Pediatric Gastrointestinal Tract Outcomes During the Postacute Phase of COVID-19
Dazheng Zhang1,2, Ronen Stein3,4, Yiwen Lu1,5
1The Center for Health AI and Synthesis of Evidence, University of Pennsylvania, Philadelphia.
Insights
Children and adolescents with documented COVID-19 have a higher risk of gastrointestinal (GI) symptoms and disorders in both the postacute and chronic phases. Lingering GI issues are more common after infection, highlighting the need for clinical awareness.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Public Health
Background:
- The long-term gastrointestinal (GI) effects of COVID-19 in pediatric populations are not well understood.
- Investigating postacute and chronic GI outcomes following SARS-CoV-2 infection in children is crucial.
Purpose of the Study:
- To assess the risk of GI symptoms and disorders in children and adolescents during the postacute (28-179 days) and chronic (180-729 days) phases after SARS-CoV-2 infection.
- To compare GI outcomes between pediatric patients with and without documented COVID-19.
Main Methods:
- Retrospective cohort study involving over 1.5 million pediatric patients across 29 US healthcare institutions.
- SARS-CoV-2 infection was identified through positive test results or diagnostic codes.
- GI symptoms and disorders were identified using diagnostic codes; risk was analyzed using stratified Poisson regression.
Main Results:
- Pediatric patients with documented COVID-19 showed an increased risk of GI symptoms/disorders in the postacute phase (ARR, 1.25) and chronic phase (ARR, 1.28).
- Specifically, the risk of abdominal pain was elevated in COVID-19-positive children during both postacute (ARR, 1.14) and chronic (ARR, 1.24) phases.
- The cohort included 413,455 patients with documented SARS-CoV-2 infection and 1,163,478 without.
Conclusions:
- Documented SARS-CoV-2 infection is associated with a higher risk of GI symptoms and disorders in children and adolescents.
- Clinicians should be aware of the potential for persistent GI issues in pediatric patients following COVID-19.
- These findings underscore the importance of monitoring GI health in children post-COVID-19 infection.
Importance:
The profile of gastrointestinal (GI) tract outcomes associated with the postacute and chronic phases of COVID-19 in children and adolescents remains unclear.
Objective:
To investigate the risks of GI tract symptoms and disorders during the postacute (28-179 days after documented SARS-CoV-2 infection) and the chronic (180-729 days after documented SARS-CoV-2 infection) phases of COVID-19 in the pediatric population.
Design, Setting, And Participants:
This retrospective cohort study was performed from March 1, 2020, to September 1, 2023, at 29 US health care institutions. Participants included pediatric patients 18 years or younger with at least 6 months of follow-up. Data analysis was conducted from November 1, 2023, to February 29, 2024.
Exposures:
Presence or absence of documented SARS-CoV-2 infection. Documented SARS-CoV-2 infection included positive results of polymerase chain reaction analysis, serological tests, or antigen tests for SARS-CoV-2 or diagnosis codes for COVID-19 and postacute sequelae of SARS-CoV-2.
Main Outcomes And Measures:
GI tract symptoms and disorders were identified by diagnostic codes in the postacute and chronic phases following documented SARS-CoV-2 infection. The adjusted risk ratios (ARRs) and 95% CI were determined using a stratified Poisson regression model, with strata computed based on the propensity score.
Results:
The cohort consisted of 1 576 933 pediatric patients (mean [SD] age, 7.3 [5.7] years; 820 315 [52.0%] male). Of these, 413 455 patients had documented SARS-CoV-2 infection and 1 163 478 did not; 157 800 (13.6%) of those without documented SARS-CoV-2 infection had a complex chronic condition per the Pediatric Medical Complexity Algorithm. Patients with a documented SARS-CoV-2 infection had an increased risk of developing at least 1 GI tract symptom or disorder in both the postacute (8.64% vs 6.85%; ARR, 1.25; 95% CI, 1.24-1.27) and chronic (12.60% vs 9.47%; ARR, 1.28; 95% CI, 1.26-1.30) phases compared with patients without a documented infection. Specifically, the risk of abdominal pain was higher in COVID-19-positive patients during the postacute (2.54% vs 2.06%; ARR, 1.14; 95% CI, 1.11-1.17) and chronic (4.57% vs 3.40%; ARR, 1.24; 95% CI, 1.22-1.27) phases.
Conclusions And Relevance:
In this cohort study, the increased risk of GI tract symptoms and disorders was associated with the documented SARS-CoV-2 infection in children or adolescents during the postacute or chronic phase. Clinicians should note that lingering GI tract symptoms may be more common in children after documented SARS-CoV-2 infection than in those without documented infection.
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