neurologic disease in children hospitalized in the Paediatric Active Enhanced Disease Surveillance network, 2020–2023. Neurologic complications included encephalitis, encephalopathy, Guillain–Barre syndrome, seizures and cerebrovascular accident among others. We calculated the proportion of hospitalized pediatric COVID-19 cases associated with neurologic disease and described the spectrum of presentations including clinical features and severity. We calculated incidence rates of neurologic disease within COVID-19 variant eras among hospitalized patients.</h3><h3><b>Results: </b>We identified 311 cases of SARS-CoV-2 infection with neurologic disease among 4616 hospitalized pediatric cases of COVID-19 reported through the surveillance network, representing 5.3 cases per 100 pediatric COVID-19 admissions. The most common COVID-19–associated neurologic presentations were seizures (n = 215), including febrile seizures. Nonspecific encephalopathy (n = 62), encephalitis, Guillain–Barre Syndrome, acute cerebellar syndromes, acute demyelinating encephalomyelitis and cerebrovascular accident were also reported. Almost 60% of children were ≤4 years, approximately 30% had pre-existing neurologic conditions and almost half had other medical comorbidities. COVID-19–associated neurologic complications infrequently led to death, although 25% (n = 2/8) of children with COVID-19 encephalitis died. The incidence rate of COVID-19-associated neurologic disease was lowest during the late Omicron era.</h3><h3><b>Conclusions: </b>Neurologic complications among COVID-19 hospitalized children are relatively frequent. While most neurologic complications are transient, including seizures, encephalitis remains a cause of significant morbidity. Children with pre-existing neurologic disease and other comorbidities are at higher risk.</h3><p></p>