Myth: It’s Not Dangerous for Children

Comparative study showed that children faced a 78% higher risk of new-onset conditions after they had COVID-19 (2023)

The study assessed the incidence of the onset of new conditions in children who had COVID-19 up to a maximum of 21 months after they tested positive for the virus. This showed that 158/1656 (9.5%) exposed children had at least one new diagnosis after COVID-19 (IR 10.6 × 100 person-months, 95% CI 9.0–12.3), compared to 98/1656 (5.9%) unexposed children (IR 6.5 × 1000 person-months, 95% CI 5.2–7.7) (p value < 0.0001).

In general, the excess risk of new-onset conditions after COVID-19 was 78% higher in the exposed children when we compared them to the unexposed cohort, with an aHR of 1.7 (95% CI 1.4–2.3) (data not shown). The risk was significantly increased after COVID-19 for mental health disorders (aHR 1.8, 95% CI 1.1–3.0), neurological diseases (aHR 2.4, 95% CI 1.4–4.1), and other conditions, including skin rashes and taste and smell alterations (aHR 2.0, 95% CI 1.0–3.8)

Incidence of Diabetes Among Youth Before and During the COVID-19 Pandemic (2023)

Incidence of type 1 diabetes increased from 18.5 per 100 000 PYs in 2016 to 2019 to 22.4 per 100 000 PYs from 2020 to 2021 with increased IRRs among individuals aged 10 to 19 years, male individuals, and Hispanic individuals. Incidence of type 2 diabetes increased from 14.8 per 100 000 PYs from 2016 to 2019 to 24.7 per 100 000 PYs from 2020 to 2021 with increased IRRs among individuals aged 10 to 19 years, male and female individuals, and those with Black, Hispanic, and other/unknown race and ethnicity.

The incidence of both type 1 and type 2 diabetes among youth increased following the start of the COVID-19 pandemic with the largest increases observed among Black and Hispanic individuals.

Long COVID in Children: A Multidisciplinary Review (2023)

Recent scientific reports have raised attention to the burden of Long COVID syndrome in the paediatric population. Although the clinical characteristics and the course of this condition seem to be similar to those affecting adults, there are limited data on the pathophysiologic bases.

We herein analyze current evidence on Long COVID syndrome in children, focusing on a clinical multidisciplinary assessment aimed at providing practical insights.

Viral persistence in children infected with SARS-CoV-2: current evidence and future research strategies (2023)

Our analysis suggests that in children, independent from disease severity, SARS-CoV-2 can spread systemically and persist for weeks to months.

These findings raise the intriguing hypothesis that SARS-CoV-2 fragments can chronically stimulate local immune responses, and, through unknown mechanisms, contribute to or be the major pathological event leading to symptoms, including myalgic encephalomyelitis or chronic fatigue syndrome, pains, and other symptoms that characterise long COVID, or even lead to uncontrolled inflammatory events of multisystem inflammatory syndrome in children.

Trends in COVID-19-Associated Hospitalizations — COVID-19-Associated
Hospitalization Surveillance Network (COVID-NET), March 2020–February 2023 (2023)

Tracking the clonal dynamics of SARS-CoV-2-specific T cells in children and adults with mild/asymptomatic COVID-19 (2023)

We show by longitudinal multimodal analysis that SARS-CoV-2 leaves a small footprint in the circulating T cell compartment in children with mild/asymptomatic COVID-19 compared to adult household contacts with the same disease severity who had more evidence of systemic T cell interferon activation, cytotoxicity and exhaustion. Children harbored diverse polyclonal SARS-CoV-2-specific naïve T cells whereas adults harbored clonally expanded SARS-CoV-2-specific memory T cells. A novel population of naïve interferon-activated T cells is expanded in acute COVID-19 and is recruited into the memory compartment during convalescence in adults but not children. This was associated with the development of robust CD4+ memory T cell responses in adults but not children. These data suggest that rapid clearance of SARS-CoV-2 in children may compromise their cellular immunity and ability to resist reinfection.

Prevalence of mental health problems among children with long COVID: A systematic review and meta-analysis (2023)

The systematic review and meta-analysis of mental health problems in long COVID among children showed that anxiety and depression were significant mental health problems in the population. Children with previous COVID-19 infection had more than two times higher odds of having anxiety or depression and 14% higher odds of having appetite problems.

Type 1 Diabetes Incidence and Risk in Children With a Diagnosis of COVID-19 (2023)

A diagnosis of COVID-19 in children was associated with an increased incidence of type 1 diabetes since 2020 in Bavaria. The findings suggest that SARS-CoV-2 infection contributed to the observed increase in type 1 diabetes incidence during the pandemic. Undiagnosed infection, which represents the majority of SARS-CoV-2 antibody–positive children,5 could also have contributed to the moderately increased incidence of type 1 diabetes observed in children without a COVID-19 diagnosis. Possible mechanisms include initiation of autoimmunity or acceleration of disease progression.

Case report: Acute hepatitis in neonates with COVID-19 during the Omicron SARS-CoV-2 variant wave: a report of four cases (2023)

We present the clinical and laboratory characteristics of four COVID-19 neonate patients with acute hepatitis during the Omicron SARS-CoV-2 variant wave. All patients had a clear history of Omicron exposure and were infected via contact with confirmed caregivers.

Newborns are a high-risk group for COVID-19 in the condition of postnatal infection during the Omicron variants epidemic. Besides fever and respiratory symptoms, the clinical doctor should pay much attention to evaluating the risk of liver function injury after SARS-CoV-2 variants infection, which is usually asymptomatic and has a delayed onset. If the patient was co-infected with other pathogens, the symptoms and signs might be severe and long-lasting. It takes time for liver function recovery, so the patient should be followed up closely after discharge.

Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study (2023)

Almost one-fourth (537/2148) of our hospitalised participants were neonates. These were babies born in hospital to COVID-19 positive mothers (84.2%, 452/537) or those brought to hospital with illness, or history of contact, and tested positive (15.8%, 85/537). In the cohort of neonates born to COVID-19 positive mothers, 67.3% (304) were asymptomatic, 8.2% (37) had mild illness, and one-fourth (111) had severe COVID-19 but the overall mortality was 0.9% (4). However, in the cohort of neonates with community acquired SARS-CoV-2 infection, almost half (40) had severe COVID-19, and 13 (15.3%) died

Maternal SARS-CoV-2, Placental Changes and Brain Injury in 2 Neonates (2023)

Long-term neurodevelopmental sequelae are a potential concern in neonates following in utero exposure to severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2). We report 2 neonates born to SARS-CoV-2 positive mothers, who displayed early-onset (day 1) seizures, acquired microcephaly, and significant developmental delay over time.

To our knowledge, the 2 cases described here represent the first time that neonates born to SARS-CoV-2 positive mothers present with a neonatal clinical course mimicking hypoxic-ischemic encephalopathy of the newborn. There was no preceding clinical event in labor that heralded an acute hypoxic-ischemic event in either case, and the neurologic sequelae extended well beyond the neonatal period. Both placentas and brains showed evidence of SARS-CoV-2 infection and the placentas displayed alterations in inflammatory and oxidative stress markers.

Post-COVID-19 Sequelae in Children (2023)

The prevalence of post-COVID sequelae in children is highly variable among studies, with an average of 25%. The sequelae may affect many organ systems, though mood symptoms, fatigue, cough, dyspnea, and sleep problems are common.

COVID-19 is a new disease, and it is difficult to predict the course of its sequelae. Most studies have shown a steady decline in the prevalence of persistent symptoms over time [2,3,4,5,618]; however, the maximum reported follow-up duration was 12 mo only. Therefore, it is currently unknown how long these symptoms will persist and what the long-term outcome of COVID-19 in children will be.

COVID-19 Associated Vasculitis Confirmed by the Tissues RT-PCR: A Case Series Report (2023)

In the studied patients, the following systems were involved: skin (4/4), respiratory (3/4), cardiovascular (2/4), GI (2/4), nervous (1/4), eye (1/4), kidney (1/4), and inner ear (1/4). In all previously healthy patients, known rheumatic diseases (e.g., systemic lupus erythematosus, systemic juvenile arthritis, autoinflammatory diseases, and antiphospholipid syndrome) were ruled out, as well as known monogenic autoinflammatory disease. All patients had increased inflammatory markers (ESR and CRP) and thrombotic parameters (D-dimer). No patient met the MIS-C criteria. Two patients met the criteria of polyarteritis nodosa, one met the IgA vasculitis/Henoch–Schonlein purpura criteria, and one met the unclassified vasculitis criteria.

Thrombotic events remain an important effect of COVID-19 in adult and pediatric patients. Macro- and microvascular thrombosis of arteries, veins, arterioles, capillaries, and venules of internal organs were found in patients who died of COVID-19. It is known that normal vascular endothelium regulates the coagulation process and might be the source of proinflammatory cytokines.

COVID-19 is not just a new respiratory infection that causes severe lung damage. Detailed studies of the pathogenesis require a better understanding of COVID-19 mechanisms of damage to vital organs, such as blood vessels, the heart, lungs, and brain. Endothelial dysfunction, which has already been found in young patients, is perhaps a new and still underestimated challenge.

Ocular manifestations of COVID-19 in pediatric patients (2023)

The ocular signs in most cases are mild and limited to conjunctival hyperemia or chemosis. However, the patients infected with SARS-CoV-2 who present with severe ophthalmic disorders indicate high viral load and severe pathological changes systemically.

COVID-19 Heart Lesions in Children: Clinical, Diagnostic and Immunological Changes (2023)

In mild COVID-19 in childhood…they can have the second phase, related to the exacerbation of inflammation in the heart tissue even if the viral infection was completely eliminated—post infectious myocarditis.

Currently, analysis of long-term consequences of SARS-CoV-2’s impact on the body of children and adults is ongoing. Approximately 20–55% of patients in young and middle age with COVID-19 were hospitalized, and up to 18.5% of them had a severe course of the disease, wherein patients with cordial and vessels pathology, especially children, including children with congenital pathology, take special place.

Thus, extensive evidence suggests that the heart damage in COVID-19 is triggered by systemic hyperinflammation caused by viral infection.

There is an incomplete understanding of the course as an acute infection and its subsequent manifestations such as Long-COVID-19 or Post-COVID-19 (PASC) in the pediatric population, correlations with comorbidities and immunological changes. It should be added that the clinical manifestations and mechanisms of damage, including the heart, both against the background and after COVID-19 in children differ from those in adults.

Long-Term Effect of COVID-19 on Lung Imaging and Function, Cardiorespiratory Symptoms, Fatigue, Exercise Capacity, and Functional Capacity in Children and Adolescents: A Systematic Review and Meta-Analysis (2022)

The results of this systematic review of the literature and meta-analysis reveal that children and adolescents may experience persistent lung imaging changes, lung function abnormalities, cardiorespiratory symptoms, fatigue, decreased exercise capacity and functional limitations beyond 3 months after COVID-19 infection. The most commonly reported symptoms included fatigue and dyspnea. Exercise limitations were identified in 1 in 5 studies, and functional limitations were reported in almost half of the children and adolescents studied. The lingering effects of COVID-19 identified in youth are similar to those in adults, but less prevalent.

Findings of post COVID-19 CT chest scans or X-rays were reported in 4 studies, which identified persistent abnormalities in 10% (n = 21) of the patients studied. It is important to note that CT and X-ray abnormalities within the paediatric population may be underrepresented due to limiting factors such as radiation safety regulations.

Although long COVID is primarily considered a respiratory tract infection, it is well-documented as a multisystem disease in both adults and children that can adversely affect other organs. However, the effects of long COVID on the cardiovascular system remains unclear. It has been primarily suggested that a condition termed multisystem inflammatory syndrome in children (MIS-C) has been temporarily associated with the post-acute phase of COVID-19. MIS-C can occur in asymptomatic children and is characterized by disturbances in cardiac, respiratory, gastrointestinal and neurological symptoms.

Additional long COVID-19 symptoms identified in this review, such as heart rhythm disturbances, chest pain/tightness, persistent fatigue, and decreased exercise capacity, are commonly reported in patient’s experiencing dysautonomia, a medical condition of autonomic dysregulation that can be triggered by various viruses.

COVID-19 and Acute Neurologic Complications in Children (2022)

Of the 15,137 COVID-19-associated hospitalizations, 1060 (7.0%) children had a neurologic complication. The most common neurologic complication was febrile seizures (582, 3.8%) followed by nonfebrile seizures (352, 2.3%) and encephalopathy (332, 2.1%). The least common neurologic complications were brain abscess or bacterial meningitis (19, 0.13%), and cerebral infarction (8, 0.05%).

We also found that neurologic complications were associated with more intensive resource use, increased ICU admissions, longer ICU LOS, and higher hospital costs, as compared with those without neurologic complications. Deaths and readmissions were also more common among those with neurologic complications. These findings suggest that children hospitalized with COVID-19 who experience neurologic complications are at risk for worse clinical outcomes.

Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C  (2022)

By 2 to 4 months after hospitalization, 32 of 119 (26.9%) patients with acute COVID-19 had persistent symptoms or activity impairment; with 27 of 119 (22.7%) having persistent symptoms and 17 of 119 (14.3%) having activity impairments. Fever and respiratory symptoms, which were common upon admission, had resolved at follow-up, but fatigue or weakness persisted in 14.3% of patients. Patients with persistent symptoms or activity impairment most frequently had respiratory, hematologic, or gastrointestinal organ system involvement during hospitalization. Patients with impaired activity had longer ICU stays compared with those without impaired activity (11.0 days [IQR 4.0–26.5] versus 4.0 days [IQR 2.0–7.0], P = .01), whereas there was no difference in length of ICU stay among patients with and without persistent symptoms.

In this multicenter follow-up study of United States children and adolescents hospitalized with acute COVID-19 or MIS-C, more than 1 in 4 patients had persistent symptoms or activity impairment after having 2 to 4 months to recover from their illness. Fatigue or weakness were the most common symptoms in both children with acute COVID-19 and MIS-C, followed by cough and shortness of breath in the acute COVID-19 group, and headache in the MIS-C group. More than 1 in 5 patients with MIS-C were not able to walk or exercise at their prior level.

Left ventricular longitudinal strain alterations in asymptomatic or mildly symptomatic paediatric patients with SARS-CoV-2 infection (2022)

We analysed a cohort of 53 paediatric patients (29 males, 55%), mean age 7.5 ± 4.7 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or only mildly symptomatic for COVID-19…SARS-CoV-2 infection may affect left ventricular deformation in 26% of children despite an asymptomatic or only mildly symptomatic acute illness.

Epidemiology and Outcomes of SARS-CoV-2 Infection or Multisystem Inflammatory Syndrome in Children vs Influenza Among Critically Ill Children (2022)

Our findings are supported by studies showing increased admissions,1 mortality rate,3 and absolute numbers of deaths2 among children with SARS-CoV-2 vs influenza…Even with pandemic-era public health measures in use, we observed more PICU admissions from SARS-CoV-2 between April 2020 and June 2021 than from influenza during the preceding 2 years. Absence of public health measures when SARS-CoV-2 variants similar to the original and Alpha strains are in circulation would likely lead to a volume of critical illness and death in unimmunized children that is markedly higher than what is typically seen with influenza.

Incidence of New-Onset Type 1 Diabetes Among US Children During the COVID-19 Global Pandemic (2002)

From March 19, 2020, to March 18, 2021, 187 children (mean [SD] age, 9.6 [4.2] years; 106 girls [56.7%]; 81 boys [43.3%]) were admitted for new-onset T1D compared with 119 children admitted the previous year, which represents an increase of 57%. For part of the COVID-19 year (July 2020 through February 2021), the number of new diagnoses of T1D exceeded the number of patients anticipated within the 95% CI based on a quarterly moving average of the preceding 5 years (July 2020: 15 diagnoses; 10 forecasted diagnoses; 95% CI, 6.79-13.89; February 2021: 21 diagnoses; 10 forecasted diagnoses; 95% CI, 6.88-13.54)

Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany (2022)

Our study extends existing evidence on post-COVID-19 syndrome among children and adolescents. We observed relevant post-COVID-19 healthcare utilization and new-onset morbidity patterns documented by physicians in children and adolescents following SARS-CoV-2 infection in a large sample of patients with confirmed COVID-19 compared with a matched control group.

The main strength of our analysis is its broad database including more than 150,000 individuals with available data in the post-COVID-19 phase. This unselected sample from all over Germany covers both outpatient and inpatient care and, thus, constitutes a unique and comprehensive source of evidence. 

Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021 (2022)

In this study, new T1D diagnoses were more likely to occur among pediatric patients with prior COVID-19 than among those with other respiratory infections (or with other encounters with health systems). Respiratory infections have previously been associated with onset of T1D, but this risk was even higher among those with COVID-19 in our study, raising concern for long-term, post–COVID-19 autoimmune complications among youths.

Trends in clinical presentation of children with COVID-19: a systematic review of individual participant data (2022)

Of the 123 children in this review, 29 (23.6%) patients remained asymptomatic, 17 (13.8%) were diagnosed with pneumonia, and 66 (52.8%) reported upper respiratory infection symptoms.

Our review showed that 41.6% of cases presented with only one non-specific symptom. Therefore, symptom-based screening is neither sensitive nor specific as a tool to detect SARS-CoV-2 infection in children; for example, only 62.4% of patients presented with fever. Furthermore, children presented with a variety of other non-specific symptoms referable to the upper respiratory tract (fever, cough, nasal congestion), gastrointestinal tract (vomiting, diarrhea), or neurologic system (headache, seizure). A recent meta-analysis also described fever and cough as the most common presenting symptoms in children with diarrhea occurring in a minority of patients.43 While anosmia and ageusia have been described as early symptoms of COVID-19 in adults, we did not identify a single case in our study that reported these symptoms in children. However, this may be due to a reporting bias as young children may have difficulty articulating these symptoms. As several cases had prolonged shedding of viral material in fecal samples detected by PCR assays, the role of fecal-oral transmission also needs further investigation.

Hospitalization of Infants and Children Aged 0–4 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 2020–February 2022 (2022)

Cerebrovascular Complications of COVID-19 Disease in Children: A Single-Center Case Series (2022)

This work presents a case series of four children diagnosed with severe cerebrovascular disease in association with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, yet no patient from the group met typical diagnostic criteria for multisystem inflammatory syndrome in children.

It is generally believed that COVID-19 infection in children usually has an asymptomatic benign course. However, in connection with the COVID-19 pandemic, we are more likely to encounter diseases that have rarely been seen before that share a common denominator of past COVID-19 infections.

SARS-CoV-2 infection of the central nervous system in a 14-month-old child: A case report of a complete autopsy (2021)

Here we describe multi-organ pathological alterations in the post-mortem tissues of a 14-month-old child, who died of respiratory failure that complicated COVID-19. Our findings revealed microthrombi in veins and arteries in addition to pulmonary involvement resulting in congestion, bronchiolar injury, and collapsed alveolar spaces. The brain exhibited severe atrophy and neuronal loss.

Liver Involvement in Children with COVID-19 and Multisystem Inflammatory Syndrome: A Single-Center Bulgarian Observational Study (2021)

During the fall and winter months of 2020 and the first three months of 2021, 19 children were hospitalized in the pediatric department of University Hospital “N. I. Pirogov”, Sofia, and were found to meet the diagnostic criteria for MIS-C. Most of them exhibited gastrointestinal symptoms, some to the point of imitating acute abdomen, accompanied by highly elevated inflammatory markers—several children presented with elevated liver enzymes, as well as hypoproteinemia and hypoalbuminemia. 

In all our MIS-C patients, the disease ended with complete recovery. One patient had MRI data for myocardial infarction (but the child recovered). Unfortunately, one child developed a complication—hepatic vein thrombosis (Budd Chiari syndrome). The latter underwent successful liver transplantation. In the COVID-19 group, we observed complications only in the ICU group—one exitus letalis and one thrombotic complication (post-stroke hemiparesis). All other children were followed up (at between 1 and 3 months). We did not record any complaints or permanent disabilities and objectified complete normalization of paraclinical parameters.