Abstract
Background
To determine the prevalence of pediatric Post-COVID-19 condition (PPCC), identify risk factors, and assess the quality of life in children with differing severities of acute COVID-19.
Methods
During a prospective longitudinal study with a 1-year follow-up, we compared non-hospitalized (mild) and hospitalized (severe) COVID-19 cases to a negatively tested control group.
Results
579 children were included in this study. Of these, 260 had mild acute disease (median age:8, IQR:6–10), 60 had severe acute disease (median age:1, IQR:0.1–4.0), and 259 tested negative for SARS-CoV-2 (NT) (median age:8, IQR:5-10).
At three months, 14.6% of the SARS-CoV-2 positive mild group (RR:6.31 (CI 95%: 2.71–14.67)) and 29.2% of the severe group (RR:12.95 (CI 95%: 5.37–31.23)) reported sequelae, versus 2.3% of the NT group. PPCC prevalence in the mild group decreased from 16.1% at one month to 4.4% at one year. Children with PPCC exhibited lower physical health-related quality of life scores and higher fatigue scores than the NT children.
Conclusions
Severe acute COVID-19 in children leads to a higher PPCC prevalence than in mild cases. PPCC prevalence decreases over time. Risk factors at three months include prior medical history, hospital admission, and persistent fatigue one month after a positive test.
Impact
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We demonstrate children with severe COVID-19 are more likely to develop Post-COVID-19 condition than those with mild or no infections, and highlights the risk factors.
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Here we have stratified by acute disease severity, prospectively included a negative control group, and have demonstrated the heterogeneity in prevalence when utilizing various recent definitions of post-COVID.
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Identifying risk factors for pediatric post-COVID and highlighting the heterogeneity in prevalence based on various current definitions for post-COVID should aid in correctly identifying potential pediatric post-COVID cases, aiding in early intervention.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Change history
01 November 2024
In the original version of this article, the name of the author Anke H. Maitland-van der Zee was incorrectly structured. The author’s family name is ‘Maitland-van der Zee’.
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Acknowledgements
For the collection of data for the PoCoCoChi study, we would like to acknowledge and thank the Public Health Service (GGD) Kennemerland. For the collection of the COPP Clinical data a large group of medical professionals and researchers (listed below) cooperated to make the data-collection possible. We Would like to acknowledge these as the ‘COPP study group’, the complete list of members can be found in the supplemental Digital Content Table E12. 1. Research grant for pediatric COVID research: ZonMw (10430072110007 and 10430102110009). 2. Research grant for pediatric COVID research: Bontius Stichting and the Leiden University Fund. 3. SAB (Stichting Steun Astma Bestrijding) Grant.
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Coen R. Lap and Caroline L.H. Brackel are responsible for the conception and design of the study, designed the data collection instruments, coordinated and supervised data collection, analyzed and interpreted the data, drafted, and critically reviewed and revised the manuscript for important intellectual content. Angelique M.A.M. Winkel, dr. Simone Hashimoto, Lieke C.E. Noij, Milly Haverkort, dr. Mattijs W. Alsem, Erik G.J. von Asmuth, dr. Michiel A.G.E. Bannier, dr Emmeline P. Buddingh, Adam J. Tulling, and dr. Gertjan Lugthart are responsible for the conception and design of the study, designed the data collection instruments, coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. Dr. Johannes B. van Goudoever, dr Lotte Haverman, dr. Miriam G. Mooij, dr. Kim Oostrom, dr. Mariëlle W. Pijnenburg, and Sanne Kloosterman coordinated and supervised data collection, drafted, and critically reviewed and revised the manuscript for important intellectual content. Lorynn Teela and dr. Michiel Luijten designed the data collection instruments, coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. dr. Anke H. Maitland – van der Zee, Dr. Debby Bogaert, dr. Giske Biesbroek, dr. Marlies A. van Houten, and dr. Suzanne W.J. Terheggen-Lagro are responsible for the conception and design of the study, designed the data collection instruments, coordinated and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Patient consent was required and obtained prior to inclusion in both the PoCoCoChi and COPP studies.
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Lap, C.R., Brackel, C.L.H., Winkel, A.M.A.M. et al. Post-COVID-19 condition in children: epidemiological evidence stratified by acute disease severity. Pediatr Res 97, 1016–1024 (2025). https://doi.org/10.1038/s41390-024-03597-3
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DOI: https://doi.org/10.1038/s41390-024-03597-3
