ABSTRACT
RATIONALE4,4-44,4% of children suffer from post-COVID syndrome, commonly known as long- COVID, after an acute SARS-CoV-2 infection. However, an uniform clinical definition, and guidelines to diagnose or treat children suspected of long-COVID are lacking. Multiple careprograms have been initiated worldwide. In this study, we aimed to assess the currently available pediatric international long-COVID care programs and explore the characteristics of their patient cohorts.METHODSWe established an international network (IP4C) and performed a crosssectional analysis from aggregated data collected by its members using a survey. Topics included: the used definition for long-covid in children, the organization of pediatric long-COVID clinics and long-COVID patients characteristics. Descriptive analysis of the aggregated data was used to summarize and compare each of these categories across countries. RESULTSWe included data concerning organization of care from 17 cohorts based in 13 different countries. A wide range of definitions for long COVID was used, which differed mostly in duration of symptoms and the necessity of microbiologically proven SARS-COV-2 infection. 66,6-100% of patients in the long- COVID cohorts suffered from complaints for more than twelve weeks, and 49,5-97,3% of patients had a positive RT-PCR or serology for SARS-CoV-2. Most long-COVID care programs consisted of real-life visits with multidisciplinary teams, consisting of general pediatricians, pediatric lung specialists, cardiologists and infectiologist, a physiotherapist and psychologist. The type of investigations performed at the long-COVID clinics ranged from assessment of medical history (100%) and standardized questionnaires (91%) to in depth evaluation of organ functioning (e.g. spirometry performed in 0-100% of patients). Aggregated data of 431 long-COVID patients from 11 dedicated long-COVID care programs were analyzed. Mean age of patients ranged from 6,5-16,4 years old. Girls were overrepresented in most cohorts (20-65%). 28-81,8% of patient had a positive medical history, most commonly atopic syndrome, asthma and prematurity. Most patients (90- 100%) suffered from asymptomatic or mild acute COVID-19. Frequent long-COVID symptoms were fatigue, headaches, concentration difficulties, dyspnea and sleep disturbances. 5-37% of patients had severe limitations in daily life. CONCLUSIONSThis is the first study to describe the organization of pediatric long-COVID care. It demonstrates that pediatric long-COVID is recognized worldwide as a multisystemic disease, but its definition and care programs for pediatric long- COVID patients differ between cohorts. A clear definition of pediatric long-COVID is needed to improve international scientific collaboration and patient care. Our international network will facilitate further collaboration in investigation pathophysiology and therapeutic interventions in order to provide evidence based medical care for these patients.
ABSTRACT
Objectives: The COVID-19 pandemic has spread across the world, leading to government measures such as national lockdowns and social distancing, which are associated with a negative impact on mental health. This study evaluated the impact of COVID-19 on anxiety, depression and resilience in Dutch children and adults with cystic fibrosis (CF) or primary ciliary dyskinesia (PCD) and their caregivers during the second wave of the pandemic. Methods: Adolescents (12–18 years), adults and caregivers of children (0–18 years) with CF or PCD completed screening questionnaires from Sept-Dec 2020 on anxiety (GAD-7), depression (PHQ-9), and resilience (BRS). The psychosocial impact of COVID-19 was measured by the Exposure and Family Impact Survey (CEFIS) part 2, which was translated into Dutch using EMA guidelines. Results from the GAD-7 and PHQ-9 were compared to participants’ pre-pandemic scores. Results: 65 individuals participated (CF: 6 adolescents, 32 caregivers. PCD: 17 patients, 10 caregivers). Prevalence of symptoms of anxiety and depression (score of ≥5 on the GAD-7 and/or PHQ-9) during the pandemic was high (34% and 37% respectively for CF, 48% and 37% PCD), but median GAD-7 and PHQ-9 scores during the pandemic (CF: GAD-7 = 3.0 and PHQ-9 = 2.5;PCD: GAD-7 = 3.0 and PHQ-9 = 4.0) did not differ from the pre-pandemic outcomes for both groups (CF: GAD-7 = 2.0 and PHQ-9 = 2.0;PCD: GAD-7 = 5.0, PHQ-9 = 5.0). Resilience was within the normal range (mean for CF: 3.33;PCD: 3.29). The mean CEFIS scores for both CF and PCD corresponded to a low (PCD: 11.3) to normal (CF: 21.7) impact. Conclusion: Despite the high prevalence of symptoms of anxiety and depression in this selected population, there was no detected change in these symptoms during the pandemic. Therefore, the current study could not demonstrate a significant impact of COVID-19 on mental health, but does still emphasise the need for psychological care in individuals with CF or PCD and their caregivers.