Study identifies risk factors for persistent symptoms after COVID-19 illness:


According to a large US study of 25 children’s hospitals, more than a quarter of children and adolescents hospitalized with a coronavirus infection at the start of the pandemic still had health problems two to four months later. They were either affected by persistent ailments or by limitations in their daily lives. Children in particular who are very overweight, suffer from asthma or have multiple organ systems involved in corona disease had to struggle longer with the after-effects.

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As part of the national Overcoming-COVID-19 study, researchers led by Prof. Dr. Adrienne Randolph, MD, MSc, of Boston Childrens Hospital, family caregivers of patients younger than 21 hospitalized with COVID-19 or Multisystem Inflammatory Syndrome in Children (MIS-C). The study period from May 2020 to May 2021 before vaccines are available. Of 358 patients, 279 answered the questions (78%).
Of these children and adolescents, approximately 40% were hospitalized with acute COVID-19 and approximately 60% with MIS-C. 50% and 86% had to be treated in the intensive care unit.
After two to four months of follow-up, 27% of patients with acute COVID-19 and 30% of patients with MIS-C still had symptoms, impaired activity, or both.

“Nearly three-quarters of the children had fully recovered, which is reassuring. But unfortunately, this was not the case for more than one in four. Although this is much better than many reports in hospitalized older people, it is still very concerning. The risk of serious illness and ongoing complications is greater than the risk of complications from the vaccine, which are very rare,” Randolph said.

The following complaints were particularly common in children and adolescents with persistent symptoms:

  • Fatigue or weakness (in 11.3% of COVID-19 patients and 20% of MIS-C patients)
  • Shortness of breath (9.2% and 2.5% respectively)
  • Cough (9.2 and 2.5%)
  • Headaches (8.4 and 7.5%)
  • Muscle and body pain (5 and 3.1%)
  • Fever (2.5 and 0.6%).

Restrictions in daily life occurred slightly more frequently after MIS-C (21.3% of young patients were affected) than after acute COVID-19 (14.3%).

  • 6.7% of patients in the COVID-19 group and 14.4% in the MIS-C group could no longer walk or move as much as before.
  • 6.7 or 7.5% of teenagers slept significantly more than usual.
  • 4.2% and 3.8% of teens, respectively, had difficulty completing school work or felt distracted and unfocused.

Three factors were associated with an increased risk of long-term health problems:

  • Multiple organ system involvement in patients with acute COVID-19.
  • Pre-existing respiratory disease (usually asthma) in small patients with MIS-C.
  • Severe obesity in patients with MIS-C.

Randolph noted that this study was limited to children and adolescents who required hospitalization and occurred early in the pandemic. Most children and adolescents were admitted before the peak of the delta wave.

“We are in the process of analyzing recent data covering the Delta wave and part of the Omicron wave, including the impact on health-related quality of life,” Randolph added. “I think there will be differences. It’s important to understand how all the different variants affect children and to track the effectiveness of vaccination to prevent long-term complications.”
Ongoing research from Boston Children’s Hospital was also exploring the neurological complications of acute COVID-19 and MIS-C using detailed neurocognitive testing, Randolph reported.

“Now that vaccines are available, I strongly encourage children and young people to get vaccinated,” she said. “We know that patients can be re-infected even if they have had COVID-19, and we have already shown that vaccination can prevent MIS-C and a severe course of COVID-19.”

Ass.-Prof. Dr. Aline Maddux, MD of the University of Colorado School of Medicine and Colorado Children’s Hospital was the first author of the present study. The study was funded by the Centers for Disease Control and Prevention (at Boston Children’s) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD096018, at Maddux).

Quellen:, Boston Children’s Hospital, Pediatrics

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