Prevalence and clinical presentation of long COVID in children: a systematic review

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Abstract

A systematic literature review was conducted up to 15th February 2022 to summarize long COVID evidence and to assess prevalence and clinical presentation in children and adolescents. Articles reporting long COVID prevalence and symptoms based on original data in the paediatric population were included. Case series quality was assessed through the JBI Critical Appraisal Checklist. For observational studies, adherence to STROBE checklist was evaluated. Twenty-two articles were included: 19 observational studies (12 cohort/7 cross-sectional) and 3 case series. Nine studies provided a control group. We found a high variability in terms of prevalence (1.6–70%). The most frequently reported symptoms were fatigue (2–87%), headache (3.5–80%), arthro-myalgias (5.4–66%), chest tightness or pain (1.4–51%), and dyspnoea (2–57.1%). Five studies reported limitations in daily function due to long COVID. Alterations at brain imaging were described in one study, transient electrocardiographic abnormalities were described in a minority of children, while most authors did not evidence long-term pulmonary sequelae. Older age, female sex, and previous long-term pathological conditions were more frequently associated with persistent symptoms.

Conclusion: Long COVID evidence in children is limited, heterogeneous, and based on low-quality studies. The lockdown consequences are difficult to distinguish from long COVID symptoms. High-quality studies are required: WHO definition of long COVID should be used, controlled clinical studies should be encouraged, and the impact of new variants on long COVID prevalence should be investigated to ensure an objective analysis of long COVID characteristics in children and a proper allocation of healthcare system resources.

What is Known:

• Children rarely develop a severe respiratory disease in the acute phase of COVID-19.

• A limited number of patients develop a multisystem inflammatory condition that can lead to multiorgan failure and shock.

What is New:

• Persistent symptoms after SARS-CoV-2 infection are reported in children and limitations in daily function due to long COVID symptoms affect school attendance.

• Functional complaints of post-acute COVID are difficult to be distinguished from those due to social restrictions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00431-022-04600-x.

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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2024)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

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The species Severe acute respiratory syndrome-related coronavirus : classifying 2019-nCoV and naming it SARS-CoV-2

Alexander E. Gorbalenya, Susan C. Baker, Ralph Baric … (2020)

The present outbreak of a coronavirus-associated acute respiratory disease called coronavirus disease 19 (COVID-19) is the third documented spillover of an animal coronavirus to humans in only two decades that has resulted in a major epidemic. The Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is responsible for developing the classification of viruses and taxon nomenclature of the family Coronaviridae, has assessed the placement of the human pathogen, tentatively named 2019-nCoV, within the Coronaviridae. Based on phylogeny, taxonomy and established practice, the CSG recognizes this virus as forming a sister clade to the prototype human and bat severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus, and designates it as SARS-CoV-2. In order to facilitate communication, the CSG proposes to use the following naming convention for individual isolates: SARS-CoV-2/host/location/isolate/date. While the full spectrum of clinical manifestations associated with SARS-CoV-2 infections in humans remains to be determined, the independent zoonotic transmission of SARS-CoV and SARS-CoV-2 highlights the need for studying viruses at the species level to complement research focused on individual pathogenic viruses of immediate significance. This will improve our understanding of virus–host interactions in an ever-changing environment and enhance our preparedness for future outbreaks.

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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

Erik von Elm, Douglas G. Altman, Matthias Egger … (2008)

Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles.18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies.A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies

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Author and article information

Contributors

Elena Chiappini:

ORCID: http://orcid.org/0000-0002-1476-4752

elena.chiappini@unifi.it

Journal

Journal ID (nlm-ta): Eur J Pediatr

Journal ID (iso-abbrev): Eur J Pediatr

Title: European Journal of Pediatrics

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0340-6199

ISSN (Electronic): 1432-1076

Publication date (Electronic): 15 September 2022

Publication date PMC-release: 15 September 2022

Pages: 1-15

Affiliations

[1 ]GRID grid.8404.8, ISNI 0000 0004 1757 2304, Department of Health Sciences, Section of Pediatrics, , University of Florence, ; Florence, Italy

[2 ]GRID grid.411477.0, ISNI 0000 0004 1759 0844, Pediatric Infectious Disease Unit, , Anna Meyer Children’s University Hospital, ; Florence, Italy

[3 ]GRID grid.8982.b, ISNI 0000 0004 1762 5736, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, , University of Pavia, ; Pavia, Italy

[4 ]GRID grid.419425.f, ISNI 0000 0004 1760 3027, Pediatric Clinic, , Fondazione IRCCS Policlinico San Matteo, ; Pavia, Italy

Author notes

Communicated by Nicole Ritz

Author information

Roberta Pellegrino http://orcid.org/0000-0001-6454-9383

Elena Chiappini http://orcid.org/0000-0002-1476-4752

Amelia Licari http://orcid.org/0000-0002-1773-6482

Luisa Galli http://orcid.org/0000-0002-7912-3366

Gian Luigi Marseglia http://orcid.org/0000-0003-3662-0159

Article

Publisher ID: 4600

DOI: 10.1007/s00431-022-04600-x

PMC ID: 9476461

PubMed ID: 36107254

SO-VID: 8e9a8872-e066-4c67-975b-37ec88ec0457

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 16 November 2021

Date revision received : 4 August 2022

Date accepted : 20 August 2022

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Prevalence and clinical presentation of long COVID in children: a systematic review

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Novel Coronavirus Disease COVID-19

Most cited references 45

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

The species Severe acute respiratory syndrome-related coronavirus : classifying 2019-nCoV and naming it SARS-CoV-2

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

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