Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C

• DOI: 10.1542/peds.2022-057798
• Publication Date: 2022-06-29T04:02:03Z
• Authors: Aline B. Maddux; Laura Berbert; Cameron C. Young; Leora R. Feldstein; Laura D. Zambrano; Suden Kucukak; Margaret M. Newhams; Kristen Miller; Madyson M. FitzGe...; Jie He; Natasha B. Halasa; Natalie Z. Cvijan...; Laura L. Loftis; Tracie C. Walker; Stephanie P. Schw...; Shira J. Gertz; Keiko M. Tarquinio; Julie C. Fitzgerald; Michele Kong; Jennifer E. Schuster; Elizabeth H. Mack; Charlotte V. Hobbs; Courtney M. Rowan; Mary A. Staat; Matt S. Zinter; Katherine Irby; Hillary Crandall; Heidi Flori; Melissa L. Cullimore; Ryan A. Nofziger; Steven L. Shein; Mary Glas Gaspers; Janet R. Hume; Emily R. Levy; Sabrina R. Chen; Manish M. Patel; Mark W. Tenforde; Edie Weller; Angela P. Campbell; Adrienne G. Randolph
• Keywords: 2. Zero hunger; Adult; Adolescent; SARS-CoV-2; Aftercare; COVID-19; Patient Discharge; Systemic Inflammatory Response Syndrome; United States; 3. Good health; Hospitalization; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Obesity; Prospective Studies; Child

OBJECTIVES To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C).

METHODS Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).

RESULTS Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04–1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06–1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55–6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35–4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C).

CONCLUSIONS Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.