Journal
EUROPEAN JOURNAL OF PEDIATRICS
Volume 181, Issue 12, Pages 3995-4009Publisher
SPRINGER
DOI: 10.1007/s00431-022-04600-x
Keywords
COVID-19; SARS-CoV-2; Post COVID; Sequelae; Children
Categories
Funding
- Universita degli Studi di Firenze within the CRUI-CARE Agreement
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This systematic literature review summarizes the evidence of long COVID in children and adolescents, finding that the evidence is limited, heterogeneous, and based on low-quality studies. The prevalence of long COVID varies greatly, with a wide range of symptoms reported. Differentiating long COVID symptoms from the consequences of lockdown measures is challenging. High-quality studies, including controlled clinical studies and investigations into the impact of new variants, are needed for an objective analysis and proper allocation of healthcare resources for long COVID in children.
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.
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