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www.thelancet.com/child-adolescent Vol 5 June 2021 e22Post-acute COVID-19
outcomes in children with mild and asymptomatic disease
Data on the clinical outcomes
of children with COVID-19 are
scarce, particularly in those with asymptomatic and mild disease.
1,2
Studies involving adults suggest that long-term multisystem sequelae and complications can occur, even with mild COVID-19.
3 We aimed
to describe medium-term clinical outcomes 3–6 months after diagnosis in children with COVID-19 presenting to a tertiary paediatric hospital.
We followed children (aged ≤18 years)
at a dedicated COVID-19 follow-up clinic at the Royal Children’s Hospital (RCH) in Melbourne, Australia, between March 21, 2020 and March 17, 2021. Children who tested positive for SARS-CoV-2 at the RCH or externally between March 21 and Oct 28, 2020, were referred to this clinic.
A standardised clinic proforma was
used to collect information on acute COVID-19 symptoms, transmission risk factors, medical history, and post-acute COVID-19 symptoms (eg, dyspnoea, fatigue, rash, or abdominal pain; appendix pp 1–2). Acute disease severity was classified according to WHO criteria.
4 Data were extracted
from the RCH electronic medical record. This study was approved by the RCH Human Research and Ethics Committee (HREC QA/63103/RCHM-2020).
A total of 171 children from
137 house holds attended the
clinic (appen dix p 3). Most cases of COVID-19 (136 [80%] of 171 children)
were identified between July and August, 2020, corresponding with the
epidemio logical peak in Melbourne during this period.
5 There have been
3285 reported cases of COVID-19
in children and adolescents (aged 0–19 years) in Victoria to date (March 17, 2021).
5 Our cohort comprised of 171 children
(median age 3 years [IQR 1–8]): 90 (53%) boys and 81 (47%) girls. Most children had mild disease (100 [58%]) or were asymptomatic (61 [36%]), and nine (5%) children had moderate disease. The few hospital admissions (14 [8%] children) were generally brief and were for observation or fluid rehydration. One (1%) child with complex congenital heart disease had severe COVID-19 pneumonitis with acute respiratory failure (appendix p 3). Two (1%) children had post-
acute COVID-19 inflammatory con-
ditions temporally associated with
SARS-CoV-2: a 7-year-old child with paediatric multisystem inflammatory syndrome who required intensive care management, and an 11-month-old child with Kawasaki disease.
Follow-up data at 3–6 months
were available for 151 (88%) of 171 children, of whom 54 (36%) were asymptomatic and 97 (64%) were symptomatic (ie, with mild, moderate, or severe disease) with acute COVID-19. 12 (8%) children had post-acute COVID-19 symptoms, all of whom were symptomatic with acute COVID-19 (table). The
most common post -acute COVID-19
symptoms were mild post-viral cough
(six [4%] of 151 children), fatigue
(three [2%] children) or both post-viral cough and fatigue (one [1%] child). The duration of post-viral cough ranged from 3 weeks to 8 weeks and of post-viral fatigue ranged from 6 weeks to 8 weeks from the time of symptom onset. At the most recent review in March, 2021, all 151 children had returned to their baseline health status and post-acute COVID-19 symptoms had resolved. Follow-up data for 20 children were not available; seven (35%) of these children had asymptomatic COVID-19.
These findings contrast those
of studies of COVID-19 in adults, which have identified multisystem complications and a higher prevalence and severity of persistent symptoms.
3 Common complications in adults are respiratory sequelae and persistent fatigue (eg, residual dyspnoea ranging from 11% to 43% and fatigue ranging from 35% to 64%).
3 In our paediatric
cohort, full recovery occurred within weeks of acute symptom onset and reported symptoms were mild in severity.
This study was done at a single
centre in a metropolitan tertiary paediatric hospital with predominantly young (median age 3 years [IQR 1–8]) children, which could limit the generalisability of results. Our cohort included a large proportion of
Children (n=12)
Sex ··
Male 7 (58%)
Female 5 (42%)
Age, years ··
Mean 3·7 (3·5)
Median 2 (1–7)
Age group, years ··
0–2 8 (67%)
6–12 years 4 (33%)
13–18 years 0
Comorbidities 3 (25%)
Congenital cardiac disease 1 (8%)
Chronic respiratory condition 2 (17%)
Symptom duration, days ··
Mean 14·6 (12·8)
Median 11·5 (3·5–25·5)
Acute disease severity ··
Asymptomatic 0
Mild disease 11 (92%)
Moderate disease 0
Severe disease 1 (8%)
Admitted to hospital* 6 (50%)
For observation 2 (17%)
For fluid rehydration 1 (8%)
Received intensive care unit care* 3 (25%)
Post-acute COVID-19 symptoms ··
Post-viral cough 6 (50%)
Fatigue 3 (25%)
Both cough and fatigue 1 (8%)
Inflammatory conditions 2 (17%)
Data are n (%), mean (SD), or median (IQR). *All hospital admissions were for acute
COVID-19 illness except for two children who were admitted
to the intensive care unit
due to post-acute inflammatory conditions.
Table: Demographic and clinical characteristics of children with post-acute
COVID-19 symptomsSee Online for appendixPublished Online
April 20, 2021 https://doi.org/10.1016/S2352-4642(21)00124-3
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Correspondence
e23 www.thelancet.com/child-adolescent Vol 5 June 20214 WHO. Clinical management of COVID-19:
interim guidance 27 May 2020. Geneva:
World Health Organization, 2020.
5 Department of Health and Human Services,
State Government of Victoria. Victorian coronavirus (COVID-19) data. 2021. https://www.dhhs.vic.gov.au/victorian-coronavirus-covid-19-data (accessed April 1, 2021). children with asymptomatic infection
(61 [36%] of 171 children), which reflects state government testing
guidelines for asymp tom atic close contacts of individuals with confirmed
COVID-19.
Follow-up was limited to 3–6 months,
with outcomes measured with clin-
ical assessments, apart from for
two children with post-acute COVID-19 inflammatory conditions who had echocardiograms. As most post-acute
COVID-19 symptoms were mild in severity, objective evaluation with
lung
function tests, a chest CT scan, or both, was not done.
Data on the long-term effects of
COVID-19 in children and ado lescents
are needed, and such data should
ideally be nationally representative and include broader demographics. On-
going follow-up of paediatric patients
with COVID-19, including assess ment
of mental health outcomes, is needed
to comprehensively describe long-
term
outcomes in this population.
We declare no competing interests. DS, ST, and NC
designed the study. DS and ST extracted and analysed the data. DS drafted the initial manuscript. All authors interpreted the data and reviewed and revised the manuscript. We thank Kate Dohle, Alissa McMinn, and Isabella Overmars from the Infection and Immunity Theme, Murdoch Children’s Research Institute (Melbourne, VIC, Australia).
Daniela Say, Nigel Crawford,
Sarah McNab, Danielle Wurzel, Andrew Steer, *Shidan Tosif
[email protected]
Immunisation Service (DS, NC) and Department of
General Medicine (SM, AS, ST), Royal Children’s Hospital Melbourne, Melbourne, VIC, Australia; Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia (DS, NC, DW, AS, ST); School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia (DW)
1 Götzinger F, Santiago-García B,
Noguera-Julián A, et al. COVID-19 in children
and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health 2020; 4: 653–61.
2 Denina M, Pruccoli G, Scolfaro C, et al.
Sequelae of COVID-19 in hospitalized children: a 4-months follow-up. Pediatr Infect Dis J 2020;
39: e458–59.
3 Nalbandian A, Sehgal K, Gupta A, et al.
Post-acute COVID-19 syndrome. Nat Med
2021; published online March 22. DOI:10.1038/s41591-021-01283-z.
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