Post-COVID-19 conditions (PCCs), aligning with what’s come to be known as long COVID, persisted at 3 months for many children who sought emergency care for acute illness, according to an international pediatric hospital network study.
Out of 1,884 children diagnosed with COVID-19 infections who received a 90-day follow-up, 5.8% of those who had been seen in the emergency department or hospital for COVID-19 reported PCCs, most often fatigue or weakness, cough, shortness of breath, and other respiratory symptoms.
This percentage was higher among children who had been hospitalized, with 9.8% reporting PCC symptoms, compared with 4.6% among those discharged from the emergency department, reported Stephen Freedman, MDCM, MSc, of the Alberta Children’s Hospital Research Institute in Calgary, and colleagues in JAMA Network Open.
A matched analysis comparison showed similar symptoms in 5.0% of hospitalized children without SARS-CoV-2 infections and 2.7% of non-hospitalized children without SARS-CoV-2 infections.
While the rate of long COVID was lower in their study than previously reported for adults, the risk factor findings match with previous research surrounding PCCs in adult patients, indicating that children face similar hurdles, the researchers suggested.
Children who had four or more symptoms at the time of their emergency department visit, were hospitalized for 48 or more hours, or were 14 years and older were more likely to report PCCs.
PCCs were more common for patients with more index emergency department visit symptoms, rising from 4.7% among those hospitalized with one to three symptoms to 22.7% in those hospitalized with seven or more symptoms and from 1.5% to 11.2%, respectively, in non-hospitalized patients.
“Unfortunately, there are no known therapies for long COVID in children and more research is needed in this area,” said Todd Florin, MD, MSCE, of Lurie Children’s Hospital of Chicago, in a press release. “However, if symptoms are significant, treatment targeting the symptoms is most important. Multidisciplinary care is warranted if symptoms are impacting quality of life.”
Findings on PCCs among children haven’t been consistent and remain “poorly described,” the group said. “Early reports estimated that 25% to 58% of children experienced PCCs months after their acute illnesses and occurrence was not associated with disease severity,” wrote Freedman and coauthors. “However, a subsequent study that included primarily non-hospitalized, SARS-CoV-2–positive children reported that only 4% were symptomatic 28 days after being tested and 2% were symptomatic 56 days after being tested.”
They added that the “lower PCC prevalence in our study may reflect a higher follow-up rate and thus lower risk of bias and our use of different approaches to eliciting PCCs.”
Regardless of the exact prevalence, it’s higher than seen in uninfected children, they concluded.
Their data was taken from 39 different pediatric emergency departments within the Pediatric Emergency Research Network, and spanned from March 7, 2020, to Jan. 20, 2021. Children participated with guardian consent from a total of eight different countries: the U.S., Italy, Paraguay, Singapore, Argentina, Canada, Costa Rica, and Spain.
The average age of patients was 3 years old, and 52.8% of the group were male.
The association with age “may reflect the fact that younger, less-verbal children are less likely to report specific symptoms, compared with verbal teenagers,” the researchers wrote. The findings were also “consistent with research in adults that found that the presence of five or more symptoms during the acute illness was associated with PCCs.”
Limitations included the inability to draw causal conclusions, such that the associations might not have been specific to SARS-CoV-2 infection and “may reflect the association that infection has with perception of symptoms.” Also, there was no follow-up antibody testing, and the findings predated emerging SARS-CoV-2 variants of concern and might not extrapolate to children who do not seek emergency department care.
Disclosures
The study was supported by grants from the Canadian Institutes of Health Research, the Alberta Health Services–University of Calgary–Clinical Research Fund, the Alberta Children’s Hospital Research Institute, the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California Davis, and the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grants Program.
Freedman reported reported relationships with the Canadian Institutes of Health Research, the Alberta Health Services–University of Calgary, the Alberta Children’s Hospital Research Institute, and the Alberta Children’s Hospital Foundation. Florin reported a relationship with the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grant Program. Other coauthors reported relationships with International Flavors & Fragrances and Pfizer, and a patent pending for therapies for the treatment of coronaviruses.