Some children in need of neurodevelopmental review after picornavirus CNS infection

A parent-administered assessment of children with a history of early picornavirus infection of the central nervous system (CNS) has identified a subgroup that needs formal neurodevelopmental review, reports a recent study.

In this analysis, the authors asked parents of children who presented between 2014 and 2019, underwent a lumbar puncture, and whose cerebrospinal fluid was polymerase chain reaction-positive for enteroviruses (EV) or parechoviruses (hPeV) to complete a caregiver-administered neurodevelopmental assessment tool, The Ages and Stages Instrument (ASQ3).

The authors then collected clinical data of the infective episode from patient notes.

One hundred one children participated, of whom 43 (10 hPeV+, 33 EV+) submitted ASQ3 results. Median age at assessment was 38.9 months (interquartile range [IQR], 15.4–54.8), with follow-up interval of 3 years (median 37 months; IQR range, 13.9–53.1).

Age, inflammatory markers, and cerebrospinal fluid pleocytosis during the infective event did not correlate with ASQ3 scores. No neurodevelopmental concerns arose in 23 children (17 EV+, six hPeV+).

Two participants had pre-existing developmental delay and were thus excluded. Of the 41 children left, 18 (43.9 percent) reported ASQ3 scores suggesting need for monitoring or professional review in at least one category, not differing by pathogen (EV 14/31, 45.2 percent; hPeV 4/10, 40 percent; p=0.71).

Formal review is warranted in seven children, scoring ≥2 SD below the mean in at least one category (6/31 EV+, 1/10 hPeV+; p=0.07) while three scored ≥2 SD below the mean in more than one area.

“Wider application of community-based developmental screening will complement our understanding of the impact of CNS infections in early childhood,” the authors said.