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Clinical-based phenotypes in children with pediatric post-COVID-19 condition
Lieke C E Noij1,2, Jelle M Blankestijn3, Coen R Lap4,5
1Department of Pediatric Pulmonology and Allergy, Amsterdam UMC, Location AMC, Emma Children's Hospital, Amsterdam University Medical Center, Room G2-222, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. l.noij@amsterdamumc.nl.
Insights
Pediatric post coronavirus disease 2019 (COVID-19) condition (PPCC) presents varied symptoms. This study identified three distinct PPCC phenotypes in children, aiding in better characterization and treatment strategies for long COVID in pediatrics.
Area of Science:
- Pediatric medicine
- Infectious diseases
- Public health
Background:
- Pediatric post coronavirus disease 2019 (COVID-19) condition (PPCC) is a complex syndrome impacting children's daily lives.
- Understanding PPCC's heterogeneity is crucial for effective clinical management.
Purpose of the Study:
- To identify distinct clinical phenotypes in children experiencing PPCC.
- To characterize these phenotypes based on demographic factors, symptoms, and impact on daily life.
- To inform targeted treatment approaches for pediatric long COVID.
Main Methods:
- Retrospective analysis of 111 children diagnosed with PPCC at a Dutch academic hospital (November 2021-March 2023).
- Collection of demographic data, post-COVID symptoms, comorbidities, and daily life impact.
- Application of unsupervised clustering for mixed data types to identify patient subgroups.
Main Results:
- Three distinct PPCC clusters were identified among children aged 3-18 years.
- Cluster 1 (predominantly girls) exhibited exercise intolerance, dyspnea, and smell disorders.
- Cluster 2 (balanced gender distribution) presented with sleep issues, memory loss, GI symptoms, and arthralgia.
- Cluster 3 (predominantly boys) experienced fever, fewer symptoms, and less impact on daily life.
Conclusions:
- This study successfully delineated three unique clinical phenotypes within pediatric post-COVID conditions.
- These findings underscore the diverse nature of PPCC, necessitating further investigation into underlying mechanisms.
- Phenotypic characterization is essential for advancing the understanding and treatment of long COVID in children.
Background:
Pediatric post coronavirus disease 2019 (COVID-19) condition (PPCC) is a heterogeneous syndrome, which can significantly affect the daily lives of children. This study aimed to identify clinically meaningful phenotypes in children with PPCC, to better characterize and treat this condition.
Methods:
Participants were children with physician-diagnosed PPCC, referred to the academic hospital Amsterdam UMC in the Netherlands between November 2021 and March 2023. Demographic factors and information on post-COVID symptoms, comorbidities, and impact on daily life were collected. Clinical clusters were identified using an unsupervised and unbiased approach for mixed data types.
Results:
Analysis of 111 patients (aged 3-18 years) revealed three distinct clusters within PPCC. Cluster 1 (n = 62, median age = 15 years) predominantly consisted of girls (74.2%). These patients suffered relatively more from exercise intolerance, dyspnea, and smell disorders. Cluster 2 (n = 33, median age = 13 years) contained patients with an even gender distribution (51.5% girls). They suffered from relatively more sleep problems, memory loss, gastrointestinal symptoms, and arthralgia. Cluster 3 (n = 16, median age = 11 years) had a higher proportion of boys (75.0%), suffered relatively more from fever, had significantly fewer symptoms (median of 5 symptoms compared to 8 and 10 for clusters 1 and 2 respectively), and experienced a lower impact on daily life.
Conclusions:
This study identified three distinct clinical PPCC phenotypes, with variations in sex, age, symptom patterns, and impact on daily life. These findings highlight the need for further research to understand the potentially diverse underlying mechanisms contributing to post-COVID symptoms in children.
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