Standardized Approach to Pediatric Post-COVID Syndrome and Its Impact on Children and Adolescents: A Perspective From a Tertiary Center

Overview

Journal Pediatr Infect Dis J

Specialty Pediatrics

Date 2024 Oct 24

PMID 39446622

Authors

Shadya Nzale

Anne Perrin

Cindy Soroken

Mayssam Nehme

Klara M Posfay-Barbe

Arnaud G LHuillier

Affiliations

Soon will be listed here.

Abstract

Background: Pediatric post-COVID syndrome (pPCS) affects a notable number of children. This study aims to describe its clinical manifestations, biopsychosocial impact and management strategies.

Methods: A prospective, single-center study was conducted to analyze data of pPCS patients presenting to our institution between May 2021 and November 2022. Functional impact was evaluated by assessing school absenteeism and by using the Adolescent Depression Rating Scale (ADRS), Pediatric Quality of Life Inventory (PedsQL) and Fatigue Severity Scale.

Results: Among the 50 patients included [median age (interquartile range): 14.0 (12.9-15.8) years; females: 70%], the most common symptoms were extreme fatigue (84%), exertion intolerance (82%), orthostatism (66%), dyspnea (66%) and headache (66%); 25% had an abnormal Schellong test. Median (interquartile range) ADRS, PedsQL and Fatigue Severity Scale scores were 3.0 (1.0-5.0), 56% (49%-71%) and 45.0 (32.0-53.0), respectively. Sixty percent experienced partial (34%) or complete (26%) school absenteeism. The most common referrals to specialized consultations were child psychiatry (48%), pulmonology (46%), physiotherapy (36%) and an ear-nose-throat specialist (24%). Eighty percent had a typical form of pPCS, whereas 20% had a clinical presentation suggestive of a functional disorder triggered by COVID-19. The latter had more frequent thoracic pain ( P = 0.012) and more referrals to pediatric neurology ( P = 0.01), gastroenterology ( P = 0.011), ophthalmology ( P = 0.037) and child psychiatry ( P = 0.035), but less to pulmonology ( P = 0.014). School absenteeism and social withdrawal were also more common in this group, with more severe PedsQL and ADRS scores.

Conclusion: pPCS is associated with a significant socio-educational burden that should be taken into account in medical, social and educational care.

References

Nguyen N, Hoang V, Dao T, Dudouet P, Eldin C, Gautret P . Clinical patterns of somatic symptoms in patients suffering from post-acute long COVID: a systematic review. Eur J Clin Microbiol Infect Dis. 2022; 41(4):515-545. PMC: 8830952. DOI: 10.1007/s10096-022-04417-4. View

Campos C, Prokopich S, Loewen H, Sanchez-Ramirez D . Long-Term Effect of COVID-19 on Lung Imaging and Function, Cardiorespiratory Symptoms, Fatigue, Exercise Capacity, and Functional Capacity in Children and Adolescents: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2022; 10(12). PMC: 9778658. DOI: 10.3390/healthcare10122492. View

Soriano J, Murthy S, Marshall J, Relan P, Diaz J . A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22(4):e102-e107. PMC: 8691845. DOI: 10.1016/S1473-3099(21)00703-9. View

Pellegrino R, Chiappini E, Licari A, Galli L, Marseglia G . Prevalence and clinical presentation of long COVID in children: a systematic review. Eur J Pediatr. 2022; 181(12):3995-4009. PMC: 9476461. DOI: 10.1007/s00431-022-04600-x. View

Naik H, Shao S, Tran K, Wong A, Russell J, Khor E . Evaluating fatigue in patients recovering from COVID-19: validation of the fatigue severity scale and single item screening questions. Health Qual Life Outcomes. 2022; 20(1):170. PMC: 9792925. DOI: 10.1186/s12955-022-02082-x. View

Barisione G, Brusasco V . Lung diffusing capacity for nitric oxide and carbon monoxide following mild-to-severe COVID-19. Physiol Rep. 2021; 9(4):e14748. PMC: 7903940. DOI: 10.14814/phy2.14748. View

Soroken C, Posfay-Barbe K, Caflisch M, ZGraggen W . Postural tachycardia syndrome among adolescents. Arch Pediatr. 2022; 29(5):398-403. DOI: 10.1016/j.arcped.2022.03.006. View

Schwendinger F, Knaier R, Radtke T, Schmidt-Trucksass A . Low Cardiorespiratory Fitness Post-COVID-19: A Narrative Review. Sports Med. 2022; 53(1):51-74. PMC: 9483283. DOI: 10.1007/s40279-022-01751-7. View

Dumont R, Richard V, Lorthe E, Loizeau A, Pennacchio F, Zaballa M . A population-based serological study of post-COVID syndrome prevalence and risk factors in children and adolescents. Nat Commun. 2022; 13(1):7086. PMC: 9708639. DOI: 10.1038/s41467-022-34616-8. View

10.

Kuodi P, Gorelik Y, Gausi B, Bernstine T, Edelstein M . Characterization of post-COVID syndromes by symptom cluster and time period up to 12 months post-infection: A systematic review and meta-analysis. Int J Infect Dis. 2023; 134:1-7. DOI: 10.1016/j.ijid.2023.05.003. View

11.

Morrow A, Malone L, Kokorelis C, Petracek L, Eastin E, Lobner K . Long-Term COVID 19 Sequelae in Adolescents: the Overlap with Orthostatic Intolerance and ME/CFS. Curr Pediatr Rep. 2022; 10(2):31-44. PMC: 8906524. DOI: 10.1007/s40124-022-00261-4. View

12.

Han Q, Zheng B, Daines L, Sheikh A . Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms. Pathogens. 2022; 11(2). PMC: 8875269. DOI: 10.3390/pathogens11020269. View

13.

Varni J, Seid M, Kurtin P . PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001; 39(8):800-12. DOI: 10.1097/00005650-200108000-00006. View

14.

Heiss R, Tan L, Schmidt S, Regensburger A, Ewert F, Mammadova D . Pulmonary Dysfunction after Pediatric COVID-19. Radiology. 2022; 306(3):e221250. PMC: 9513839. DOI: 10.1148/radiol.221250. View

15.

Hilberath J, Mast A, Holweg M, Krankel L, Remppis J, Renk H . Quality of life and healthcare utilization during the COVID-19 pandemic are more restricted in chronically ill than in healthy children: a tertiary care children's hospital experience. Eur J Pediatr. 2024; 183(4):1801-1810. PMC: 11001739. DOI: 10.1007/s00431-023-05382-6. View

16.

Racine N, McArthur B, Cooke J, Eirich R, Zhu J, Madigan S . Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis. JAMA Pediatr. 2021; 175(11):1142-1150. PMC: 8353576. DOI: 10.1001/jamapediatrics.2021.2482. View

17.

Zheng Y, Zeng N, Yuan K, Tian S, Yang Y, Gao N . Prevalence and risk factor for long COVID in children and adolescents: A meta-analysis and systematic review. J Infect Public Health. 2023; 16(5):660-672. PMC: 9990879. DOI: 10.1016/j.jiph.2023.03.005. View

18.

Lin J, Han Z, Li X, Ochs T, Zhao J, Zhang X . Risk factors for postural tachycardia syndrome in children and adolescents. PLoS One. 2014; 9(12):e113625. PMC: 4256207. DOI: 10.1371/journal.pone.0113625. View

19.

Valko P, Bassetti C, Bloch K, Held U, Baumann C . Validation of the fatigue severity scale in a Swiss cohort. Sleep. 2008; 31(11):1601-7. PMC: 2579971. DOI: 10.1093/sleep/31.11.1601. View

20.

Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G . Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Res. 2020; 293:113429. PMC: 7444649. DOI: 10.1016/j.psychres.2020.113429. View