Study of Prevalence and Characteristics of Long Covid in Spanish Children (preprint)

Objectives: Prolonged symptoms after acute COVID-19 have been described in the pediatric population. Our objective was to know the prevalence of prolonged symptoms in children with confirmed SARS-CoV-2 infection, and to describe their clinical characteristics and possible risk factors.Patients & methodsMulticentre retrospective study carried by telephone questionnaire of all children under 18 years old diagnosed of symptomatic COVID-19, both hospitalized and outpatient attended in three hospitals in Spain between March and December 2020. Long-COVID was defined as the presence of symptoms longer than 12 weeks. A control group of children attended by other causes was also contacted and compared.Results451 children met criteria and agreed to participate; 370/451 (82%) presented mild outpatient infection, and 23 required admission in PICU (5.1%). The mean age was 5.9 years old (SD 5.3). A control group of 98 children was included.In 66 cases (14.6%) at least one symptom lasted longer than 12 weeks. Insomnia, concentration problems, apathy or sadness and anxiety were the longest (median >90 days). Age above 5 years (48/66; 72.7%, OR: 3, CI 95% (1.8-5)); admission (OR 3.9 CI 95% (2.2-6.8)), the need for PICU (OR 4.3 CI 95% (1.8-10.4)), and to have a relative with prolonged symptoms (OR 2.8 CI 95% (1.5-5.2)) were significantly associated with Long-COVID. When comparing with controls age above 5 years old, myalgia, asthenia, and loss of appetite were significantly associated with Long-COVID.ConclusionsOur study shows that children also suffer prolonged symptoms after COVID-19 infection, and require specific attention.

The Spectrum of COVID-19 in Children in Spain (preprint)

Background: We aimed to identify the spectrum of disease in children with COVID-19, and the risk factors for admission in paediatric intensive care units (PICUs). Methods: : We conducted a multicentre, prospective study of children with SARS-CoV-2 infection in 76 Spanish hospitals. We included children with COVID-19 or multi-inflammatory syndrome (MIS-C) younger than 18 years old, attended during the first year of the pandemic. Results: We enrolled 1 200 children. A total of 666 (55.5%) were hospitalized, and 123 (18.4%) required admission to PICU. Most frequent major clinical syndromes in the cohort were: mild syndrome (including upper respiratory tract infection and flu-like syndrome, skin or mucosae problems and asymptomatic), 44.8%; bronchopulmonary syndrome (including pneumonia, bronchitis and asthma flare), 18.5%; fever without a source, 16.2%; MIS-C, 10.6%; and gastrointestinal syndrome, 10%. In hospitalized children, the proportions were: 28.5%, 25.7%, 16.5%, 19.1% and 10.2%, respectively. Risk factors associated with PICU admission were MIS-C (odds ratio [OR]: 37.5,95% CI 22.7 to 57.8), moderate or severe liver disease (OR: 9,95% CI 1.6 to 47.6), chronic cardiac disease (OR: 4.8,95% CI 1.8 to 13) and asthma or recurrent wheezing (OR: 2.8,95% CI 1.3 to 5.8). However, asthmatic children were admitted into the PICU due to MIS-C or pneumonia, not due to asthma flare. Conclusion: Hospitalized children with COVID-19 usually present as one of five major clinical phenotypes of decreasing severity. Risk factors for PICU include MIS-C, elevation of inflammation biomarkers, asthma, moderate or severe liver disease and cardiac disease.

IS ASTHMA A RISK FACTOR FOR COVID-19 IN CHILDREN? (preprint)

The prevalence of asthma in children in Europe is an average of 10.3%. The role of asthma as a risk factor for COVID-19 in children is unknown. Our aim was to study the prevalence of asthma in children with SARS-CoV-2 infection and to compare them in hospitalized children and those with mild ambulatory symptoms. We conducted an observational retrospective study in 99 children (between 3- 17 years of age) with a confirmed SARS-CoV-2 infection between March and December 2020. The existence of a history of asthma was investigated using the validated ISAAC questionnaire and clinical data on COVID-19 were compiled. The median age was 10 years (IQR=13-5), and 60/99 (60.6%) patients had mild infections controlled as outpatient, while 39/99 (39.4%) required admission. The prevalence of asthma ─affirmative response to question 6 of the ISAAC questionnaire─ was 11.1% (11/99). The prevalence of asthma in children who required admission increased to 17.9% and to 21.4% in patients requiring PICU, while in outpatients children was 6.7% (p=0.079). We found a significant association between the use of salbutamol during the last year and the need for admission (23.1% in hospitalized patients vs 3.3% in outpatients; OR= 8.7, 95%CI 1.7-42.8). Likewise, budesonide treatment in the last year (17.9% vs 1.7%, OR= 12.9, 95%CI 1.5-109.5) was also a risk factor for admission. Therefore, a history of asthma was not a risk factor for SARS-CoV-2 infection in our series, but active asthma could be a risk factor for severity and need for hospitalization for COVID-19 in children