Comparative study showed that children faced a 78% higher risk of new-onset conditions after they had COVID-19, 2023, Di Chiara et al

Comparative study showed that children faced a 78% higher risk of new-onset conditions after they had COVID-19

Abstract
Aim
Children have largely been unaffected by severe COVID-19 compared to adults, but data suggest that they may have experienced new conditions after developing the disease. We compared outcomes in children who had experienced COVID-19 and healthy controls.

Methods
A retrospective nested cohort study assessed the incidence rate of new-onset conditions after COVID-19 in children aged 0–14 years. Data were retrieved from an Italian paediatric primary care database linked to Veneto Region registries. Exposed children with a positive nasopharyngeal swab were matched 1:1 with unexposed children who had tested negative. Conditional Cox regression was fitted to estimate the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for the exposure and outcome associations after adjusting for covariates.

Results
We compared 1656 exposed and 1656 unexposed children from 1 February 2020 to 30 November 2021. The overall excess risk for new-onset conditions after COVID-19 was 78% higher in the exposed than unexposed children. We found significantly higher risks for some new conditions in exposed children, including mental health issues (aHR 1.8, 95% CI 1.1–3.0) and neurological problems (aHR 2.4, 95% CI 1.4–4.1).

Conclusion
Exposed children had a 78% higher risk of developing new conditions of interest after COVID-19 than unexposed children.

https://onlinelibrary.wiley.com/doi/10.1111/apa.16966

 

The following classification was used.

Neurological: Focal deficits, Hearing loss, Seizures, Cognitive impairment, including attention deficits (ADHD), amnestic problems, learning disabilities in children, Visual impairment, Headache (migraine), Asthenia or Fatigue, Vertigo, Motor impairment, including palsy

Mental health: Anxiety, Depression, Mood disorder, Disturbance of emotions specific to childhood and adolescence, Sleep disorders, including insomnia and hypersomnia, Hyperkinetic syndrome of childhood, Developmental disorders, Behavior disorders, Eating disorders, including nervous anorexia and bulimia, Communication disorder

Metabolic: Overweight, Metabolic syndrome, Poor growth, Hyperglycemia or diabetes, Hyper or hypothyroidism

Musculoskeletal: Persistent muscle pain, Joint pain or swelling

Respiratory: Nasal congestion/ rhinorrhea, Persistent cough, Asthma or wheezing

Cardiovascular: Palpitations, Chest tightness or pain

Gastrointestinal: Constipation, Stomach/abdominal pain, Diarrhea

Other: Altered smell and taste, Skin rashes

 

While it's possible that there's a real change in immune system responses which leads to decreased chances of fighting off infections, I'm guessing that this is an artifact of questionnaires designed to produce desired numbers.

 

I also think they did well in not overestimating things, using good controls, excluding children with pre-existing pathologies, validated everything by two paediatricians and a third one in case of uncertainty. Furthermore outpatient visits, specialist visits and even antibiotic courses are extremely well matched. Unless I am missing something, I can only interpret these numbers as underrepresentation given asymptomatic infections or infections that are not picked up by RATs. Of course the sample size could be bigger and less regionally dependent, but for what was done it looks pretty good compared to almost all other studies.

Interestingly there were no sex differences.