Tang Chunjiao, Wang Shouyi, Fan Jingyi
Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China.
Front Pediatr. 2024 Aug 1;12:1359057. doi: 10.3389/fped.2024.1359057. eCollection 2024.
Since the Chinese government changed its COVID-19 prevention and control policies, the rapid spread of the omicron variant resulted in a pervasive surge of infections throughout the nation, particularly affecting children. Although the acute symptoms of children infected with COVID-19 are milder compared to adults, the impact of post-COVID-19 syndromes (PCS) on the growth and development of children should not be ignored. The clinical manifestations, treatment methods, and long-term effects of children are significantly different from those of adults, making it necessary to understand the phenotype of children with PCS in order to effectively manage their health.
The study focuses on hospitalized children infected with omicron variant in Zhongnan Hospital of Wuhan University from December 7, 2022, to January 5, 2023. Three telephone follow-ups with the guardians was conducted at 4-5 weeks, 12-13 weeks, and 24-25 weeks after the patients' discharge to understand their prevalence, clinical characteristics, and risk factors of PCS.
The age range of the 112 hospitalized pediatric patients was 0-13 years, with a median age of 19 months. After three follow-ups, 49.1% patients had PCS, while the incidence of PCS persisting 3 month was 21.4%, with a prevalence of PCS persisting 6 month of 10.7%. From the first follow-up phase to the third phase, there was a significant decrease in the incidence of PCS. In infants, the most common persistent symptom was sleep disorder (19.2%), followed by respiratory symptoms, diarrhea (8.2%), and decreased appetite (6.8%). In children and adolescents, decreased appetite was the most common persistent symptom (30.8%), followed by respiratory symptoms, fatigue (15.4%), and mood changes (15.4%). Decreased appetite was more common in the children and adolescents, while diarrhea and sleep disorders were more common in the infants. Binary logistic regression analysis and ordered logistic regression analysis showed that times of illness (OR = 1.671, 95% CI: 1.339-2.086) were positively correlated with the duration of symptoms. Times of illness was positively correlated with cough/expectoration (OR = 1.491, 95% CI: 1.039-2.138). Age (OR = 0.844, 95% CI: 0.755-0.944) and re-hospitalization (OR = 0.146, 95% CI: 0.022-0.969) were positively correlated with sleep disorders.
Children with Omicron variant may still experience PCS, but the incidence is lower compared to adults and compared to other variants and the incidence of PCS will gradually decrease over time. The symptoms of PCS differ between older children and infants and it is necessary to prevent recurrent illness for at least half a year after COVID-19 recovery. In order to further understand and ameliorate the impact of PCS on the health of children infected with COVID-19, subsequent follow-up studies will expand the scope, combine with objective follow-up contents, and establish an assessment and management system especially for children of different ages.
自中国政府调整新冠疫情防控政策以来，奥密克戎变异株迅速传播，导致全国范围内感染人数激增，儿童尤其受到影响。尽管儿童感染新冠病毒后的急性症状比成人轻，但新冠后综合征（PCS）对儿童生长发育的影响不容忽视。儿童的临床表现、治疗方法和长期影响与成人有显著差异，因此有必要了解儿童PCS的表型，以便有效管理他们的健康。
本研究聚焦于2022年12月7日至2023年1月5日在武汉大学中南医院住院的感染奥密克戎变异株的儿童。在患者出院后的4 - 5周、12 - 13周和24 - 25周对监护人进行了三次电话随访，以了解他们的PCS患病率、临床特征和危险因素。
112名住院儿科患者的年龄范围为0 - 13岁，中位年龄为19个月。经过三次随访，49.1%的患者出现PCS，持续3个月的PCS发病率为21.4%，持续6个月的患病率为10.7%。从第一次随访阶段到第三阶段，PCS的发病率显著下降。在婴儿中，最常见的持续症状是睡眠障碍（19.2%），其次是呼吸道症状、腹泻（8.2%）和食欲减退（6.8%）。在儿童和青少年中，食欲减退是最常见的持续症状（30.8%），其次是呼吸道症状、疲劳（15.4%）和情绪变化（15.4%）。食欲减退在儿童和青少年中更常见，而腹泻和睡眠障碍在婴儿中更常见。二元逻辑回归分析和有序逻辑回归分析表明，患病次数（OR = 1.671，95% CI：1.339 - 2.086）与症状持续时间呈正相关。患病次数与咳嗽/咳痰呈正相关（OR = 1.491，95% CI：1.039 - 2.138）。年龄（OR = 0.844，95% CI：0.755 - 0.944）和再次住院（OR = 0.146，95% CI：0.022 - 0.969）与睡眠障碍呈正相关。
感染奥密克戎变异株的儿童仍可能出现PCS，但与成人相比以及与其他变异株相比发病率较低，且PCS的发病率会随着时间逐渐降低。大龄儿童和婴儿的PCS症状有所不同，新冠康复后至少半年内有必要预防疾病复发。为了进一步了解和改善PCS对感染新冠病毒儿童健康的影响，后续随访研究将扩大范围，结合客观随访内容，并建立专门针对不同年龄段儿童的评估和管理体系。
