Characterizing Long COVID in Children and Adolescents.
Abstract
Most research to understand postacute sequelae of SARS-CoV-2 infection (PASC), or long COVID, has focused on adults, with less known about this complex condition in children. Research is needed to characterize pediatric PASC to enable studies of underlying mechanisms that will guide future treatment.
To identify the most common prolonged symptoms experienced by children (aged 6 to 17 years) after SARS-CoV-2 infection, how these symptoms differ by age (school-age [6-11 years] vs adolescents [12-17 years]), how they cluster into distinct phenotypes, and what symptoms in combination could be used as an empirically derived index to assist researchers to study the likely presence of PASC.
Multicenter longitudinal observational cohort study with participants recruited from more than 60 US health care and community settings between March 2022 and December 2023, including school-age children and adolescents with and without SARS-CoV-2 infection history.
SARS-CoV-2 infection.
PASC and 89 prolonged symptoms across 9 symptom domains.
A total of 898 school-age children (751 with previous SARS-CoV-2 infection [referred to as infected] and 147 without [referred to as uninfected]; mean age, 8.6 years; 49% female; 11% were Black or African American, 34% were Hispanic, Latino, or Spanish, and 60% were White) and 4469 adolescents (3109 infected and 1360 uninfected; mean age, 14.8 years; 48% female; 13% were Black or African American, 21% were Hispanic, Latino, or Spanish, and 73% were White) were included. Median time between first infection and symptom survey was 506 days for school-age children and 556 days for adolescents. In models adjusted for sex and race and ethnicity, 14 symptoms in both school-age children and adolescents were more common in those with SARS-CoV-2 infection history compared with those without infection history, with 4 additional symptoms in school-age children only and 3 in adolescents only. These symptoms affected almost every organ system. Combinations of symptoms most associated with infection history were identified to form a PASC research index for each age group; these indices correlated with poorer overall health and quality of life. The index emphasizes neurocognitive, pain, and gastrointestinal symptoms in school-age children but change or loss in smell or taste, pain, and fatigue/malaise-related symptoms in adolescents. Clustering analyses identified 4 PASC symptom phenotypes in school-age children and 3 in adolescents.
This study developed research indices for characterizing PASC in children and adolescents. Symptom patterns were similar but distinguishable between the 2 groups, highlighting the importance of characterizing PASC separately for these age ranges.
EDRN PI Authors
Medline Author List
- Akshoomoff N
- Aschner JL
- Aupperle R
- Baker FC
- Balaraman V
- Banich MT
- Barch DM
- Baskin-Sommers A
- Bhattacharjee R
- Bind MC
- Bjork JM
- Bogie A
- Bookheimer SY
- Brown SA
- Bukulmez H
- Carmilani M
- Casey BJ
- Chan J
- Chang L
- Chibnik LB
- Clark DB
- Coombs K
- Cottrell LA
- Cowan K
- D'Sa VA
- Dale AM
- Dapretto M
- Dozor AJ
- Dreyer BP
- Eckrich D
- Elliott AJ
- Ernst TM
- Evans DN
- Fair DA
- Farkas JS
- Faustino EVS
- Feldstein Ewing SW
- Fiks AG
- Fischer L
- Fitzgerald ML
- Flaherman VJ
- Foulkes AS
- Foxe JJ
- Freedman EG
- Friedman NP
- Gallagher R
- Garavan H
- Gaur S
- Gee DG
- Gennaro ML
- Gonzalez R
- Gray KM
- Gross RS
- Guan Z
- Guttierrez JL
- Güthe N
- Harahsheh AS
- Hasan UN
- Hasson DC
- Heitzeg MM
- Herting MM
- Hornig M
- Hsia DS
- Huerta-Montañez G
- Hummel KD
- Irby K
- Jacobus J
- Jernigan TL
- Kadish MP
- Kaelber DC
- Karlson EW
- Katz SD
- Khare M
- Kinser PA
- Kleinman LC
- Kosut JS
- Krishnamoorthy A
- Krishnan S
- Laird AR
- Lamendola-Essel MF
- Larrabee J
- Larson CL
- Letts RJ
- Lim PPC
- Lisdahl KM
- Luciana M
- Luna B
- Madden PAF
- McCulloh RJ
- McGlade EC
- Metz TD
- Michelow IC
- Milner JD
- Mohandas S
- Morse RE
- Müller-Oehring EM
- Nagel BJ
- Narang S
- Neale MC
- Ness-Cochinwala M
- Newburger JW
- Nolan S
- Oliveira CR
- Palumbo P
- Pant DB
- Paulus MP
- Peddie AK
- Potter AS
- Raissy H
- Reeder HT
- Renshaw PF
- Rhee KE
- Rosario-Pabon Z
- Rosenzweig EB
- Ross JL
- Ryu J
- Salazar JC
- Salisbury AL
- Sato AI
- Selvarangan R
- Snowden JN
- Sowell ER
- Squeglia LM
- Stein CR
- Stevenson MD
- Stockwell MS
- Talavera-Barber MM
- Tantisira KG
- Tapert S
- Taylor BD
- Teufel RJ
- Thaweethai T
- Truong DT
- Uddin LQ
- Warburton D
- Weakley KE
- Werzberger A
- Wilson S
- Wood JC
- Yin S
- Yurgelun-Todd DA
- Zempsky WT
- Zimmerman E