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Rothensteiner M, Leeb F, Götzinger F, Tebruegge M, Zacharasiewicz A. Long COVID in Children and Adolescents: A Critical Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:972. [PMID: 39201907 PMCID: PMC11352730 DOI: 10.3390/children11080972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/03/2024]
Abstract
(1) Background: Data on persisting symptoms after SARS-CoV-2 infection in children and adolescents are conflicting. Due to the absence of a clear pathophysiological correlate and a definitive diagnostic test, the diagnosis of Long COVID currently rests on consensus definitions only. This review aims to summarise the evidence regarding Long COVID in children and adolescents, incorporating the latest studies on this topic. (2) Methods: We designed a comprehensive search strategy to capture all relevant publications using Medline via the PubMed interface, with the initial literature search conducted in April 2023. To be included, publications had to present original data and include >50 participants with Long COVID symptoms aged between 0 and18 years. (3) Results: A total of 51 studies met the inclusion criteria, with most studies originating from Europe (n = 34; 66.7%), followed by the Americas (n = 8; 15.7%) and Asia (n = 7; 13.7%). Various study designs were employed, including retrospective, cross-sectional, prospective, or ambispective approaches. Study sizes varied significantly, with 18/51 studies having fewer than 500 participants. Many studies had methodological limitations: 23/51 (45.1%) studies did not include a control group without prior COVID-19 infection. Additionally, a considerable number of papers (33/51; 64.7%) did not include a clear definition of Long COVID. Other limitations included the lack of PCR- or serology-based confirmation of SARS-CoV-2 infection in the study group. Across different studies, there was high variability in the reported prevalence of Long COVID symptoms, ranging from 0.3% to 66.5%, with the majority of studies included in this review reporting prevalences of approximately 10-30%. Notably, the two studies with the highest prevalences also reported very high prevalences of Long COVID symptoms in the control group. There was a relatively consistent trend for Long COVID prevalence to decline substantially over time. The prevalence of Long COVID appeared to differ across different paediatric age groups, with teenagers being more commonly affected than younger children. Furthermore, data suggest that children and adolescents are less commonly affected by Long COVID compared to adults. In children and adolescents, Long COVID is associated with a very broad range of symptoms and signs affecting almost every organ system, with the respiratory, cardiovascular, and neuropsychiatric systems being most commonly affected. (4) Conclusions: The heterogeneity and limitations of published studies on Long COVID in children and adolescents complicate the interpretation of the existing data. Future studies should be rigorously designed to address unanswered questions regarding this complex disease.
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Affiliation(s)
- Maria Rothensteiner
- Department of Paediatrics and Adolescent Medicine, Klinik Ottakring, 1160 Vienna, Austria
| | - Franziska Leeb
- Department of Paediatrics and Adolescent Medicine, Medical University Vienna, 1090 Wien, Austria
| | - Florian Götzinger
- Department of Paediatrics and Adolescent Medicine, Klinik Ottakring, 1160 Vienna, Austria
| | - Marc Tebruegge
- Department of Paediatrics and Adolescent Medicine, Klinik Ottakring, 1160 Vienna, Austria
- Department of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Infection, Immunity & Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London WCN1 1EH, UK
| | - Angela Zacharasiewicz
- Department of Paediatrics and Adolescent Medicine, Klinik Ottakring, 1160 Vienna, Austria
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Rao S, Gross RS, Mohandas S, Stein CR, Case A, Dreyer B, Pajor NM, Bunnell HT, Warburton D, Berg E, Overdevest JB, Gorelik M, Milner J, Saxena S, Jhaveri R, Wood JC, Rhee KE, Letts R, Maughan C, Guthe N, Castro-Baucom L, Stockwell MS. Postacute Sequelae of SARS-CoV-2 in Children. Pediatrics 2024; 153:e2023062570. [PMID: 38321938 PMCID: PMC10904902 DOI: 10.1542/peds.2023-062570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 02/08/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Rachel S. Gross
- Departments of Pediatrics
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Sindhu Mohandas
- Division of Infectious Diseases
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl R. Stein
- Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Abigail Case
- Department of Pediatrics and Rehabilitation Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benard Dreyer
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathan M. Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children’s Health, Nemours Children’s Hospital, Delaware, Wilmington, Delaware
| | - David Warburton
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Berg
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan B. Overdevest
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mark Gorelik
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Joshua Milner
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Sejal Saxena
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Rebecca Letts
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Christine Maughan
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Nick Guthe
- Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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Bakhtiari E, Moazzen N. Pulmonary function in children post -SARS-CoV-2 infection: a systematic review and meta-analysis. BMC Pediatr 2024; 24:87. [PMID: 38302891 PMCID: PMC10832141 DOI: 10.1186/s12887-024-04560-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE There are some concerns regarding long-term complications of COVID-19 in children. A systematic review and meta-analysis was performed evaluating the respiratory symptoms and pulmonary function, post-SARS-CoV-2 infection. METHODS A systematic search was performed in databases up to 30 March 2023. Studies evaluating respiratory symptoms and pulmonary function after COVID-19 infection in children were selected. The major outcomes were the frequency of respiratory symptoms and the mean of spirometry parameters. A pooled mean with 95% confidence intervals (CIs) was calculated. RESULTS A total of 8 articles with 386 patients were included in meta-analysis. Dyspnea, cough, exercise intolerance, and fatigue were the most common symptoms. The meta-mean of forced expiratory volume (FEV1) and forced vital capacity (FVC) was 101.72%, 95% CI= (98.72, 104.73) and 101.31%, 95% CI= (95.44, 107.18) respectively. The meta-mean of FEV1/FVC and Forced expiratory flow at 25 and 75% was 96.16%, 95% CI= (90.47, 101.85) and 105.05%, 95% CI= (101.74, 108.36) respectively. The meta-mean of diffusing capacity for carbon monoxide was 105.30%, 95%CI= (88.12, 122.49). There was no significant difference in spirometry parameters before and after bronchodilator inhalation. CONCLUSIONS Despite some clinical respiratory symptoms, meta-results showed no abnormality in pulmonary function in follow-up of children with SARS-CoV-2 infection. Disease severity and asthma background had not confounded this outcome.
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Affiliation(s)
- Elham Bakhtiari
- Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasrin Moazzen
- Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Socolovsky M, Lu JCY, Zarra F, Wei CK, Chang TNJ, Chuang DCC. Effects of COVID-19 Pandemic in Patients with a Previous Phrenic Nerve Transfer for a Traumatic Brachial Plexus Palsy. J Brachial Plex Peripher Nerve Inj 2024; 19:e20-e26. [PMID: 38868462 PMCID: PMC11168810 DOI: 10.1055/s-0044-1787296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024] Open
Abstract
Background With the advent of the coronavirus disease 2019 (COVID-19) pandemic, some doubts have been raised regarding the potential respiratory problems that patients who previously underwent a phrenic nerve transfer could have. Objectives To analyze the effects of the coronavirus infection on two populations, one from Argentina and another from Taiwan. Specific objectives were: (1) to identify the rate of COVID in patients with a history of phrenic nerve transfer for treatment of palsy; (2) to identify the overall symptom profile; (3) to compare Argentinian versus Taiwanese populations; and (4) to determine if any phrenic nerve transfer patients are at particular risk of more severe COVID. Methods A telephonic survey that included data regarding the number of episodes of acute COVID-19 infection, the symptoms it caused, the presence or absence of potential or life-threatening complications, and the status of COVID-19 vaccination were studied. Intergroup comparisons were conducted using the nonparametric Mann-Whitney U test, with categorical variables conducted using either the Pearson χ2 analysis or the Fisher's exact test, as appropriate. Results A total of 77 patients completed the survey, 40 from Taiwan and 37 from Argentina. Fifty-five (71.4%) developed a diagnosis of COVID. However, among these, only four had any level of dyspnea reported (4/55 = 7.3%), all mild. There were also no admissions to hospital or an intensive care unit, no intubations, and no deaths. All 55 patients isolated themselves at home. Conclusions It can be concluded that an acute COVID-19 infection was very well tolerated in our patients. (Level of evidence 3b, case reports).
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Affiliation(s)
- Mariano Socolovsky
- Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Johnny Chuieng-Yi Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Francisco Zarra
- Department of Neurosurgery, Sanatorio Guemes, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Chen Kuan Wei
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - David Chwei-Chin Chuang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Shmueli E, Bar-On O, Amir B, Mei-Zahav M, Stafler P, Levine H, Steuer G, Rothschild B, Tsviban L, Amitai N, Dotan M, Chodick G, Prais D, Ashkenazi-Hoffnung L. Pulmonary Evaluation in Children with Post-COVID-19 Condition Respiratory Symptoms: A Prospective Cohort Study. J Clin Med 2023; 12:6891. [PMID: 37959356 PMCID: PMC10648595 DOI: 10.3390/jcm12216891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
Background: Studies on post-COVID-19 condition (PCC) in adults have shown deterioration in pulmonary function tests (PFTs), mainly a diffusion limitation. Among the pediatric population, data are scarce. Aim: To characterize PFTs in children with PCC, including changes over time. Methods: A prospective longitudinal study of children with defined PCC and respiratory complaints who were referred to a designated multidisciplinary clinic from 11/2020 to 12/2022. Results: Altogether, 184 children with a mean age of 12.4 years (SD 4.06) were included. A mild obstructive pattern was demonstrated in 19/170 (11%) at presentation, as indicated by spirometry and/or positive exercise challenge test and/or reversibility post bronchodilators, only three had a previous diagnosis of asthma. Lung volumes and diffusion were normal in all but one patient (1/134, 0.7%). Exhaled nitric oxide levels were elevated in 32/144 (22%). A total of 33 children who had repeated PFTs had normal or near-normal PFTs on follow-up testing, including seven (21.2%) who had mild obstructive PFTs at presentation. Multivariate analysis identified older age [OR 1.36 (95% CI:1.07-1.75)], specific imaging findings (prominent bronchovascular markings (OR 43.28 (95% CI: 4.50-416.49)), and hyperinflation (OR 28.42, 95% CI: 2.18-370.84)] as significant predictors of an obstructive pattern on PFTs. Conclusions: In children with PCC and respiratory symptoms, the most common impairment was a mild obstructive pattern; most were without a history of asthma. Improvement was witnessed in long-term follow-up. In contrast to the adult population, no diffusion limitation was found. Empirical periodic inhaler therapy may be considered in children with factors associated with PFT abnormalities.
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Affiliation(s)
- Einat Shmueli
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Ophir Bar-On
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
| | - Ben Amir
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Meir Mei-Zahav
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Patrick Stafler
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Hagit Levine
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Guy Steuer
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
| | - Benjamin Rothschild
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
| | - Lior Tsviban
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
| | - Nofar Amitai
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Miri Dotan
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Gabriel Chodick
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Dario Prais
- Pulmonology Institute, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, Petach Tikva 49202, Israel; (O.B.-O.); (M.M.-Z.); (P.S.); (H.L.); (G.S.); (B.R.); (L.T.); (N.A.); (M.D.); (D.P.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
| | - Liat Ashkenazi-Hoffnung
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel; (B.A.); (G.C.); (L.A.-H.)
- Department of Day Hospitalization, Schneider Children’s Medical Center of Israel, Petach Tikva 49202, Israel
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Martino L, Morello R, De Rose C, Buonsenso D. Persistent respiratory symptoms associated with post-Covid condition (Long Covid) in children: a systematic review and analysis of current gaps and future perspectives. Expert Rev Respir Med 2023; 17:837-852. [PMID: 37844017 DOI: 10.1080/17476348.2023.2271836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION There is increasing evidence that also children can develop Long Covid. However, there are no specific reviews providing a clear description of reported respiratory symptoms and potential diagnostics. AREAS COVERED We performed on PubMed a systematic search of studies conducted on children aged less than 18 years with previous SARS-CoV-2 infection complaining about persistent respiratory symptoms; the aim of our review is to characterize the incidence, pattern and duration of respiratory symptoms after the acute infection in pediatric population. EXPERT OPINION Children can develop persisting respiratory symptoms, as documented by several follow-up studies both including or not control groups of non-infected children. However, the methodological variabilities of the analyzed studies does not allow to provide firm conclusions about the rate, type and best diagnostics for children with persistent respiratory symptoms. Future studies should investigate on larger pediatric cohorts the role of noninvasive diagnostics and new biomarkers as well as investigating therapeutic options both during acute infection or when Long Covid has been diagnosed.
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Affiliation(s)
- Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italia
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Al-Shamrani A, Al-Shamrani K, Al-Otaibi M, Alenazi A, Aldosaimani H, Aldhalaan Z, Alalkami H, Yousef AA, Kobeisy S, Alharbi S. Residual Cough and Asthma-like Symptoms Post-COVID-19 in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1031. [PMID: 37371263 DOI: 10.3390/children10061031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide and is characterized by different presentations ranging from asymptomatic to severe pneumonia. COVID-19 affects all age groups, including pediatric patients. We observed numerous children complaining of a cough post-COVID-19, even if it was trivial. The most reported persistent symptoms after recovery from COVID-19 were insomnia, coughing, fatigue, dyspnea, loss of taste and/or smell, and headache. To date, residual cough post-COVID-19 has been reported in pediatrics and adolescents. METHOD we conducted a retrospective study, with a self-administered questionnaire by the patient or caregiver, 12 months post-COVID-19-infection. RESULT A total of 94.8% of patients were Saudi citizens and were mainly from the southern region of Saudi Arabia (50.0%). Mothers (64.4%) submitted most of the results. The ages were as follows: 6-14 years (51.0%), 3-5 years (32.3%), and younger than 2 years of age (only 16.7%). Females accounted for 41.7% of those studied. Nearly half of the patients (48.5%) had had a previous COVID-19 infection in 2022, with only 2.1% infected in 2019. Only 27/194 (13.9%) patients required hospital admission, and 7 of them (4.2%) required intensive care treatment. A total of 179 (92.2%) patients still reported persistent symptoms 4 weeks post-COVID-19-infection. A cough was reported in 69.8% of patients, followed by cough and wheezing in 12.3%. The cough was described as dry in 78.0% and nocturnal in 54.1%, while 42.5% did not notice any diurnal variation. For those reporting residual cough, 39.3% found that it affected school attendance and daily activities, 31.1% reported associated chest pain, 51.9% associated it with wheezing, and 27.1% associated it with shortness of breath. For 54.4%, the residual cough lasted less than one month, while 31.4% reported a 1-2 month duration. Only 1.0% had a duration of cough of more than 3 months. For cough relief, 28.2% used bronchodilators, 19.9% used cough syrup, 16.6% used a combination of bronchodilators and steroid inhalers, and 1.7% used antibiotics. Surprisingly, 33% attempted herbal remedies for cough relief. Sesame oil was used the most (40.0%), followed by a mixture of olive oil and sesame oil (25.0%), and 21.7% used male frankincense. The majority (78.4%) sought medical advice for their post-infection cough, either from general pediatricians (39.5%) or via specialist pediatric pulmonology consultations (30.9%). A total of 11.0% with a residual cough reported having pets at home, while 27.2% reported secondhand smoke exposure in the household. Before infection with COVID-19, only 32.6% were diagnosed with asthma, while 68.2% reported a diagnosis of atopic skin. CONCLUSIONS There was a high prevalence of residual cough post-COVID-19, extended for a minimum of two months, and the characteristics of the cough were very similar to those of asthmatic patients. There was still a high prevalence of using cough syrup and herbal remedies, especially olive oil, sesame oil, and male frankincense. A residual cough adversely affected school attendance in daily activities, and there was a high prevalence of other siblings in the family being affected. The study showed that a minority of patients were seen by the pulmonologist; luckily, long COVID was rare in our study, and so further studies are highly needed to confirm the association with asthma. More educational programs are highly needed regarding herbal remedies and cough syrup.
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Affiliation(s)
- Abdullah Al-Shamrani
- Department of Pediatrics, Prince Sultan Military Medical City, Al Faisal University, P.O. Box 7897, Riyadh 11159, Saudi Arabia
| | - Khalid Al-Shamrani
- College of Medicine, Al Marifah University, P.O. Box 92882, Riyadh 11663, Saudi Arabia
| | - Maram Al-Otaibi
- Department of Pediatrics, Prince Sultan Military Medical City, P.O. Box 26523, Riyadh 12841, Saudi Arabia
| | - Ayed Alenazi
- Respiratory Division, Department of Pediatrics, Prince Sultan Military Medical City, P.O. Box 7456, Riyadh 13326, Saudi Arabia
| | - Hareth Aldosaimani
- Department of Emergency, Prince Sultan Military Medical City, P.O. Box 282236, Riyadh 11392, Saudi Arabia
| | - Zeyad Aldhalaan
- Department of Infectious Disease, Prince Sultan Military Medical City, P.O. Box 106383, Riyadh 11666, Saudi Arabia
| | - Haleimah Alalkami
- Department of Pediatrics, Abha Maternity & Children Hospital, P.O. Box 62521, Abha 3613, Saudi Arabia
| | - Abdullah A Yousef
- Department of Pediatrics, King Fahd Hospital of the University, P.O. Box 2208, Al-Khobar 31952, Saudi Arabia
- College of Medicine, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 34212, Saudi Arabia
| | - Sumayyah Kobeisy
- Dr. Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
| | - Saleh Alharbi
- Dr. Soliman Fakeeh Hospital, P.O. Box 2537, Jeddah 21461, Saudi Arabia
- Department of Pediatrics, Umm Al-Qura University, P.O. Box 715, Mecca 24382, Saudi Arabia
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Abstract
Coronavirus disease 19 (COVID-19), caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), has been implicated in having post-COVID-19 sequelae in both adults and children. There is a lack of good data on the prevalence and risk factors for post-COVID-19 sequelae in children. The authors aimed to review the current literature on post-COVID sequelae. The prevalence of post-COVID sequelae in children is highly variable among studies, with an average of 25%. The sequelae may affect many organ systems, though mood symptoms, fatigue, cough, dyspnea, and sleep problems are common. In many studies, it is difficult to establish a causal association due to the lack of a control group. Furthermore, it is difficult to differentiate whether the neuropsychiatric symptoms in children after COVID-19 are due to infection or a result of lockdowns and social restrictions imposed by the pandemic. Children with COVID-19 should be followed by a multidisciplinary team and screened for symptoms, followed by focused laboratory evaluations as needed. There is no specific treatment for the sequelae. Only symptomatic and supportive treatment is required in most cases. More research is necessary to standardize the definitions of sequelae, establish a causal association, assess various treatment options, and the effects of different virus variants, and finally, see the impact of vaccination on the sequelae.
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Zheng YB, Zeng N, Yuan K, Tian SS, Yang YB, Gao N, Chen X, Zhang AY, Kondratiuk AL, Shi PP, Zhang F, Sun J, Yue JL, Lin X, Shi L, Lalvani A, Shi J, Bao YP, Lu L. Prevalence and risk factor for long COVID in children and adolescents: A meta-analysis and systematic review. J Infect Public Health 2023; 16:660-672. [PMID: 36931142 PMCID: PMC9990879 DOI: 10.1016/j.jiph.2023.03.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/09/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Millions of COVID-19 pediatric survivors are facing the risk of long COVID after recovery from acute COVID-19. The primary objective of this study was to systematically review the available literature and determine the pooled prevalence of, and risk factors for long COVID among the pediatric survivors. METHODS Studies that assessed the prevalence of, or risk factors associated with long COVID among pediatric COVID-19 survivors were systematically searched in PubMed, Embase, and Cochrane Library up to December 11th, 2022. Random effects model was performed to estimate the pooled prevalence of long COVID among pediatric COVID-19 patients. Subgroup analyses and meta-regression on the estimated prevalence of long COVID were performed by stratification with follow-up duration, mean age, sex ratio, percentage of multisystem inflammatory syndrome, hospitalization rate at baseline, and percentage of severe illness. RESULTS Based on 40 studies with 12,424 individuals, the pooled prevalence of any long COVID was 23.36 % ([95 % CI 15.27-32.53]). The generalized symptom (19.57 %, [95 % CI 9.85-31.52]) was reported most commonly, followed by respiratory (14.76 %, [95 % CI 7.22-24.27]), neurologic (13.51 %, [95 % CI 6.52-22.40]), and psychiatric (12.30 %, [95% CI 5.38-21.37]). Dyspnea (22.75 %, [95% CI 9.38-39.54]), fatigue (20.22 %, [95% CI 9.19-34.09]), and headache (15.88 %, [95 % CI 6.85-27.57]) were most widely reported specific symptoms. The prevalence of any symptom during 3-6, 6-12, and> 12 months were 26.41 % ([95 % CI 14.33-40.59]), 20.64 % ([95 % CI 17.06-24.46]), and 14.89 % ([95 % CI 6.09-26.51]), respectively. Individuals with aged over ten years, multisystem inflammatory syndrome, or had severe clinical symptoms exhibited higher prevalence of long COVID in multi-systems. Factors such as older age, female, poor physical or mental health, or had severe infection or more symptoms were more likely to have long COVID in pediatric survivors. CONCLUSIONS Nearly one quarter of pediatric survivors suffered multisystem long COVID, even at 1 year after infection. Ongoing monitoring, comprehensive prevention and intervention is warranted for pediatric survivors, especially for individuals with high risk factors.
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Affiliation(s)
- Yong-Bo Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China; Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Na Zeng
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China; School of Public Health, Peking University, Beijing, China; Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Kai Yuan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Shan-Shan Tian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Ying-Bo Yang
- The First Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - Nan Gao
- The First Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - Xuan Chen
- The First Affiliated Hospital of Xinxiang Medical University, Henan, China
| | - An-Yi Zhang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Alexandra L Kondratiuk
- NIHR Health Protection Research Unit in Respiratory Infections, National Heart and Lung Institute, Imperial College, London W2 1NY, UK
| | - Pei-Pei Shi
- Department of Neurology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Fang Zhang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China
| | - Jie Sun
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Jing-Li Yue
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Xiao Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Ajit Lalvani
- NIHR Health Protection Research Unit in Respiratory Infections, National Heart and Lung Institute, Imperial College, London W2 1NY, UK
| | - Jie Shi
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Yan-Ping Bao
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China; School of Public Health, Peking University, Beijing, China.
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China; Peking-Tsinghua Centre for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China.
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10
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de Oliveira TCP, Gardel DG, Ghetti ATA, Lopes AJ. The Glittre-ADL test in non-hospitalized patients with post-COVID-19 syndrome and its relationship with muscle strength and lung function. Clin Biomech (Bristol, Avon) 2022; 100:105797. [PMID: 36244099 PMCID: PMC9554320 DOI: 10.1016/j.clinbiomech.2022.105797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with post-acute COVID-19 syndrome tend to have limitations in performing activities of daily living, which may negatively impact performance during the Glittre-ADL test. This study aimed to verify if the Glittre-ADL test is associated with measures of pulmonary function, muscle function, and health-related quality of life in the assessment of non-hospitalized patients with sequelae of COVID-19, and also to identify the predictor variables related to the Glittre-ADL test in order to create a predictive model. METHODS Cross-sectional study with 37 women with post-acute COVID-19 syndrome who underwent Glittre-ADL test. They performed pulmonary function tests and measurements of handgrip strength and quadriceps strength. Additionally, they completed the Post-COVID-19 Functional Status scale and the Short Form-36 questionnaire. FINDINGS The mean value of Glittre-ADL test time was 4.8 ± 1.1 min, which was 163.7 ± 39.7% of the predicted. The Glittre-ADL test time showed correlation with diffusing capacity for carbon monoxide (r = -0.671, P < 0.0001), forced vital capacity (r = -0.588, P = 0.0001), maximum inspiratory pressure (r = -0.391, P = 0.015), handgrip strength (r = -0.453, P = 0.005), quadriceps strength (r = -0.591, P = 0.0001), and various dimensions of the Short Form-36 questionnaire. In the regression analysis, diffusing capacity for carbon monoxide, quadriceps strength, and forced vital capacity explained 64% of the Glittre-ADL test time variability. INTERPRETATION In patients with post-acute COVID-19 syndrome, lung function and quadriceps strength strongly affect the time to perform Glittre-ADL test multiple tasks.
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Affiliation(s)
| | - Damara Guedes Gardel
- Faculty of Physiotherapy, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil
| | | | - Agnaldo José Lopes
- Rehabilitation Sciences Post-Graduation Programme, Augusto Motta University Centre (UNISUAM), Rio de Janeiro, Brazil; School of Medical Sciences, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil; Medical Sciences Post-Graduation Programme, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil.
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11
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Krivchenia K. Long Coronavirus Disease 2019 in Children. Infect Dis (Lond) 2022. [DOI: 10.17925/id.2022.1.1.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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