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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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Li Y, Zhao G, Su L, Fu J, Sun S, Chen R, Chen D, Hu X, Jiang T, Shen F. The "supercompensation" effect of children's lockdown during COVID-19: based on the analysis of changes in physical activity, sleep, and psychology. BMC Public Health 2024; 24:1522. [PMID: 38844937 PMCID: PMC11154994 DOI: 10.1186/s12889-024-19035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE To investigate the "supercompensation" effect of preschoolers during the coronavirus disease 2019 lockdown by comparing the changes in physical activity (PA), psychological, and sleep indicators before and after the lockdown. METHODS A total of 127 children (aged 3-6 years) were recruited. Before and after the lockdown, the children's PA levels were measured using the ActiGraph GT3X+, and their psychological and sleep indicators were measured using the Strengths and Difficulties Questionnaire (SDQ) and Child Sleep Habit Questionnaire (CSHQ), respectively. RESULTS Regarding PA, the children's total physical activity, low-intensity physical activity, and medium-intensity physical activity (MVPA) were higher after the lockdown than before the lockdown, with significant differences in MVPA (p < 0.05). Regarding psychology, the children's SDQ and multidimensional scores were better after the lockdown than before the lockdown, with a significant difference in SDQ scores (p < 0.05). Regarding sleep, the children's CSHQ scores were better after the lockdown than before the lockdown, with a highly significant difference in CSHQ scores (p < 0.01). CONCLUSION After lockdown, children's PA, psychological, and sleep effects were "supercompensated." In particular, the PA of preschoolers before, during, and after the lockdown may show a "baseline-inhibition-supercompensation" process.
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Affiliation(s)
- Yunong Li
- School of Physical Education, Nanchang University, Nanchang, 330031, China
| | - Guanggao Zhao
- School of Physical Education, Nanchang University, Nanchang, 330031, China.
| | - Liqiang Su
- School of Physical Education, Jiangxi Normal University, Nanchang, 330027, China
| | - Jinmei Fu
- Jiangxi Sports Science Medicine Centre, Nanchang, 330006, China
| | - Shunli Sun
- Jiangxi Sports Science Medicine Centre, Nanchang, 330006, China
| | - Ruiming Chen
- School of Physical Education, Nanchang University, Nanchang, 330031, China
| | - Delong Chen
- School of Physical Education, Nanchang University, Nanchang, 330031, China
| | - Xuewen Hu
- School of Physical Education, Nanchang University, Nanchang, 330031, China
| | - Tianle Jiang
- School of Physical Education, Nanchang University, Nanchang, 330031, China
| | - Fanchao Shen
- School of Physical Education, Nanchang University, Nanchang, 330031, China
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Marcotullio C, Attanasi M, Porreca A, Di Filippo P, Matricardi S, Venanzi A, Schiavo M, Paone A, Rossi N, Chiarelli F, Prezioso G. Neuropsychological Symptoms and Quality of Life during the COVID-19 Pandemic in Children: A Survey in a Pediatric Population in the Abruzzo Region, Italy. CHILDREN (BASEL, SWITZERLAND) 2024; 11:532. [PMID: 38790527 PMCID: PMC11119843 DOI: 10.3390/children11050532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND The SARS-CoV-2 pandemic has significantly affected the pediatric population. Long-term sequelae (Long COVID-19) may particularly involve the central nervous system, with possible effects on psychological well-being and quality of life (QoL), aspects that were already influenced by the restrictive measures and general social impact of the pandemic. METHODS We conducted a cross-sectional survey that aims at investigating the neuropsychological effects and the QoL impairment of SARS-CoV-2 on a cohort of children and adolescents in the Abruzzo region (Italy). A questionnaire was submitted to caregivers with the help of the PEDIATOTEM platform. A control group of healthy subjects was also included to distinguish between the effects of infection from the general influence of the pandemic. RESULTS A total of 569 subjects responded: 396 COVID-19 patients (99 of whom had Long COVID-19) and 111 controls. After the pandemic, when compared with the COVID-19 group, the controls reported significantly increased appetite, sleeping habits, and time spent remotely with friends and a reduction in physical activity and time spent in person with friends. A significant higher rate of controls asked for psychological/medical support for emotional problems. On the other hand, the Long COVID-19 group showed more fatigue and emotional instability with respect to non-Long-COVID-19 subjects. No differences in QoL results (EuroQOL) were found between the COVID-19 patients and controls, while the Long-COVID-19 subgroup showed significantly higher rates of pain/discomfort and mood instability, as confirmed by the analysis of variation of responses from the pre-COVID-19 to the post-COVID-19 period. CONCLUSIONS Among COVID-19 patients, neuropsychological and QoL impairment was more evident in the Long COVID-19 subgroup, although emotional and relational issues were also reported by uninfected patients, with a growing request for specialist support as a possible consequence of social restriction.
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Affiliation(s)
- Chiara Marcotullio
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Marina Attanasi
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Annamaria Porreca
- Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Paola Di Filippo
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Annamaria Venanzi
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Marco Schiavo
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Antonio Paone
- Department of Neuroscience, Imaging and Clinical Science, University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Nadia Rossi
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
| | - Giovanni Prezioso
- Department of Pediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (C.M.); (M.A.); (P.D.F.); (S.M.); (A.V.); (M.S.); (N.R.); (F.C.)
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Chepo M, Martin S, Déom N, Khalid AF, Vindrola-Padros C. Twitter Analysis of Health Care Workers' Sentiment and Discourse Regarding Post-COVID-19 Condition in Children and Young People: Mixed Methods Study. J Med Internet Res 2024; 26:e50139. [PMID: 38630514 PMCID: PMC11063881 DOI: 10.2196/50139] [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: 06/20/2023] [Revised: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post-COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post-COVID-19 condition on this demographic. OBJECTIVE With a social media analysis of the discourse surrounding the prevalence of post-COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post-COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post-COVID-19 condition and identify critical areas and future directions for researchers and policy makers. METHODS From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post-COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. RESULTS We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post-COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. CONCLUSIONS The perceptions described on Twitter by HCWs concerning the presence of the post-COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post-COVID-19 condition.
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Affiliation(s)
- Macarena Chepo
- School of Nursing, Universidad Andrés Bello, Santiago, Chile
| | - Sam Martin
- Department of Targeted Intervention, University College London, London, United Kingdom
- Oxford Vaccine Group, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Noémie Déom
- Department of Targeted Intervention, University College London, London, United Kingdom
| | - Ahmad Firas Khalid
- Canadian Institutes of Health Research Health System Impact Fellowship, Centre for Implementation Research, Ottawa Hospital Research Institute, Otawa, ON, Canada
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Faux-Nightingale A, Saunders B, Burton C, Chew-Graham CA, Somayajula G, Twohig H, Welsh V. Experiences and care needs of children with long COVID: a qualitative study. BJGP Open 2024; 8:BJGPO.2023.0143. [PMID: 37914226 PMCID: PMC11169971 DOI: 10.3399/bjgpo.2023.0143] [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: 08/04/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Long COVID, the patient-preferred term, describes symptoms persisting after an acute episode of COVID-19 infection. Symptoms in children and young people (CYP) can affect daily routine, with broader impacts on education, health-related quality of life, and social activities, which may have long-term effects on health and wellbeing. AIM To explore the lived experiences and care needs of CYP with long COVID from the perspectives of CYP with long COVID, their parents, and professionals associated with the care of children and families living with the condition. DESIGN & SETTING CYP and their parent or carer were invited for interview following participation in a cohort study, which recruited the sample from a primary care setting. METHOD Interviews were carried out with four CYP with long COVID (all female, aged 10-17 years); three interviews included a parent. Two focus groups were conducted, which included seven professionals involved with care of CYP or long COVID, from a range of disciplines. Interviews and focus groups were transcribed verbatim, and data analysed thematically using constant comparison techniques. RESULTS The three main themes presented are as follows: living with long COVID; uncertainty surrounding long COVID; and seeking help for symptoms. CONCLUSION Long COVID can severely impact the lives of CYP and their families. CYP and their families need to be listened to by professionals and have any uncertainties acknowledged. It is imperative that agencies working with them understand the condition and its impact, and are able to offer support where needed.
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Affiliation(s)
| | | | - Claire Burton
- School of Medicine, Keele University, Staffordshire, UK
| | | | | | - Helen Twohig
- School of Medicine, Keele University, Staffordshire, UK
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Grzejszczak J, Strzelecki D, Gabryelska A, Kotlicka-Antczak M. Evaluation of COVID-19 Effect on Mental Health, Self-Harm, and Suicidal Behaviors in Children and Adolescents Population. J Clin Med 2024; 13:744. [PMID: 38337437 PMCID: PMC10856233 DOI: 10.3390/jcm13030744] [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: 12/16/2023] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES The impact of the COVID-19 pandemic on the psychological state of the under-18 population includes an increased risk of psychopathological symptoms development and exacerbation of already present psychiatric disorders. This study aimed to assess the prevalence of mental health problems in Polish children and adolescents with a focus on suicidal and self-harm behavior with the impact of the pandemic. METHODS The questionnaire collected demographic data, information regarding mental states and psychopathological symptoms, history of self-harm and suicidal behaviors, as well as the experience of psychological, and physical violence, and suicidal self-harm behaviors before and during the COVID-19 pandemic. RESULTS In the final analysis, 782 responses were included. Self-evaluation of general and mental health scores was significantly lower during the pandemic among children (both p < 0.001) and adolescents (both p < 0.001). Moreover, general and mental health scores were lower among adolescents compared to children before (both p < 0.001) and during (both p < 0.001) the pandemic. The frequency of seeking help because of mental health problems increased during the pandemic among children and adolescents, while no changes were observed in the prevalence of psychiatric hospitalizations in either of the populations (p = 0.317 and p = 1.00, respectively). Out of autoregressive behaviors among children during the pandemic period, only the frequency of thinking about death increased (p = 0.038). No suicidal attempts were undertaken by children in either of the evaluated time periods. The presence of all autoaggressive behaviors was greater among adolescents compared to children both before and during the COVID-19 pandemic (all p<0.05). CONCLUSIONS A subjective decrease in psychophysical well-being, an increase in the frequency of seeking mental health help during the pandemic, as well as an increased prevalence of depressive and anxiety symptoms were observed in the under-18 population as a potential consequence of the COVID-19 pandemic and related socioeconomic changes. The marked increase in self-harm behavior in the adolescent population (age > 12) and the marked increase in the frequency of death thinking in children (age ≤ 12) suggests the need for greater awareness and easier access to professional help from mental health specialists, particularly in a time of unprecedented stress and social isolation.
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Affiliation(s)
- Jagoda Grzejszczak
- Department of Child and Adolescent Psychiatry, Medical University of Lodz, 92-216 Lodz, Poland;
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland;
| | - Agata Gabryelska
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, 92-215 Lodz, Poland;
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Matsuo OM, Lindoso L, Sousa Marques HHD, Polanczyk GV, Farhat SCL, Bain V, Fink TT, Martins F, Astley C, Suguita P, Trindade V, Correa-Silva S, Palmeira P, Yoshino de Paula CS, Litvinov N, Ferreira JCOA, Sakita NK, Gualano B, Silva CAA, Pereira MFB. Mental health among children and adolescents after SARS-CoV-2 infection: A prospective study in a tertiary university hospital. J Infect 2023; 87:576-578. [PMID: 37739272 DOI: 10.1016/j.jinf.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Olivia Mari Matsuo
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil.
| | - Livia Lindoso
- Department of Pediatrics, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Heloisa Helena de Sousa Marques
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | | | - Sylvia Costa Lima Farhat
- Department of Pediatrics, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Vera Bain
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Thais T Fink
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Fernanda Martins
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Camilla Astley
- Laboratory of Assessment and Conditioning in Rheumatology, Sao Paulo, Brazil; Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Priscila Suguita
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Vitor Trindade
- Department of Pediatrics, Division of Pediatric Rheumatology, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Simone Correa-Silva
- Department of Pediatrics, Laboratório de Pediatria Clínica (LIM-36), Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Patricia Palmeira
- Department of Pediatrics, Laboratório de Pediatria Clínica (LIM-36), Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Camila Sanson Yoshino de Paula
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Nadia Litvinov
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Juliana Caires O A Ferreira
- Department of Pediatrics, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Neusa Keico Sakita
- Department of Pediatrics, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | - Bruno Gualano
- Laboratory of Assessment and Conditioning in Rheumatology, Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
| | | | - Maria Fernanda Badue Pereira
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas (HCFMUSP), Sao Paulo, Brazil
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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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9
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Boufidou F, Medić S, Lampropoulou V, Siafakas N, Tsakris A, Anastassopoulou C. SARS-CoV-2 Reinfections and Long COVID in the Post-Omicron Phase of the Pandemic. Int J Mol Sci 2023; 24:12962. [PMID: 37629143 PMCID: PMC10454552 DOI: 10.3390/ijms241612962] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
We are reviewing the current state of knowledge on the virological and immunological correlates of long COVID, focusing on recent evidence for the possible association between the increasing number of SARS-CoV-2 reinfections and the parallel pandemic of long COVID. The severity of reinfections largely depends on the severity of the initial episode; in turn, this is determined both by a combination of genetic factors, particularly related to the innate immune response, and by the pathogenicity of the specific variant, especially its ability to infect and induce syncytia formation at the lower respiratory tract. The cumulative risk of long COVID as well as of various cardiac, pulmonary, or neurological complications increases proportionally to the number of SARS-CoV-2 infections, primarily in the elderly. Therefore, the number of long COVID cases is expected to remain high in the future. Reinfections apparently increase the likelihood of long COVID, but less so if they are mild or asymptomatic as in children and adolescents. Strategies to prevent SARS-CoV-2 reinfections are urgently needed, primarily among older adults who have a higher burden of comorbidities. Follow-up studies using an established case definition and precise diagnostic criteria of long COVID in people with or without reinfection may further elucidate the contribution of SARS-CoV-2 reinfections to the long COVID burden. Although accumulating evidence supports vaccination, both before and after the SARS-CoV-2 infection, as a preventive strategy to reduce the risk of long COVID, more robust comparative observational studies, including randomized trials, are needed to provide conclusive evidence of the effectiveness of vaccination in preventing or mitigating long COVID in all age groups. Thankfully, answers not only on the prevention, but also on treatment options and rates of recovery from long COVID are gradually starting to emerge.
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Affiliation(s)
- Fotini Boufidou
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Snežana Medić
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia;
- Center for Disease Control and Prevention, Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
| | - Vicky Lampropoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.L.); (A.T.)
| | - Nikolaos Siafakas
- Department of Clinical Microbiology, Attikon General Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.L.); (A.T.)
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (V.L.); (A.T.)
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10
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Howe de la Torre S, Parlatini V, Cortese S. Long-term central nervous system (CNS) consequences of COVID-19 in children. Expert Rev Neurother 2023; 23:703-720. [PMID: 37545414 DOI: 10.1080/14737175.2023.2239500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Neurological/neuropsychiatric symptoms are commonly reported by children/young people with long COVID, especially headache, fatigue, cognitive deficits, anosmia and ageusia, dizziness, mood symptoms, and sleep problems. However, reported prevalence estimates are highly variable due to study heterogeneity and often small sample size; most studies only considered short-term follow-ups; and, apart from mood and sleep problems, neuropsychiatric conditions have received less attention. Considering the potential debilitating effects of neurological/neuropsychiatric conditions, a comprehensive review of the topic is timely, and needed to support clinical recognition as well as to set the direction for future research. AREAS COVERED The authors discuss neurological/neuropsychiatric manifestations of long COVID in pediatric populations, with a focus on prevalence, associated demographic characteristics, and potential pathogenetic mechanisms. EXPERT OPINION Children/young people may develop persistent neurological/neuropsychiatric symptoms following acute SARS-CoV-2 infection, which may affect daily functioning and well-being. Studies in larger samples with longer follow-ups are needed to clarify prevalence and symptom duration; as well as less investigated risk factors, including genetic predisposition, ethnicity, and comorbidities. Controlled studies may help separate infection-related direct effects from pandemic-related psychosocial stressors. Clarifying pathogenetic mechanisms is paramount to develop more targeted and effective treatments; whilst screening programs and psychoeducation may enhance early recognition.
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Affiliation(s)
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- School of Psychology, University of Southampton, Southampton, UK
- Horizon Centre, CAMHS West, William Macleod Way, Solent NHS Trust, Southampton, UK
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA
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