AUTHOR=Maddux Aline B. , Young Cameron C. , Kucukak Suden , Zambrano Laura D. , Newhams Margaret M. , Rollins Caitlin K. , Halasa Natasha B. , Gertz Shira J. , Mack Elizabeth H. , Schwartz Stephanie , Kong Michele , Loftis Laura L. , Irby Katherine , Rowan Courtney M. , Tarquinio Keiko M. , Zinter Matt S. , Crandall Hillary , Cvijanovich Natalie Z. , Schuster Jennifer E. , Fitzgerald Julie C. , Staat Mary A. , Hobbs Charlotte V. , Nofziger Ryan A. , Shein Steven , Flori Heidi , Cullimore Melissa L. , Chatani Brandon M. , Levy Emily R. , Typpo Katri V. , Hume Janet R. , Campbell Angela P. , Randolph Adrienne G. , the Overcoming COVID-19 Investigators , Kong Michele , Murdock Meghan , Kelley Heather , Colston Candice , Gaspers Mary Glas , Typpo Katri V. , Sanders Ronald C. , Irby Katherine , Cvijanovich Natalie Z. , Zinter Matt S. , Maddux Aline B. , Port Emily , Mansour Rachel , Shankman Sara , Chatani Brandon M. , Tarquinio Keiko M. , Jones Kaitlin , Rowan Courtney M. , Randolph Adrienne G. , Newhams Margaret M. , Young Cameron C. , Kucukak Suden , Rollins Caitlin , Novak Tanya , Chou Janet , Son Mary Beth , Clarke Julia , Sens Brooke , Listerud Eve , Chen Sabrina , Stewart Kasey , Flori Heidi R. , Dahmer Mary K. , Hume Janet R. , Levy Emily R. , Behl Supriya , Drapeau Noelle M. , Hobbs Charlotte V. , Martin Lora , Malloch Lacy , Martin Maygan , Patterson Kayla , Sanders Cameron , Inagaki Kengo , McGraw Sarah , Dhanrajani Anita , Schuster Jennifer E. , Kietzman Abigail , Hill Shannon , Cullimore Melissa L. , McCulloh Russell J. , Gertz Shira J. , Schwartz Stephanie P. , Walker Tracie C. , Nofziger Ryan A. , Staat Mary Allen , Shein Steven , Rasal Rajashri , Fitzgerald Julie C. , Burnett Ryan , Bush Jenny , Mack Elizabeth H. , Halasa Natasha B. , Golcha Meena , Stewart Laura , Loftis Laura L. , Crandall Hillary , Ampofo Krow , Patel Manish M. , Feldstein Leora R. , Tenforde Mark W. , Jackson Ashley M. , Campbell Angela , Zambrano Laura D. TITLE=Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C JOURNAL=Frontiers in Pediatrics VOLUME=11 YEAR=2023 URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1260372 DOI=10.3389/fped.2023.1260372 ISSN=2296-2360 ABSTRACT=Objective

To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.

Methods

Across 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).

Results

Of 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n = 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments.

Discussion

Among patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.