儿童新冠后状况：按急性疾病严重程度分层的流行病学证据
Post-COVID-19 condition in children: epidemiological evidence stratified by acute disease severity.
作者信息
Lap Coen R, Brackel Caroline L H, Winkel Angelique M A M, Hashimoto Simone, Haverkort Milly, Noij Lieke C E, Alsem Mattijs W, von Asmuth Erik G J, Bannier Michiel A G E, Buddingh Emmeline P, van Goudoever Johannes B, Haverman Lotte, Maitland-van der Zee Anke H, Mooij Miriam G, Oostrom Kim, Pijnenburg Mariëlle W, Kloosterman Sanne, Teela Lorynn, Luijten Michiel, Tulling Adam J, Lugthart Gertjan, Bogaert Debby, Biesbroek Giske, van Houten Marlies A, Terheggen-Lagro Suzanne W J
机构信息
Department of Pediatrics - Van Houten research group, Spaarne Gasthuis, Hoofddorp and Haarlem, Haarlem, The Netherlands.
Department of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam (UvA), Amsterdam, The Netherlands.
出版信息
Pediatr Res. 2025 Feb;97(3):1016-1024. doi: 10.1038/s41390-024-03597-3. Epub 2024 Sep 27.
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
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. 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. 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.
背景
确定儿童新冠后状况（PPCC）的患病率，识别风险因素，并评估不同严重程度的急性新冠患儿的生活质量。
方法
在一项为期1年随访的前瞻性纵向研究中，我们将非住院（轻症）和住院（重症）新冠病例与新冠病毒检测阴性的对照组进行比较。
结果
本研究纳入了579名儿童。其中，260名患有轻度急性疾病（中位年龄：8岁，四分位间距：6 - 10岁），60名患有重度急性疾病（中位年龄：1岁，四分位间距：0.1 - 4.0岁），259名新冠病毒检测呈阴性（NT）（中位年龄：8岁，四分位间距：5 - 10岁）。在三个月时，新冠病毒阳性轻症组的14.6%（相对风险：6.31（95%置信区间：2.71 - 14.67））和重症组的29.2%（相对风险：12.95（95%置信区间：5.37 - 31.23））报告有后遗症，而NT组为2.3%。轻症组的PPCC患病率从1个月时的16.1%降至1年时的4.4%。与NT儿童相比，患有PPCC的儿童身体健康相关生活质量得分较低，疲劳得分较高。
结论
儿童严重急性新冠导致的PPCC患病率高于轻症病例。PPCC患病率随时间下降。三个月时的风险因素包括既往病史、住院以及检测呈阳性1个月后持续疲劳。
影响
我们证明，与轻症或未感染的儿童相比，患有严重新冠的儿童更有可能出现新冠后状况，并突出了风险因素。我们按急性疾病严重程度进行了分层，前瞻性纳入了一个阴性对照组，并证明了在使用各种最新的新冠后定义时患病率的异质性。识别儿童新冠后的风险因素并突出基于各种当前新冠后定义的患病率异质性，应有助于正确识别潜在的儿童新冠后病例，有助于早期干预。
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