Phenotyping Pediatric Long COVID: Symptom Clusters from a Longitudinal Multicenter Italian Cohort

Area of Science:

• Pediatric infectious diseases
• Public health
• Clinical epidemiology

Background:

• Identifying patient clusters for pediatric post-acute sequelae of SARS-CoV-2 infection (PASC) is crucial for understanding disease trajectories.
• Previous studies have not fully elucidated age-specific symptom profiles and characteristics associated with PASC development and sequelae.

Purpose of the Study:

• To identify patient clusters based on acute symptoms and characteristics predicting PASC in children.
• To characterize PASC clusters based on sequelae and associated factors in pediatric populations.

Main Methods:

• A multicenter cohort study involving 12 Italian pediatric units.
• Enrollment of children aged 0-17 years with laboratory-confirmed SARS-CoV-2 infection.
• Analysis of data from participants completing at least two surveys over one year, using Multiple Correspondence Analysis and Hierarchical Clustering.

Main Results:

• PASC affected 32.8% of participants, with varying sequelae distribution by age.
• Three clusters identified: young children with respiratory symptoms and higher hospitalization risk; older children with minimal sequelae; adolescents, particularly females, with more severe acute symptoms and higher PASC incidence.
• PASC clusters confirmed age-related patterns: young children with respiratory sequelae, adolescents (especially females) with persistent neuropsychological issues like fatigue and insomnia.

Conclusions:

• Age-tailored follow-up strategies are essential for pediatric PASC management.
• Recommendations include respiratory monitoring for young children and targeted neuropsychological support for adolescents, particularly girls.