Post–COVID-19 Condition in Children 6 and 12 Months After Infection
Authors: Dun-Dery Frederick , Xie Jianling , Winston Kathleen , Burstein Brett , Gravel Jocelyn , Emsley Jason , Sabhaney Vikram , Zemek Roger , Berthelot Simon , Beer Darcy , Kam April , Freire Gabrielle , Mater Ahmed , Porter Robert , Poonai Naveen , Moffatt Anne , Dixon Andrew , Salvadori Marina I. , Freedman Stephen B. ,   Pediatric Emergency Research Canada (PERC) COVID Study Group, Wright Bruce , Crawford Tyrus , Alqurashi Waleed , Ali Samina 
Published: December 2023

Importance

There is a need to understand the long-term outcomes among children infected with SARS-CoV-2.

Objective

To quantify the prevalence of post–COVID-19 condition (PCC) among children tested for SARS-CoV-2 infection in pediatric emergency departments (EDs).

Design, Setting, and Participants

Multicenter, prospective cohort study at 14 Canadian tertiary pediatric EDs that are members of the Pediatric Emergency Research Canada network with 90-day, 6-month, and 12-month follow-up. Participants were children younger than 18 years who were tested for SARS-CoV-2 infection between August 2020 and February 2022. Data were analyzed from May to November 2023.

Exposure

The presence of SARS-CoV-2 infection at or within 14 days of the index ED visit.

Main Outcomes and Measures

Presence of symptoms and QoL reductions that meet the PCC definition. This includes any symptom with onset within 3 months of infection that is ongoing at the time of follow-up and affects everyday functioning. The outcome was quantified at 6 and 12 months following the index ED visit.

Results

Among the 5147 children at 6 months (1152 with SARS-CoV-2 positive tests and 3995 with negative tests) and 5563 children at 12 months (1192 with SARS-CoV-2 positive tests and 4371 with negative tests) who had sufficient data regarding the primary outcome to enable PCC classification, the median (IQR) age was 2.0 (0.9-5.0) years, and 2956 of 5563 (53.1%) were male. At 6-month follow-up, symptoms and QoL changes consistent with the PCC definition were present in 6 of 1152 children with positive SARS-CoV-2 tests (0.52%) and 4 of 3995 children with negative SARS-CoV-2 tests (0.10%; absolute risk difference, 0.42%; 95% CI, 0.02% to 0.94%). The PCC definition was met at 12 months by 8 of 1192 children with positive SARS-CoV-2 tests (0.67%) and 7 of 4371 children with negative SARS-CoV-2 tests (0.16%; absolute risk difference, 0.51%; 95% CI, 0.06 to 1.08%). At 12 months, the median (IQR) PedsQL Generic Core Scale scores were 98.4 (90.0-100) among children with positive SARS-CoV-2 tests and 98.8 (91.7-100) among children with negative SARS-CoV-2 tests (difference, −0.3; 95% CI, −1.5 to 0.8;P = .56). Among the 8 children with SARS-CoV-2 positive tests and PCC at 12-month follow-up, children reported respiratory (7 of 8 patients [88%]), systemic (3 of 8 patients [38%]), and neurologic (1 of 8 patients [13%]) symptoms.

Conclusions and Relevance

In this cohort study of children tested for SARS-CoV-2 infection in Canadian pediatric EDs, although children infected with SARS-CoV-2 reported increased chronic symptoms, few of these children developed PCC, and overall QoL did not differ from children with negative SARS-CoV-2 tests.