Long COVID in children and adolescents: COVID-19 follow-up results in third-level pediatric hospital 2023 del Carmen Jamaica Balderas et al

[Andy]

Introduction: In children, the manifestations of coronavirus disease 2019 (COVID-19) in the acute phase are considered mild compared with those in adults; however, some children experience a severe disease that requires hospitalization. This study was designed to present the operation and follow-up results of the Post-COVID-19 Detection and Monitoring Sequels Clinic of Hospital Infantil de Mexico Federico Gómez in managing children with a history of SARS-CoV-2 infection.

Methods: This was a prospective study conducted from July 2020 to December 2021, which included 215 children aged 0–18 years who tested positive for SARS-CoV-2 on polymerase chain reaction and/or immunoglobulin G test. The follow-up was conducted in the pulmonology medical consultation; ambulatory and hospitalized patients were assessed at 2, 4, 6, and 12 months.

Results: The median age of the patients was 9.02 years, and neurological, endocrinological, pulmonary, oncological, and cardiological comorbidities were the most commonly observed among the patients. Moreover, 32.6% of the children had persistent symptoms at 2 months, 9.3% at 4 months, and 2.3% at 6 months, including dyspnea, dry cough, fatigue, and runny nose; the main acute complications were severe pneumonia, coagulopathy, nosocomial infections, acute renal injury, cardiac dysfunction, and pulmonary fibrosis. The more representative sequelae were alopecia, radiculopathy, perniosis, psoriasis, anxiety, and depression.

Conclusions: This study showed that children experience persistent symptoms, such as dyspnea, dry cough, fatigue, and runny nose, although to a lesser extent than adults, with significant clinical improvement 6 months after the acute infection. These results indicate the importance of monitoring children with COVID-19 through face-to-face consultations or telemedicine, with the objective of offering multidisciplinary and individualized care to preserve the health and quality of life of these children.

Open access, https://www.frontiersin.org/articles/10.3389/fped.2023.1016394/full

 

[Hutan]

Prospective studies like this have tremendous potential to tell us about recovery rates. But, this is a 'tertiary' hospital and the abstract and method does not make it clear how the children came to be assessed. It therefore seems likely that this sample was not an unbiased population sample. I don't know why these sorts of studies so often fail to make clear how the sample was selected.

215 children aged 0–18 years who tested positive for SARS-CoV-2 on polymerase chain reaction (PCR) and/or immunoglobulin G test.

It sounds as though most children at this clinic with a positive test were included in the study.

For this study, the following definitions were established: long COVID: the persistence of symptoms for more than 12 weeks after acute SARS-CoV-2 infection (12); mild cases: upper airway symptoms without pneumonia; moderate cases: mild pneumonia without acute respiratory insufficiency; severe cases: pneumonia with respiratory insufficiency that requires noninvasive ventilation; and critical cases: respiratory failure requiring mechanical ventilation or the presence of shock or organ failure (13).

The first consultation is described as a pulmonary consultation at 2 months.

Moreover, 67.4% of the patients had neurological (8.8%), endocrinological (7.9%), pulmonary and oncological (7.4%), and cardiological (5.6%) comorbidities, and 14.9% had genetic, dermatological, urological, and orthopedic comorbidities. Of the 215 patients, 50.7% had mild disease, 26% had moderate disease, 14.9% had severe disease, and 8.4% had MIS-C (Multisystem Inflammatory Syndrome in Children)

Then, 63.7% required In-patient treatment, 25.5% requires an intensive care unit support, and 14.4% were discharged but were oxygen-dependent.

I think we have to conclude that this sample is not representative; these children mostly had pretty significant cases of Covid-19.

The main acute complications were severe pneumonia (14.8%), coagulopathy (3.7%), nosocomial infections (1.9%), acute renal injury (1.3%), cardiac dysfunction (1.3%), and pulmonary fibrosis (0.5%). The more representative sequelae were alopecia (2.3%), radiculopathy (1%), perniosis (0.5%), psoriasis (0.5%), anxiety (0.5%), and depression (0.5%)

 

[Hutan]

Only one young person out of the 215 was recorded as having depression; only one was recorded as having anxiety. Both, or perhaps the same person, had moderate disease. Only one person out of the 215 was recorded as having behaviour change. Quite a lot of these children had severe Covid or comorbidities - these stressful experiences did not seem to cause mood disorders. The parents on the other seemed to have (understandable) worries.

however, it was observed that some parents of patients with mild COVID did not show up for consultation due to anxiety and fear of reinfection, which could reduce the cases of mild COVID in our study, contrary to the parents of patients with severe COVID, where post-traumatic stress and anxiety about the severity of the disease led them to a greater commitment to the study in question.

There is no data provided on the numbers of children attending each phase of assessment. From a later comment, it looks like the drop out rate was substantial.

Only 6.5% had fatigue at 2 months; 2.3% at 4 months and 0% at subsequent consultations. There is nothing there about exercise intolerance.

This study seems to have been focused on lung symptoms. I guess it was a pulmonary clinic - you have a hammer and the world looks like a nail.

From the discussion:

This study showed that on third of the children had persistent symptoms at 2 months, including dyspnea, dry cough, fatigue, and runny nose. These findings are consistent with those reported in other pediatric studies, where between 8% and 58% of children who test positive for SARS-CoV-2 experience symptoms of long COVID. However, because a control group was not included, there is a risk of overestimating the prevalence of long COVID (2). In a prospective study in the United Kingdom, where 1,735 cases and controls were included, a prevalence rate of 3.5% was reported (14). Moreover, a Danish study that included 37,522 children aged 0–17 years who tested positive for SARS-CoV-2 on PCR and 78,037 randomly selected controls who tested negative for SARS-CoV-2 reported a prevalence rate of 2.8% in children aged 0–5 years and 0.8% in children aged 6–17 years [2)]. These findings reflect the need to conduct a study with controls in our setting to predict more reliable prevalence.

Basically the international data on Long Covid in children is a mess. I don't think this study makes anything much clearer.

From the conclusion:

The main acute complications were found to be severe pneumonia, nosocomial infection, coagulopathy, acute kidney injury, and heart failure; moreover, the sequelae observed included hair loss, radiculopathy, perniosis, psoriasis, depression, and anxiety.

the inclusion of some of those sequelae, including depression and anxiety is just ridiculous - as I noted, only one out of 215 patients is recorded as having depression and one out of 215 patients is recorded as having anxiety.

Yeah, disappointing.