ABSTRACT
Background. The COVID-19 pandemic is affecting children worldwide. Although pediatric infections are usually mild, children are at risk for complicated disease. It is imperative that we collect key data of children with COVID-19 to expand understanding of the epidemiology and pathophysiology of this disease. The objective of this research was to describe the demographic and range of pathology in children infected with SARS-CoV-2. Methods. Pediatric COVID care at the University of Minnesota is coordinated through a multidisciplinary team that also contributes to a national registry for children infected with SARS-CoV-2. Utilizing these mechanisms, we identified children infected with SARS-CoV-2 including those presenting to our health system to create a COVID-19 cohort. Inclusion criterion was confirmed SARS-CoV-2 infection, and exclusion criterion was opt-out of research on general consent form. Following IRB approved protocol, we collected demographic data and clinical information on those with symptomatic disease following SARS-CoV-2 infection. Results. As of February 2022, we reported 7440 children with SARS-CoV-2 to the national registry. We identified a cohort of 163 children with new onset disease or exacerbation of existing illnesses in association with COVID-19. The majority (110) experienced mild-to- moderate acute COVID-19, while 10 had severe COVID-19 pneumonia. Multisystem Inflammatory Syndrome in Children (MIS-C) was diagnosed and successfully treated in 34 children. Inflammatory diseases and invasive infections developed in 40 children. Long COVID was diagnosed in 42 children with lingering symptoms affecting daily function at least 3 months following infection. Conclusion. This cohort includes children across clinical settings and can be regarded as a representation of COVID-related illness. Of those with symptomatic illness, acute illness is most common, usually mild-to-moderate with 6% developing severe pneumonia. Long COVID syndrome is also commonly seen in children. 24% of children infected with the virus present with inflammatory and immune-mediated illnesses suggesting the role of SARS-CoV-2 in triggering immune dysregulation pathologies. The overall spectrum of pediatric COVID-19 infection suggests a multiphase, immune-mediated contagion.
ABSTRACT
Background. Even weeks and months after initial infection, full recovery from a Covid-19 infection is elusive for some pediatric patients. Long Covid is now recognized as a chronic condition with a constellation of lingering health problems. As the long term sequala of Covid-19 continue to become apparent, it is imperative to study this emerging disease in the pediatric population. Methods. The University of Minnesota Pediatric Covid Clinic has been receiving referrals since April 2020. The clinic is participating in a national registry (PIDTRAN-6-Covid-19), facilitating IRB approved collection of anonymized clinical data from children diagnosed with Long Covid syndrome. Results. We have identified 47 children (female 28, male 19) who were diagnosed with Long Covid at the University of Minnesota Covid Clinic. The majority were previously healthy (40) and the average age was 14.7 years (4-18yr). Acute symptomatic infection preceded the diagnosis in 41 children and 6 children were asymptomatic. Common symptoms reported by the patients included: fatigue (35), dizziness and/ or lightheadedness and/or palpitation (16), abnormal taste/smell (15), headache (14), difficulty concentrating/focusing [brain fog] (13), myalgia/arthralgia (15), dyspnea (12), abdominal pain (10), and sleep disturbance (6). Clinical Symptoms of Long Covid The nine most common clinical symptoms of Long Covid are shown in the chart above with the numbers corresponding to the number of patients who reported experiencing each symptom. Demographics of Long Covid The above graphic depicts the demographics of patients seen at the University of Minnesota Pediatric Long Covid Clinic. Conclusion. Pediatric populations, like adult populations, have patients who suffer from the lingering health effects of what is now termed Long Covid. The majority of patients presenting with Long Covid are teenagers, with females being more commonly affected than males. These patients often suffer from fatigue and are experiencing a constellation of symptoms that are reminiscent of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) and positional orthostatic tachycardia syndrome (POTS). This suggests a post-viral autoimmune injury as the likely pathophysiology for Long Covid syndrome. Further population based studies are needed to better understand the extent and prevalence of this debilitating disease.