Gross Rachel S, Thaweethai Tanayott, Kleinman Lawrence C, Snowden Jessica N, Rosenzweig Erika B, Milner Joshua D, Tantisira Kelan G, Rhee Kyung E, Jernigan Terry L, Kinser Patricia A, Salisbury Amy L, Warburton David, Mohandas Sindhu, Wood John C, Newburger Jane W, Truong Dongngan T, Flaherman Valerie J, Metz Torri D, Karlson Elizabeth W, Chibnik Lori B, Pant Deepti B, Krishnamoorthy Aparna, Gallagher Richard, Lamendola-Essel Michelle F, Hasson Denise C, Katz Stuart D, Yin Shonna, Dreyer Benard P, Carmilani Megan, Coombs K, Fitzgerald Megan L, Güthe Nick, Hornig Mady, Letts Rebecca J, Peddie Aimee K, Taylor Brittany D, Balaraman Venkataraman, Bogie Amanda, Bukulmez Hulya, Dozor Allen J, Eckrich Daniel, Elliott Amy J, Evans Danielle N, Farkas Jonathan S, Faustino E Vincent S, Fischer Laura, Gaur Sunanda, Harahsheh Ashraf S, Hasan Uzma N, Hsia Daniel S, Huerta-Montañez Gredia, Hummel Kathy D, Kadish Matt P, Kaelber David C, Krishnan Sankaran, Kosut Jessica S, Larrabee Jerry, Lim Peter Paul C, Michelow Ian C, Oliveira Carlos R, Raissy Hengameh, Rosario-Pabon Zaira, Ross Judith L, Sato Alice I, Stevenson Michelle D, Talavera-Barber Maria M, Teufel Ronald J, Weakley Kathryn E, Zimmerman Emily, Bind Marie-Abele C, Chan James, Guan Zoe, Morse Richard E, Reeder Harrison T, Akshoomoff Natascha, Aschner Judy L, Bhattacharjee Rakesh, Cottrell Lesley A, Cowan Kelly, D'Sa Viren A, Fiks Alexander G, Gennaro Maria L, Irby Katherine, Khare Manaswitha, Guttierrez Jeremy Landeo, McCulloh Russell J, Narang Shalu, Ness-Cochinwala Manette, Nolan Sheila, Palumbo Paul, Ryu Julie, Salazar Juan C, Selvarangan Rangaraj, Stein Cheryl R, Werzberger Alan, Zempsky William T, Aupperle Robin, Baker Fiona C, Banich Marie T, Barch Deanna M, Baskin-Sommers Arielle, Bjork James M, Bookheimer Susan Y, Brown Sandra A, Casey B J, Chang Linda, Clark Duncan B, Dale Anders M, Dapretto Mirella, Ernst Thomas M, Fair Damien A, Feldstein Ewing Sarah W, Foxe John J, Freedman Edward G, Friedman Naomi P, Garavan Hugh, Gee Dylan G, Gonzalez Raul, Gray Kevin M, Heitzeg Mary M, Herting Megan M, Jacobus Joanna, Laird Angela R, Larson Christine L, Lisdahl Krista M, Luciana Monica, Luna Beatriz, Madden Pamela A F, McGlade Erin C, Müller-Oehring Eva M, Nagel Bonnie J, Neale Michael C, Paulus Martin P, Potter Alexandra S, Renshaw Perry F, Sowell Elizabeth R, Squeglia Lindsay M, Tapert Susan, Uddin Lucina Q, Wilson Sylia, Yurgelun-Todd Deborah A, Foulkes Andrea S, Stockwell Melissa S
Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York.
Department of Biostatistics, Massachusetts General Hospital, Boston.
JAMA. 2024 Aug 21;332(14):1174-88. doi: 10.1001/jama.2024.12747.
Most research to understand postacute sequelae of SARS-CoV-2 infection (PASC), or long COVID, has focused on adults, with less known about this complex condition in children. Research is needed to characterize pediatric PASC to enable studies of underlying mechanisms that will guide future treatment.
To identify the most common prolonged symptoms experienced by children (aged 6 to 17 years) after SARS-CoV-2 infection, how these symptoms differ by age (school-age [6-11 years] vs adolescents [12-17 years]), how they cluster into distinct phenotypes, and what symptoms in combination could be used as an empirically derived index to assist researchers to study the likely presence of PASC.
DESIGN, SETTING, AND PARTICIPANTS: Multicenter longitudinal observational cohort study with participants recruited from more than 60 US health care and community settings between March 2022 and December 2023, including school-age children and adolescents with and without SARS-CoV-2 infection history.
SARS-CoV-2 infection.
PASC and 89 prolonged symptoms across 9 symptom domains.
A total of 898 school-age children (751 with previous SARS-CoV-2 infection [referred to as infected] and 147 without [referred to as uninfected]; mean age, 8.6 years; 49% female; 11% were Black or African American, 34% were Hispanic, Latino, or Spanish, and 60% were White) and 4469 adolescents (3109 infected and 1360 uninfected; mean age, 14.8 years; 48% female; 13% were Black or African American, 21% were Hispanic, Latino, or Spanish, and 73% were White) were included. Median time between first infection and symptom survey was 506 days for school-age children and 556 days for adolescents. In models adjusted for sex and race and ethnicity, 14 symptoms in both school-age children and adolescents were more common in those with SARS-CoV-2 infection history compared with those without infection history, with 4 additional symptoms in school-age children only and 3 in adolescents only. These symptoms affected almost every organ system. Combinations of symptoms most associated with infection history were identified to form a PASC research index for each age group; these indices correlated with poorer overall health and quality of life. The index emphasizes neurocognitive, pain, and gastrointestinal symptoms in school-age children but change or loss in smell or taste, pain, and fatigue/malaise-related symptoms in adolescents. Clustering analyses identified 4 PASC symptom phenotypes in school-age children and 3 in adolescents.
This study developed research indices for characterizing PASC in children and adolescents. Symptom patterns were similar but distinguishable between the 2 groups, highlighting the importance of characterizing PASC separately for these age ranges.
大多数旨在了解新冠病毒感染后急性后遗症（PASC）或长新冠的研究都集中在成年人身上，而对于儿童这一复杂病症的了解较少。需要开展研究来描述儿童PASC的特征，以便对潜在机制进行研究，从而指导未来的治疗。
确定新冠病毒感染后儿童（6至17岁）最常见的持续症状，这些症状在不同年龄（学龄儿童[6 - 11岁]与青少年[12 - 17岁]）之间如何不同，它们如何聚类成不同的表型，以及哪些症状组合可以用作经验性得出的指标，以帮助研究人员研究PASC的可能存在情况。
设计、背景和参与者：多中心纵向观察性队列研究，参与者于2022年3月至2023年12月期间从美国60多个医疗保健和社区机构招募，包括有和没有新冠病毒感染史的学龄儿童和青少年。
新冠病毒感染。
PASC以及9个症状领域的89种持续症状。
共纳入898名学龄儿童（751名有既往新冠病毒感染史[称为感染组]，147名无感染史[称为未感染组]；平均年龄8.6岁；49%为女性；11%为黑人或非裔美国人，34%为西班牙裔、拉丁裔或西班牙人，60%为白人）和4469名青少年（3109名感染组和1360名未感染组；平均年龄14.8岁；48%为女性；13%为黑人或非裔美国人，21%为西班牙裔、拉丁裔或西班牙人，73%为白人）。学龄儿童首次感染与症状调查之间的中位时间为506天，青少年为556天。在对性别、种族和族裔进行调整的模型中，与无感染史的儿童和青少年相比，有新冠病毒感染史的学龄儿童和青少年中各有14种症状更为常见，学龄儿童中另有4种症状仅在该组中更常见，青少年中则有3种症状仅在该组中更常见。这些症状几乎影响了每个器官系统。确定了与感染史最相关的症状组合，为每个年龄组形成了一个PASC研究指标；这些指标与较差的总体健康状况和生活质量相关。该指标在学龄儿童中强调神经认知、疼痛和胃肠道症状，但在青少年中强调嗅觉或味觉的改变或丧失、疼痛以及疲劳/不适相关症状。聚类分析在学龄儿童中确定了4种PASC症状表型，在青少年中确定了3种。
本研究制定了用于描述儿童和青少年PASC特征的研究指标。两组之间的症状模式相似但有区别，突出了针对这些年龄范围分别描述PASC的重要性。
