Investigation of the incidence and clinical features of acute sequelae of COVID-19 in children and adolescents

Previous studies have reported a wide range of clinical manifestations associated with the acute aftereffects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC) infection.

In a recent study published in medRxiv * Preprint server, researchers identify symptoms and systematic conditions associated with PASC in children. Researchers also identify risk factors associated with PASC in this patient population and treat children and adolescents with PASC 1-6 months after recovery from coronavirus disease 2019 (COVID-19). I investigated the drugs used in.

study: Clinical features and burden of acute sequelae of SARS-CoV-2 infection in children and adolescents: an exploratory EHR-based cohort study from the RECOVER program.. Image Credits: FamVeld / Shutterstock.com

Background

PASC is defined as persistent or recurrent symptoms or the emergence of new health problems after recovery from SARS-CoV-2 infection. These symptoms persist for a long time after the initial infection. Researchers have observed that some of the clinical symptoms of PASC are more serious than others.

Many studies have characterized adult PASCs with respect to persistent and recurrent nonspecific symptoms such as headache, malaise, and shortness of breath. However, the evidence to explain PASC in children is still lacking, except for the studies that explain it. Pediatric multisystem inflammatory syndrome (MIS-C).

Therefore, there is an urgent need to understand the clinical symptoms and duration of PASC in children. This information can help standardize the definitions and data collection methods associated with PASC in children.

About research

The current retrospective cohort study is part of the COVID (RECOVER) initiative that promotes recovery at the National Institutes of Health (NIH), which focuses primarily on the treatment and prevention of PASC.

In this study, researchers obtained electronic health record (EHR) data from PEDSnet. This is a multicenter clinical research network that contains EHR data from many of the major children’s healthcare facilities in the United States. PEDSnet contains relevant data for over 8 million inpatient and outpatient pediatric patients.

Survey results

Similar clinical symptoms were reported in children and adolescents with PASC as adults with this condition. Symptoms include chest pain, changes in taste and smell, cardiorespiratory symptoms, fever, and malaise. Interestingly, several other features were particularly observed in the pediatric population, some of which included hair loss, abnormal liver enzymes, diarrhea, and skin rashes.

Syndrome PASC function associated with SARS-CoV-2 infection.. 95% CI associated with patients tested positive for SARS-CoV-2 infection using the Cox proportional hazards model and patients tested negative for the risk of characteristic features of each syndrome Adjusted hazard ratio (aHR). The model was adjusted for age, gender, race / ethnicity, facility, location of inspection site, presence of complex medical conditions, and date of admission to the cohort.

Increased incidence of tonsillitis, pneumonia, and bronchiolitis has been reported in children infected with SARS-CoV-2. In terms of systemic features, myocarditis was also strongly associated with SARS-CoV-2 infection. This condition has been identified as an important complication in the pediatric population.

Researchers estimated that the PASC burden unrelated to MIS-C was 3.7%. For this estimation, they calculated the difference in the incidence of clinically predicted and empirically supported PASC function between the COVID-19 positive and negative groups.

This percentage reflects systematic, symptomatic, or dosing-related PASC function in the study cohort. However, this estimate should be considered a preliminary assessment, as the calculations are based solely on EHR data that depend on the clinician’s coding practices.

The likelihood of PASC in children infected with SARS-CoV-2 is associated with the severity of the disease. This finding is consistent with previous studies showing an increased risk of PASC with acute COVID-19.

It has been reported that children have a lower incidence of PASC than adults. This finding is different from previous studies that reported a high frequency of PASC in children. In particular, these early studies tended to be a systematic selection bias of cases due to the absence of relevant controls.

The measurable burden of PASC is in adults and children due to the lack of evidence to recognize PASC-related symptoms in children and the lack of documentation to elucidate the differences in immune responses in children associated with PASC. it’s different.

Advantages and limitations

One of the key strengths of this study was the inclusion of children and adolescents in the cohort who were confirmed to be COVID-19 positive based on the reverse transcription-polymerase chain reaction (RT-PCR) test. Similarly, the control group included RT-PCR-negative children with minimal bias.

Another strength is the inclusion of children from different geographic locations throughout the United States. In addition, the study cohort included both outpatients and inpatients.

One of the limitations of this study is the EHR-based study cohort, which relies on the clinician’s practice. Therefore, the study cohort may have missed some relevant records stored in laboratory, radiology, and unstructured textual data. Therefore, the true burden of PASC may be underestimated based on EHR data.

Another limitation of this study is to include individuals tested positive for COVID-19 in the control group outside the health care system considered. Despite the fact that COVID-19 affected the minority disproportionately, no ethnic risk factors were determined for PASC.

*Important Notices

medRxiv publishes unpeer-reviewed preliminary scientific reports and should not be considered definitive, guide clinical / health-related behaviors, or be treated as established information.