Post–COVID-19 Conditions Among Children 90 Days After SARS-CoV-2 Infection
Authors: Funk Anna L. , Kuppermann Nathan , Florin Todd A. , Tancredi Daniel J. , Xie Jianling , Kim Kelly , Finkelstein Yaron , Neuman Mark I. , Salvadori Marina I. , Yock-Corrales Adriana , Breslin Kristen A. , Ambroggio Lilliam , Chaudhari Pradip P. , Bergmann Kelly R. , Gardiner Michael A. , Nebhrajani Jasmine R. , Campos Carmen , Ahmad Fahd A. , Sartori Laura F. , Navanandan Nidhya , Kannikeswaran Nirupama , Caperell Kerry , Morris Claudia R. , Mintegi Santiago , Gangoiti Iker , Sabhaney Vikram J. , Plint Amy C. , Klassen Terry P. , Avva Usha R. , Shah Nipam P. , Dixon Andrew C. , Lunoe Maren M. , Becker Sarah M. , Rogers Alexander J. , Pavlicich Viviana , Dalziel Stuart R. , Payne Daniel C. , Malley Richard , Borland Meredith L. , Morrison Andrea K. , Bhatt Maala , Rino Pedro B. , Beneyto Ferre Isabel , Eckerle Michelle , Kam April J. , Chong Shu-Ling , Palumbo Laura , Kwok Maria Y. , Cherry Jonathan C. , Poonai Naveen , Waseem Muhammad , Simon Norma-Jean , Freedman Stephen B. ,   Pediatric Emergency Research Network–COVID-19 Study Team, Gómez-Vargas Jessica , Lerman Bethany , Chamberlain James , Owolabi Adebola , Schanche-Perret Gentil Camilla , Ringold Sofie , Perez Jocy , Vander Velden Heidi , Crawford Tyrus , Schultz Steven E , Ross Kimberly , Monroe Kathy , Stillwell Karly , Benedetti Jillian , O'Brien Sharon , Pimenta Kyle , Andrade Amia , Isacoff Adam , Sikes Kendra , Gold Nina , Reichard Kathleen , Nemetski Maureen , Avva Pavani , Mistry Rakesh , Young Shanon , Cook Marlena , Gómez Barrena Virginia , Castejón Ramírez Sandra , García Castellanos María T , Patterson Emma , Samuel Anicka , Carciurmaru Redjana , Fitzpatrick Eleanor , Bonisch Megan , Wright Bruce , Sivakumar Mithra , Candelaria Patricia , Cervantes Vincent , Manoranjithan Shaminy , Khan Nabeel , Harbour Toni , Sethuraman Usha , Spencer Priya , Gupta Neha , Kamboj Amira , Muanamputu Gael , Kohn Loncarica Guillermo , Hernández Eugenia , Dragovetzky Ana , Carlos Miguel Angelats , Torres Sylvia , Zorc Joseph , Haber Rebecca , Hiong Ren Mee , Sri Dewi Dianna , Joubert Gary , Coriolano Dasilva Kamary , Ochs Julie , Arrighini Alberto , Dallavilla Camilla , Kachelmeyer Andrea , Marty Placencia Daisy 
Published: July 2022

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.