Rotavirus Increases Risk for Neurologic Disease, Poor Outcomes in Pediatric Patients

Pediatric patients hospitalized with rotavirus infection may be at increased risk for neurologic disease, particularly those with severe symptomology.

The risk for extraintestinal complications, particularly neurologic disease, was found to be significantly increased in pediatric patients hospitalized with rotavirus infection. These study results were published in The Journal of Infectious Diseases.

Newborns, infants, and children younger than 5 years who were hospitalized with rotavirus infection from January 2015 to December 2019 were enrolled in this case-control study. Researchers used a 1:1 matching analysis to compare patients with rotavirus infection against those without the infection (controls) on the basis of age, sex, and study center. Newborns were defined as those aged 4 weeks or younger, and infants and younger children were defined as those aged more than 4 weeks to 5 years or younger. Chi-squared and Fisher exact testing were used to analyze categorical variables and Mann-Whitney U and paired t-testing were used to analyze continuous variables. The primary objective was to assess potential associations between rotavirus infection and extraintestinal complications.

There were 1,325 patients with rotavirus infection and 1,840 in the control group, of whom 40.68% and 56.25% were boys and 40.68% and 45.43% were newborns, respectively. Cardinal motor signs of rotavirus infection, such as vomiting, fever, diarrhea, and dehydration, were significantly more common among patients with vs without the infection (P <.001).

Rotavirus infection and subsequent consequences might lead to poor clinical outcome during hospitalization.

Stratified by age, the risk for neurologic disease among newborns (odds ratio [OR], 2.64; 95% CI, 1.57-4.44) and infants and younger children (OR, 1.73; 95% CI, 1.34-2.24) was significantly increased among those in the rotavirus vs control groups (both P <.001). Further analysis showed exposure to rotavirus increased the risk for hepatobiliary disease among infants and younger children with mild gastroenteritis (OR, 1.75; 95% CI, 1.20-2.57). Rotavirus exposure also increased the risk for cardiovascular disease (OR, 1.82; 95% CI, 1.28-259), as well as respiratory illness in newborns (OR, 1.47; 95% CI, 1.18-1.84). However, after adjustments for confounders, no associations between rotavirus exposure and hepatobiliary disease or respiratory illness were observed.

A downward change in cumulative hospital discharge rates was found to be associated with the development of hepatobiliary disease (hazard ratio [HR], 0.74; 95% CI, 0.63-0.87; P <.001) and respiratory illness (HR, 0.91; 95% CI, 0.82-1.01; P =.10). Owing to these findings, the researchers noted a potential association between rotavirus-induced extraintestinal complications and poor clinical outcomes.

Limitations of this study include potential selection bias. In addition, viral genotypes were not identified and some patients were infected with other viruses and/or bacteria.

Based on these findings, “Rotavirus infection and subsequent consequences might lead to poor clinical outcome during hospitalization,” the researchers concluded.


Xu X, Luo Y, He C, et al. Increased risk of neurological disease following pediatric rotavirus infection: a two-center case-control study. J Infect Dis. Published online December 15, 2022. doi:10.1093/infdis/jiac486