Postacute Sequelae of SARS-CoV-2 in Children

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.

EHR-based Case Identification of Pediatric Long COVID: A Report from the RECOVER EHR Cohort

“…Symptoms can range from fatigue and headache to loss of taste and smell and chest pain 4-9 . Although rare, diagnosed conditions associated with Long COVID include myocarditis, myositis, postural tachycardia syndrome (POTS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), among other conditions 10 . Despite certain symptoms and conditions clearly attributable to a SARS-CoV-2 infection, like multisystem inflammatory syndrome (MIS-C), much remains to be understood about others 11-12 .…”

Post-acute and Chronic Kidney Function Outcomes of COVID-19 in Children and Adolescents: An EHR Cohort Study from the RECOVER Initiative

“…While initially recognized predominantly among adults, the emergence of PASC has raised questions about its impact on the pediatric population. In the United States, PASC has affected 5-10% of children, which is comparable to adults (6.9%) 5,6 . However, there are important differences in the presentation and outcomes of acute SARS-CoV-2 infection between children and adults.…”