We aim to measure the frequency of neurological sequelae in pediatric cases of infectious gastroenteritis at our institution over a 3-year period.

Neurological complications described in association with infectious gastroenteritis have been limited to seizures associated with rotavirus and Shigella sp., encephalitis in immunocompromised patients with astrovirus, and case reports/series associated with norovirus.  These neurological consequences are poorly understood for most gastrointestinal pathogens and are likely underappreciated in pediatrics.

This is a retrospective cohort study that included children hospitalized at our institution from 2014-2017 with a viral or bacterial pathogen detected on clinical testing by Filmarray Gastrointestinal Pathogen Panel (GIP), with an ICD-10 diagnosis code suggesting potential neurological sequelae. We excluded codes indicating chronic neurological disease or neurologic complications related to trauma. We performed chart review using a standardized data collection tool to characterize potential neurological sequelae associated with norovirus, rotavirus, sapovirus, adenovirus, astrovirus, Shigella, and Shiga toxin producing E. coli (STEC) detections.

Among 1,409 hospitalizations with gastrointestinal pathogens detected on GIP, neurological complications were present in 69 (4.8%).  Neurological sequelae were identified in 17/164 (10.3%) with astrovirus, 18/263 (6.8%) with sapovirus, 11/173 (6.4%) with adenovirus, 13/291 (5.9%) with rotavirus, 4/95 (4.2%) with STEC, 6/454 (1.3%) with norovirus, and 0/41 (0%) with Shigella sp..  The most common clinical presentation overall was seizure in 43/69 (62%), although astrovirus cases were more commonly associated with a focal neurological deficit, such as ataxia, 13/17 (76%). The majority of rotavirus cases were associated with seizure, 9/13 (69%), as were norovirus cases, 5/6 (83%).

Neurological complications are present in nearly 5% of infectious gastroenteritis at our institution. The frequency and clinical characteristics differ by pathogen.