Spectrum of Disease in Children Infected with SARS-CoV-2

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.