key: cord-0710902-h17o94z1
authors: Sterky, Ellinor; Olsson‐Åkefeldt, Selma; Hertting, Olof; Herlenius, Eric; Alfven, Tobias; Ryd Rinder, Malin; Rhedin, Samuel; Hildenwall, Helena
title: Persistent symptoms in Swedish children after hospitalisation due to COVID‐19
date: 2021-07-03
journal: Acta Paediatr
DOI: 10.1111/apa.15999
sha: fd23d1c8deb1c58d8875422fa99106bf85f148f3
doc_id: 710902
cord_uid: h17o94z1

COVID-19 is generally mild in children1 and post-acute inflammatory conditions that are temporally associated with the virus are rare, but potentially severe. However, some children and adults experience persistent symptoms after COVID-19. 2 Long COVID has not been precisely defined, but one study reported symptoms approximately 60 days after the primary diagnosis.3 Although adult long COVID is increasingly being studied, the magnitude of persistent symptoms in children remains unclear.

symptoms in children aged 0-18 years who were admitted to one of the two paediatric hospitals in the Stockholm Region from 13 March to 31 August 2020 due to COVID-19. The inclusion criteria were the presence of a nasopharyngeal sample RT-PCR positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Children that tested positive, but were hospitalised for other reasons, were not included. Information on any persisting health issues following hospitalisation, their perceived severity and their impact on daily activities was collected during structured telephone interviews with the children and/or their guardians (Appendix S1). The children were followed up in December 2020 and January 2021, at least four months after being admitted (median 219 days, range 123-324 days). Three paediatricians reviewed the reported symptoms, in relation to the patient's age, and objective findings in their medical records. Symptoms were classified as mild, moderate or severe and by their uncertain or possible association with COVID-19. The Swedish Central Ethical Research Board approved the study (number 2020-02061), and guardians provided informed consent before data collection.

There were 147 SARS-CoV-2-positive children hospitalised during the study period, and 60 were primarily admitted due to COVID-19. Of these 60 children, nine fulfilled the criteria of multisystem inflammatory syndrome in children (MIS-C) and two of these required intensive care. Other reasons for admissions included dehydration (38%), infection observation (35%) and need for inhalations (23%). A total of 55 were interviewed and analysed (Table 1) , as two were lost to follow-up and three declined to participate. We found that 12/55 (22%) had persistent symptoms and 8/12 had fatigue, which was the most common symptom. There were 6/12 with mild persistent symptoms with an uncertain relationship with COVID-19, including vague symptoms, such as parental reports of poor appetite despite good growth, an infant with a congested nose and intermittent increases in body temperature. A third (4/12), aged 4, 14, 15 and 16 years, had multiple severe symptoms that were possibly related to COVID-19. All four reported fatigue and headache or myalgia, and three reported cognitive difficulties. Their median admission was seven days, compared with four days for the overall group: three had a C-reactive protein value of more than 200mg/l during their initial illness, and two were diagnosed with MIS-C. All the severe cases had symptoms that had a major impact on their daily activities, including reduced school attendance and leisure activities.

The groups were too small to determine statistically significant differences, but persistent symptoms seemed higher among children diagnosed with MIS-C.

A tenth of the 55 children who were hospitalised due to COVID-19 reported persistent symptoms that were assessed to have a possible association with the SARS-CoV-2 infection more than four months after their acute illness. This was lower than the 27% of Italian children with symptoms 120 days or more after diagnosis. 4 We found that a subset of children hospitalised for COVID-19 experienced long-term health issues, based on reports from them or their guardians. Early recognition and support for paediatric long COVID patients is needed to reduce potential consequences related to learning and social development.

The authors have no conflicts of interest to declare. Other c 2 0 0

Note: Data expressed as number of patients (with percentages for totals) or median and range values. a Including asthma, haematological/oncological, neurological/multiple.

Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults

Case report and systematic review suggest that children may experience similar long-term effects to adults after clinical COVID-19

Persistent symptoms in patients after acute COVID-19

Preliminary evidence on long COVID in children

Post-acute COVID-19 outcomes in children with mild and asymptomatic disease