Objective To analyze the clinical characteristics and neuroimaging features of severe neurological compli-cations associated with Omicron variant of COVID-19,aiming to improve the understanding of disease.Methods Clinical and imaging data of 17 patients with COVID-19 infection complicated with severe neurological complications from Shenzhen Children's Hospital from December 2022 to January 2023 were retrospectively analyzed.They were divided into death group and survival group according to the prognosis.Chi-square test was used for comparison between qualitative data groups,and t-test(normal distribution)or rank-sum test(skewed distribution)was used for quantitative data.Results In the death group,there were 10 cases,5 cases of acute fulminant cerebral edema(AFCE),4 cases of acute necrotizing encephalopathy(ANE)and 1 case of encephalitis.In the survival group,there were 7 cases,3 cases of ANE and 4 cases of encephalitis.The incidence of brain stem involvement in the death group was significantly higher than survival group(P = 0.009).The results of laboratory examination showed that PCT,IL-6,ALT,AST,LDH,D-D,TT and FDP in the death group were higher than those in the survival group(P<0.05).The proportions of cerebral hernia,MODS,myocardial injury,respiratory failure and DIC in death group were significantly higher than those in survival group(P<0.05).Conclusion Omicron variant is associated with a high mortality rate of severe neurological complications in children.Children with febrile onset,rapidly convulsions and disturbance of consciousness,need to be on high alert for ANE and AFCE.Medulla involvement is an im-portant characteristic of AFCE.
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