Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C

Aline B. Maddux; Laura Berbert; Cameron C. Young; Leora R. Feldstein; Laura D. Zambrano; Suden Kucukak; Margaret M. Newhams; Kristen Miller; Madyson M. FitzGerald; Jie He; Natasha B. Halasa; Natalie Z. Cvijanovich; Laura L. Loftis; Tracie C. Walker; Stephanie P. Schwartz; Shira J. Gertz; Keiko M. Tarquinio; Julie C. Fitzgerald; Michele Kong; Jennifer E. Schuster; Elizabeth H. Mack; Charlotte V. Hobbs; Courtney M. Rowan; Mary A. Staat; Matt S. Zinter; Katherine Irby; Hillary Crandall; Heidi Flori; Melissa L. Cullimore; Ryan A. Nofziger; Steven L. Shein; Mary Glas Gaspers; Janet R. Hume; Emily R. Levy; Sabrina R. Chen; Manish M. Patel; Mark W. Tenforde; Edie Weller; Angela P. Campbell; Adrienne G. Randolph

doi:10.1542/peds.2022-057798

Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C

Aline B. Maddux
, Laura Berbert
, Cameron C. Young
, Leora R. Feldstein
, Laura D. Zambrano
, Suden Kucukak
, Margaret M. Newhams
, Kristen Miller
, Madyson M. FitzGerald
, Jie He
, Natasha B. Halasa
, Natalie Z. Cvijanovich
, Laura L. Loftis
, Tracie C. Walker
, Stephanie P. Schwartz
, Shira J. Gertz
, Keiko M. Tarquinio
, Julie C. Fitzgerald
, Michele Kong
, Jennifer E. Schuster

Elizabeth H. Mack, Charlotte V. Hobbs, Courtney M. Rowan, Mary A. Staat, Matt S. Zinter, Katherine Irby, Hillary Crandall, Heidi Flori, Melissa L. Cullimore, Ryan A. Nofziger, Steven L. Shein, Mary Glas Gaspers, Janet R. Hume, Emily R. Levy, Sabrina R. Chen, Manish M. Patel, Mark W. Tenforde, Edie Weller, Angela P. Campbell, Adrienne G. Randolph

University of Colorado School of Medicine
Boston Children's Hospital
Centers for Disease Control and Prevention
Vanderbilt University
UCSF Benioff Children's Hospital Oakland
Texas Children's Hospital Houston
University of North Carolina at Chapel Hill
Cooperman Barnabas Medical Center
Emory University
The Children's Hospital of Philadelphia
Division of Pediatric Critical Care
Children's Mercy Hospitals and Clinics
Medical University of South Carolina
University of Mississippi
Indiana University Bloomington
University of Cincinnati
University of California at San Francisco
University of Arkansas for Medical Sciences
University of Utah
University of Michigan, Ann Arbor
Children's Hospital and Medical Center
Akron Children's Hospital
Case Western Reserve University
University of Arizona
University of Minnesota Twin Cities
Mayo Clinic Rochester, MN
Harvard University

Research output: Contribution to journal › Article › peer-review

39 Scopus citations

Abstract

OBJECTIVES: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory abstract syndrome in children (MIS-C). METHODS: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS: Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04–1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06–1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55–6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35–4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C). CONCLUSIONS: Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.

Original language	English
Article number	e2022057798
Journal	Pediatrics
Volume	150
Issue number	3
DOIs	https://doi.org/10.1542/peds.2022-057798
State	Published - 1 Sep 2022
Externally published	Yes

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Maddux, A. B., Berbert, L., Young, C. C., Feldstein, L. R., Zambrano, L. D., Kucukak, S., Newhams, M. M., Miller, K., FitzGerald, M. M., He, J., Halasa, N. B., Cvijanovich, N. Z., Loftis, L. L., Walker, T. C., Schwartz, S. P., Gertz, S. J., Tarquinio, K. M., Fitzgerald, J. C., Kong, M., ... Randolph, A. G. (2022). Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C. Pediatrics, 150(3), Article e2022057798. https://doi.org/10.1542/peds.2022-057798

@article{b1b504c790fe473c802e110678c93150,

title = "Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C",

abstract = "OBJECTIVES: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory abstract syndrome in children (MIS-C). METHODS: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95\% confidence intervals (CI). RESULTS: Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8\%) with acute COVID-19 and 160 of 203 (78.8\%) with MIS-C. Thirteen (11\%) patients with acute COVID-19 and 12 (8\%) with MIS-C had a readmission. Thirty-two (26.9\%) patients with acute COVID-19 had persistent symptoms (22.7\%) or activity impairment (14.3\%) and 48 (30.0\%) with MIS-C had persistent symptoms (20.0\%) or activity impairment (21.3\%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95\% CI, 1.04{\textendash}1.59]) and activity impairment (aRR, 1.37 [95\% CI, 1.06{\textendash}1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95\% CI, 1.55{\textendash}6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95\% CI, 1.35{\textendash}4.69]). New morbidities were infrequent (9\% COVID-19, 1\% MIS-C). CONCLUSIONS: Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.",

author = "Maddux, \{Aline B.\} and Laura Berbert and Young, \{Cameron C.\} and Feldstein, \{Leora R.\} and Zambrano, \{Laura D.\} and Suden Kucukak and Newhams, \{Margaret M.\} and Kristen Miller and FitzGerald, \{Madyson M.\} and Jie He and Halasa, \{Natasha B.\} and Cvijanovich, \{Natalie Z.\} and Loftis, \{Laura L.\} and Walker, \{Tracie C.\} and Schwartz, \{Stephanie P.\} and Gertz, \{Shira J.\} and Tarquinio, \{Keiko M.\} and Fitzgerald, \{Julie C.\} and Michele Kong and Schuster, \{Jennifer E.\} and Mack, \{Elizabeth H.\} and Hobbs, \{Charlotte V.\} and Rowan, \{Courtney M.\} and Staat, \{Mary A.\} and Zinter, \{Matt S.\} and Katherine Irby and Hillary Crandall and Heidi Flori and Cullimore, \{Melissa L.\} and Nofziger, \{Ryan A.\} and Shein, \{Steven L.\} and Gaspers, \{Mary Glas\} and Hume, \{Janet R.\} and Levy, \{Emily R.\} and Chen, \{Sabrina R.\} and Patel, \{Manish M.\} and Tenforde, \{Mark W.\} and Edie Weller and Campbell, \{Angela P.\} and Randolph, \{Adrienne G.\}",

year = "2022",

month = sep,

day = "1",

doi = "10.1542/peds.2022-057798",

language = "English",

volume = "150",

journal = "Pediatrics",

issn = "0031-4005",

publisher = "American Academy of Pediatrics",

number = "3",

}

Maddux, AB, Berbert, L, Young, CC, Feldstein, LR, Zambrano, LD, Kucukak, S, Newhams, MM, Miller, K, FitzGerald, MM, He, J, Halasa, NB, Cvijanovich, NZ, Loftis, LL, Walker, TC, Schwartz, SP, Gertz, SJ, Tarquinio, KM, Fitzgerald, JC, Kong, M, Schuster, JE, Mack, EH, Hobbs, CV, Rowan, CM, Staat, MA, Zinter, MS, Irby, K, Crandall, H, Flori, H, Cullimore, ML, Nofziger, RA, Shein, SL, Gaspers, MG, Hume, JR, Levy, ER, Chen, SR, Patel, MM, Tenforde, MW, Weller, E, Campbell, AP & Randolph, AG 2022, 'Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C', Pediatrics, vol. 150, no. 3, e2022057798. https://doi.org/10.1542/peds.2022-057798

TY - JOUR

T1 - Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C

AU - Maddux, Aline B.

AU - Berbert, Laura

AU - Young, Cameron C.

AU - Feldstein, Leora R.

AU - Zambrano, Laura D.

AU - Kucukak, Suden

AU - Newhams, Margaret M.

AU - Miller, Kristen

AU - FitzGerald, Madyson M.

AU - He, Jie

AU - Halasa, Natasha B.

AU - Cvijanovich, Natalie Z.

AU - Loftis, Laura L.

AU - Walker, Tracie C.

AU - Schwartz, Stephanie P.

AU - Gertz, Shira J.

AU - Tarquinio, Keiko M.

AU - Fitzgerald, Julie C.

AU - Kong, Michele

AU - Schuster, Jennifer E.

AU - Mack, Elizabeth H.

AU - Hobbs, Charlotte V.

AU - Rowan, Courtney M.

AU - Staat, Mary A.

AU - Zinter, Matt S.

AU - Irby, Katherine

AU - Crandall, Hillary

AU - Flori, Heidi

AU - Cullimore, Melissa L.

AU - Nofziger, Ryan A.

AU - Shein, Steven L.

AU - Gaspers, Mary Glas

AU - Hume, Janet R.

AU - Levy, Emily R.

AU - Chen, Sabrina R.

AU - Patel, Manish M.

AU - Tenforde, Mark W.

AU - Weller, Edie

AU - Campbell, Angela P.

AU - Randolph, Adrienne G.

PY - 2022/9/1

Y1 - 2022/9/1

N2 - OBJECTIVES: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory abstract syndrome in children (MIS-C). METHODS: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS: Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04–1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06–1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55–6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35–4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C). CONCLUSIONS: Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.

AB - OBJECTIVES: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory abstract syndrome in children (MIS-C). METHODS: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI). RESULTS: Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04–1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06–1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55–6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35–4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C). CONCLUSIONS: Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.

UR - https://www.scopus.com/pages/publications/85137138183

U2 - 10.1542/peds.2022-057798

DO - 10.1542/peds.2022-057798

M3 - Article

C2 - 35765138

AN - SCOPUS:85137138183

SN - 0031-4005

VL - 150

JO - Pediatrics

JF - Pediatrics

IS - 3

M1 - e2022057798

ER -

Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C

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