Long COVID in Pediatric Age: An Observational, Prospective, Longitudinal, Multicenter Study in Italy

Susanna Maria Roberta Esposito ^1* Matteo Puntoni ² Michela Deolmi ¹ Greta Ramundo ¹ Giuseppe Maglietta ² Marco Poeta ³ Stefania Zampogna ⁴ Claudia Colomba ⁵ Agnese Suppiej ⁶ FABIO CARDINALE ⁷ Samantha Bosis ⁸ Elio Castagnola ⁹ Fabio Midulla ¹⁰ Carlo Giaquinto ¹¹ Paola Giordano ¹² Giacomo Biasucci ¹³ Valentina Fainardi ¹ Francesco Nunziata ¹⁴ Roberto Grandinetti ¹ Anna Condemi ¹⁵ Giuseppe Raiola ¹⁶ Alfredo Guarino ¹⁴ Caterina Caminiti ²

• ¹ Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
• ² Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
• ³ Pediatric Infectious Disease Unit, Department of Maternal and Child health, University Hospital "Federico II", Naples, Italy
• ⁴ Department Pediatrics, Hospital of Crotone, Crotone, Italy
• ⁵ Division of Pediatric Infectious Diseases, "G. Di Cristina" Hospital, ARNAS Civico Di Cristina Benfratelli, University of Palermo, Palermo, Italy
• ⁶ Pediatric Clinic, University of Ferrara, Ferrara, Italy
• ⁷ Complex Operating Unit Paediatrics, Giovanni XXIII Paediatric Hospital, University of Bari, Bari, Italy
• ⁸ S.C. Pediatria-Pneumoinfettivologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
• ⁹ Department of Pediatric Infectious Diseases, Giannina Gaslini Institute (IRCCS), Genoa, Italy
• ¹⁰ Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
• ¹¹ Division of Pediatric Infectious Diseases, Department of Women's and Children's Health, School of Medicine and Surgery, University of Padua, Padua, Veneto, Italy
• ¹² Department of Interdisciplinary Medicine, Pediatric Section, "Aldo Moro" University of Bari, Bari, Italy
• ¹³ Pediatrics and Neonatology Unit, Department of Medicine and Surgery, University of Parma, Guglielmo da Saliceto Hospital, Piacenza, Italy
• ¹⁴ Pediatric Infectious Disease Unit, Department of Maternal and Child health, University Hospital 'Federico II', Naples, Campania, Italy
• ¹⁵ Division of Pediatric Infectious Diseases, 'G. Di Cristina' Hospital, ARNAS Civico Di Cristina Benfratelli, University of Palermo, Palermo, Sicily, Italy
• ¹⁶ Department of Pediatrics, "Pugliese-Ciaccio" Hospital, Catanzaro, Italy

This observational prospective longitudinal multicenter study examines the occurrence prevalence and characteristics of long COVID (LC) in the Italian pediatric population. Conducted across 12 Pediatric Units in Italy from January to March 2022, the study involved 1129 children diagnosed with SARS-CoV-2 infection. Data were collected via self-administered questionnaires at 1-3 months, 3-6 months, and 6-12 months post-infection, with LC defined as symptoms persisting for at least 2 months and occurring 3 months post-diagnosis. Results revealed that 68.6% of children reported at least one post-COVID symptom, with 16.2% experiencing LC. The most frequent symptoms included respiratory issues (43.4%), neurological and cognitive dysfunction (27.7%), gastrointestinal symptoms (22.1%), fatigue (21.6%), and sleep disturbances (18.8%). Age and gender differences were significant, with older children and females more prone to cardiovascular and neurological & cognitive dysfunction. The study highlights that LC in children presents similarly to adults, though less frequently. The prevalence occurrence of LC was lower compared to adult populations, likely due to the generally milder course of COVID-19 in children. The findings underscore the need for targeted follow-up and support for affected children, especially considering the long-term persistence of symptoms. Further research is necessary to explore the impact of COVID-19 vaccines on pediatric LC and the effects of different SARS-CoV-2 variants. These insights are crucial for developing strategies to manage and mitigate long-term impacts in children recovering from COVID-19.