key: cord-0854407-xwwaqyq0
authors: Say, Daniela; Crawford, Nigel; McNab, Sarah; Wurzel, Danielle; Steer, Andrew; Tosif, Shidan
title: Post-acute COVID-19 outcomes in children with mild and asymptomatic disease
date: 2021-04-21
journal: Lancet Child Adolesc Health
DOI: 10.1016/s2352-4642(21)00124-3
sha: b325decb7c0496bf9b0d21f9adfcf212f87b24bb
doc_id: 854407
cord_uid: xwwaqyq0

nan

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 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 postacute COVID-19 inflammatory conditions 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) 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 Follow-up was limited to 3-6 months, with outcomes measured with clinical 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. Ongoing 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.

COVID-19 in children and adolescents in Europe: a multinational

Sequelae of COVID-19 in hospitalized children: a 4-months follow-up

Post-acute COVID-19 syndrome

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