TY - JOUR
T1 - Post-COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection
AU - The Pediatric Emergency Research Network COVID-19 Study Team
AU - Funk, Anna L.
AU - Kuppermann, Nathan
AU - Florin, Todd A.
AU - Tancredi, Daniel J.
AU - Xie, Jianling
AU - Kim, Kelly
AU - Finkelstein, Yaron
AU - Neuman, Mark I.
AU - Salvadori, Marina I.
AU - Yock-Corrales, Adriana
AU - Breslin, Kristen A.
AU - Ambroggio, Lilliam
AU - Chaudhari, Pradip P.
AU - Bergmann, Kelly R.
AU - Gardiner, Michael A.
AU - Nebhrajani, Jasmine R.
AU - Campos, Carmen
AU - Ahmad, Fahd A.
AU - Sartori, Laura F.
AU - Navanandan, Nidhya
AU - Kannikeswaran, Nirupama
AU - Caperell, Kerry
AU - Morris, Claudia R.
AU - Mintegi, Santiago
AU - Gangoiti, Iker
AU - Sabhaney, Vikram J.
AU - Plint, Amy C.
AU - Klassen, Terry P.
AU - Avva, Usha R.
AU - Shah, Nipam P.
AU - Dixon, Andrew C.
AU - Lunoe, Maren M.
AU - Becker, Sarah M.
AU - Rogers, Alexander J.
AU - Pavlicich, Viviana
AU - Dalziel, Stuart R.
AU - Payne, Daniel C.
AU - Malley, Richard
AU - Borland, Meredith L.
AU - Morrison, Andrea K.
AU - Bhatt, Maala
AU - Rino, Pedro B.
AU - Beneyto Ferre, Isabel
AU - Eckerle, Michelle
AU - Kam, April J.
AU - Chong, Shu Ling
AU - Palumbo, Laura
AU - Kwok, Maria Y.
AU - Cherry, Jonathan C.
AU - Poonai, Naveen
AU - Wassem, Muhammad
AU - Simon, Norma Jean
AU - Freedman, Stephen B.
N1 - Funding Information:
Funding/Support: This study was supported by grants from the Canadian Institutes of Health Research (operating grant: COVID-19–clinical management); 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. Dr Funk is supported by the University of Calgary Eyes-High PostDoctoral Research Fund. Dr Freedman is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness.
Funding Information:
Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Funk, Tancredi, Xie. Obtained funding: Funk, Kuppermann, Florin, Freedman. Administrative, technical, or material support: Kuppermann, Florin, Shah, Becker, Poonai, Freedman. Supervision: Kuppermann, Florin, Freedman. Conflict of Interest Disclosures: Dr Kuppermann reported receiving grants from University of Califonia, Davis during the conduct of the study. Dr Florin reported receiving grants from Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grant Program during the conduct of the study. Dr Tancredi reported receiving personal fees from International Flavors & Fragrances Inc for statistical consulting outside the submitted work. Dr Ambroggio reported receiving grants from Pfizer Inc outside the submitted work. Dr Morris reported having a patent pending for therapies for the treatment of coronoviruses. Dr Freedman reported receiving grants from 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 during the conduct of the study. No other disclosures were reported.
Publisher Copyright:
© 2022 American Association of Physics Teachers. All rights reserved.
PY - 2022/7/22
Y1 - 2022/7/22
N2 - Importance: Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. Objectives: To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. Design, Setting, and Participants: This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. Exposure: SARS-CoV-2 detected via nucleic acid testing. Main Outcomes and Measures: Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. Results: Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). Conclusions and Relevance: In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.
AB - Importance: Little is known about the risk factors for, and the risk of, developing post-COVID-19 conditions (PCCs) among children. Objectives: To estimate the proportion of SARS-CoV-2-positive children with PCCs 90 days after a positive test result, to compare this proportion with SARS-CoV-2-negative children, and to assess factors associated with PCCs. Design, Setting, and Participants: This prospective cohort study, conducted in 36 emergency departments (EDs) in 8 countries between March 7, 2020, and January 20, 2021, included 1884 SARS-CoV-2-positive children who completed 90-day follow-up; 1686 of these children were frequency matched by hospitalization status, country, and recruitment date with 1701 SARS-CoV-2-negative controls. Exposure: SARS-CoV-2 detected via nucleic acid testing. Main Outcomes and Measures: Post-COVID-19 conditions, defined as any persistent, new, or recurrent health problems reported in the 90-day follow-up survey. Results: Of 8642 enrolled children, 2368 (27.4%) were SARS-CoV-2 positive, among whom 2365 (99.9%) had index ED visit disposition data available; among the 1884 children (79.7%) who completed follow-up, the median age was 3 years (IQR, 0-10 years) and 994 (52.8%) were boys. A total of 110 SARS-CoV-2-positive children (5.8%; 95% CI, 4.8%-7.0%) reported PCCs, including 44 of 447 children (9.8%; 95% CI, 7.4%-13.0%) hospitalized during the acute illness and 66 of 1437 children (4.6%; 95% CI, 3.6%-5.8%) not hospitalized during the acute illness (difference, 5.3%; 95% CI, 2.5%-8.5%). Among SARS-CoV-2-positive children, the most common symptom was fatigue or weakness (21 [1.1%]). Characteristics associated with reporting at least 1 PCC at 90 days included being hospitalized 48 hours or more compared with no hospitalization (adjusted odds ratio [aOR], 2.67 [95% CI, 1.63-4.38]); having 4 or more symptoms reported at the index ED visit compared with 1 to 3 symptoms (4-6 symptoms: aOR, 2.35 [95% CI, 1.28-4.31]; ≥7 symptoms: aOR, 4.59 [95% CI, 2.50-8.44]); and being 14 years of age or older compared with younger than 1 year (aOR, 2.67 [95% CI, 1.43-4.99]). SARS-CoV-2-positive children were more likely to report PCCs at 90 days compared with those who tested negative, both among those who were not hospitalized (55 of 1295 [4.2%; 95% CI, 3.2%-5.5%] vs 35 of 1321 [2.7%; 95% CI, 1.9%-3.7%]; difference, 1.6% [95% CI, 0.2%-3.0%]) and those who were hospitalized (40 of 391 [10.2%; 95% CI, 7.4%-13.7%] vs 19 of 380 [5.0%; 95% CI, 3.0%-7.7%]; difference, 5.2% [95% CI, 1.5%-9.1%]). In addition, SARS-CoV-2 positivity was associated with reporting PCCs 90 days after the index ED visit (aOR, 1.63 [95% CI, 1.14-2.35]), specifically systemic health problems (eg, fatigue, weakness, fever; aOR, 2.44 [95% CI, 1.19-5.00]). Conclusions and Relevance: In this cohort study, SARS-CoV-2 infection was associated with reporting PCCs at 90 days in children. Guidance and follow-up are particularly necessary for hospitalized children who have numerous acute symptoms and are older.
UR - http://www.scopus.com/inward/record.url?scp=85135066203&partnerID=8YFLogxK
U2 - 10.1001/jamanetworkopen.2022.23253
DO - 10.1001/jamanetworkopen.2022.23253
M3 - Article
C2 - 35867061
AN - SCOPUS:85135066203
SN - 2574-3805
VL - 5
JO - JAMA Network Open
JF - JAMA Network Open
IS - 7
M1 - E2223253
ER -