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Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review
Julian Hirt1,2, Perrine Janiaud1, Viktoria Luise Gloy1
1Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
The robustness of studies on post-COVID conditions in children is limited. More reliable research is urgently needed to understand the impact of SARS-CoV-2 infection on pediatric long-term health outcomes.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Epidemiology
Background:
- Post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID, is a growing concern in pediatric populations.
- Understanding the long-term health outcomes in children following SARS-CoV-2 infection is crucial for clinical management and public health.
- Existing literature on pediatric long COVID exhibits significant variability in reported outcomes and methodological rigor.
Conclusions:
- The robustness of reported post-acute SARS-CoV-2 health outcomes in children is seriously limited across identified studies.
- Current evidence does not provide certainty regarding the impact of SARS-CoV-2 infection on pediatric long-term health.
- There is an urgent need for more reliable, methodologically sound research to address concerns and improve care for children affected by post-COVID conditions.
Objective:
To systematically assess the robustness of reported postacute SARS-CoV-2 infection health outcomes in children.
Methods:
A search on PubMed and Web of Science was conducted to identify studies published up to 22 January 2022 that reported on postacute SARS-CoV-2 infection health outcomes in children (<18 years) with follow-up of ≥2 months since detection of infection or ≥1 month since recovery from acute illness. We assessed the consideration of confounding bias and causality, as well as the risk of bias.
Results:
21 studies including 81 896 children reported up to 97 symptoms with follow-up periods of 2.0-11.5 months. Fifteen studies had no control group. The reported proportion of children with post-COVID syndrome was between 0% and 66.5% in children with SARS-CoV-2 infection (n=16 986) and between 2.0% and 53.3% in children without SARS-CoV-2 infection (n=64 910). Only two studies made a clear causal interpretation of an association between SARS-CoV-2 infection and the main outcome of 'post-COVID syndrome' and provided recommendations regarding prevention measures. The robustness of all 21 studies was seriously limited due to an overall critical risk of bias.
Conclusions:
The robustness of reported postacute SARS-CoV-2 infection health outcomes in children is seriously limited, at least in all the published articles we could identify. None of the studies provided evidence with reasonable certainty on whether SARS-CoV-2 infection has an impact on postacute health outcomes, let alone to what extent. Children and their families urgently need much more reliable and methodologically robust evidence to address their concerns and improve care.
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