Prevalence and clinical presentation of long COVID in children: a systematic review

Pellegrino, Roberta; Chiappini, Elena; Licari, Amelia; Galli, Luisa

doi:10.1007/s00431-022-04600-x

Cited by 92 publications

(95 citation statements)

References 51 publications

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“…These authors did not stratify analyses by study design and pointed out the considerable risk of bias in particular because of the lack of standardised definitions of symptoms and a high level of heterogeneity [ 16 ]. Two recent systematic reviews including studies up to early 2022 reported rates of post-COVID syndrome in children ranging from 0% to 70% [ 52 , 53 ]. One of these reviews highlighted the critical risk of bias across studies, mostly due to confounding [ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Short and Long-Term Wellbeing of Children following SARS-CoV-2 Infection: A Systematic Review

Franco

Garegnani²,

Oltra³

et al. 2022

IJERPH

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Post-COVID conditions in children and adolescents were mostly investigated as the incidence of individual or clusters of symptoms. We aimed to describe the findings of studies assessing key outcomes related to global wellbeing and recovery in children and adolescents from a public health perspective. We searched the Cochrane COVID-19 Study Register and WHO COVID-19 Global literature on coronavirus disease database on 5 November 2021 and tracked ongoing studies published after this date. We included observational studies on children and adolescents with a follow-up greater than 12 weeks and focused on the outcomes of quality of life, recovery/duration of symptoms, school attendance and resource use/rehabilitation. We assessed their methodological quality, and we prepared a narrative synthesis of the results. We included 21 longitudinal and 4 cross-sectional studies (6 with a control group) with over 68 thousand unvaccinated children and adolescents with mostly asymptomatic or mild disease. Study limitations included convenience sampling, a poor description of their study population and heterogeneous definitions of outcomes. Quality of life was not largely affected in adolescents following COVID-19, but there might be greater impairment in young children and in those with more severe forms of the disease (4 studies). There might also be an impairment in daily activities and increased school absenteeism following COVID-19, but the findings were heterogeneous (5 studies). A total of 22 studies provided highly variable estimates based on heterogeneous definitions of overall persistence of symptoms (recovery), ranging from 0 to 67% at 8–12 weeks and 8 to 51% at 6–12 months. We found limited data on resource use and the need for rehabilitation. One controlled study indicated that the quality of life of infected children and adolescents might not substantially differ from controls. All controlled studies found a higher burden of persistent symptoms in COVID-19 cases compared with test-negative controls or cases of influenza. There is limited evidence on the short and long-term well-being of children following SARS-CoV-2 infection. High-quality longitudinal studies with control groups are needed to describe the outcomes in this population, especially in vaccinated children and those affected by new variants of the virus.

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Section: Discussionmentioning

confidence: 99%

Short and Long-Term Wellbeing of Children following SARS-CoV-2 Infection: A Systematic Review

Franco

Garegnani²,

Oltra³

et al. 2022

IJERPH

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“…When compared with adults, PASC in children may present with a milder clinical course 21 , leading to underdiagnosis in the health care setting. Some effects of PASC may have been seen in school performance or extracurricular participation, neither of which may have been captured in the HER.…”

Section: Discussionmentioning

confidence: 99%

A machine learning-based phenotype for long COVID in children: an EHR-based study from the RECOVER program

Lorman

Razzaghi

Xing

et al. 2022

Preprint

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Background As clinical understanding of pediatric Post-Acute Sequelae of SARS CoV-2 (PASC) develops, and hence the clinical definition evolves, it is desirable to have a method to reliably identify patients who are likely to have post-acute sequelae of SARS CoV-2 (PASC) in health systems data. Methods and Findings In this study, we developed and validated a machine learning algorithm to classify which patients have PASC (distinguishing between Multisystem Inflammatory Syndrome in Children (MIS-C) and non-MIS-C variants) from a cohort of patients with positive SARS- CoV-2 test results in pediatric health systems within the PEDSnet EHR network. Patient features included in the model were selected from conditions, procedures, performance of diagnostic testing, and medications using a tree-based scan statistic approach. We used an XGboost model, with hyperparameters selected through cross-validated grid search, and model performance was assessed using 5-fold cross-validation. Model predictions and feature importance were evaluated using Shapley Additive exPlanation (SHAP) values. Conclusions The model provides a tool for identifying patients with PASC and an approach to characterizing PASC using diagnosis, medication, laboratory, and procedure features in health systems data. Using appropriate threshold settings, the model can be used to identify PASC patients in health systems data at higher precision for inclusion in studies or at higher recall in screening for clinical trials, especially in settings where PASC diagnosis codes are used less frequently or less reliably. Analysis of how specific features contribute to the classification process may assist in gaining a better understanding of features that are associated with PASC diagnoses.

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“…Lastly, long COVID in children is an emerging concern [ 10 ]. There is a pressing need for studies to look at this outcome as well.…”

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confidence: 99%

Looking Back at the COVID-19 Pandemic in Children

Singhal

2022

Indian J Pediatr

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attributable to COVID-19, unlike other published studies. The study results would have been even more meaningful if the characteristics of this cohort of 65 children had been discussed in greater detail, including risk factors for mortality and severe disease.Vishwa et al. reported no significant difference in profile, severity, and outcome between the two waves. This has been the experience elsewhere as well. In a cohort of 82,798 US children between March 2020 and December 2021, the adjusted odds for severe disease did not change over time, including during the delta variant [7]. Interestingly though, in a study from Brazil in 21,000 hospitalized children < 20 y, hypoxemia, intensive care admissions, and the need for invasive ventilation were significantly higher during the gamma variant as compared to the first wave [8].And what about omicron? A Japanese study, which compared COVID-19 disease in hospitalized children between the delta-predominant period (n = 458) and the omicronpredominant period (n = 398) reported a higher incidence of fever and seizures in the latter but no difference in severity of the disease; no deaths were reported in either wave [9].Lastly, long COVID in children is an emerging concern [10]. There is a pressing need for studies to look at this outcome as well.

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Prevalence and clinical presentation of long COVID in children: a systematic review

Cited by 92 publications

References 51 publications

Short and Long-Term Wellbeing of Children following SARS-CoV-2 Infection: A Systematic Review

Short and Long-Term Wellbeing of Children following SARS-CoV-2 Infection: A Systematic Review

A machine learning-based phenotype for long COVID in children: an EHR-based study from the RECOVER program

Looking Back at the COVID-19 Pandemic in Children

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