Clinics (Nov 2021)

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

  • Thais T. Fink,
  • Heloisa H.S. Marques,
  • Bruno Gualano,
  • Livia Lindoso,
  • Vera Bain,
  • Camilla Astley,
  • Fernanda Martins,
  • Denise Matheus,
  • Olivia M. Matsuo,
  • Priscila Suguita,
  • Vitor Trindade,
  • Camila S.Y. Paula,
  • Sylvia C.L. Farhat,
  • Patricia Palmeira,
  • Gabriela N. Leal,
  • Lisa Suzuki,
  • Vicente Odone Filho,
  • Magda Carneiro-Sampaio,
  • Alberto José S. Duarte,
  • Leila Antonangelo,
  • Linamara R. Batisttella,
  • Guilherme V. Polanczyk,
  • Rosa Maria R. Pereira,
  • Carlos Roberto R. Carvalho,
  • Carlos A. Buchpiguel,
  • Ana Claudia L. Xavier,
  • Marilia Seelaender,
  • Clovis Artur Silva,
  • Maria Fernanda B. Pereira,
  • Adriana M. E. Sallum,
  • Alexandra V. M. Brentani,
  • Álvaro José S. Neto,
  • Amanda Ihara,
  • Andrea R. Santos,
  • Ana Pinheiro M. Canton,
  • Andreia Watanabe,
  • Angélica C. dos Santos,
  • Antonio C. Pastorino,
  • Bernadette D. G. M. Franco,
  • Bruna Caruzo,
  • Carina Ceneviva,
  • Carolina C. M. F. Martins,
  • Danilo Prado,
  • Deipara M. Abellan,
  • Fabiana B. Benatti,
  • Fabiana Smaria,
  • Fernanda T. Gonçalves,
  • Fernando D. Penteado,
  • Gabriela S. F. de Castro,
  • Guilherme S. Gonçalves,
  • Hamilton Roschel,
  • Ilana R. Disi,
  • Isabela G. Marques,
  • Inar A. Castro,
  • Izabel M. Buscatti,
  • Jaline Z. Faiad,
  • Jarlei Fiamoncini,
  • Joaquim C. Rodrigues,
  • Jorge D. A. Carneiro,
  • Jose A. Paz,
  • Juliana C. Ferreira,
  • Juliana C. O. Ferreira,
  • Katia R. Silva,
  • Karina L. M. Bastos,
  • Katia Kozu,
  • Lilian M. Cristofani,
  • Lucas V. B. Souza,
  • Lucia M. A. Campos,
  • Luiz Vicente R. F. Silva Filho,
  • Marcelo T. Sapienza,
  • Marcos S. Lima,
  • Marlene P. Garanito,
  • Márcia F. A. Santos,
  • Mayra B. Dorna,
  • Nadia E. Aikawa,
  • Nadia Litvinov,
  • Neusa K. Sakita,
  • Paula V. V. Gaiolla,
  • Paula Pasqualucci,
  • Ricardo K. Toma,
  • Simone Correa-Silva,
  • Sofia M. Sieczkowska,
  • Marta Imamura,
  • Silvana Forsait,
  • Vera A. Santos,
  • Yingying Zheng

DOI
https://doi.org/10.6061/clinics/2021/e3511
Journal volume & issue
Vol. 76

Abstract

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OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.

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