Long-Term Effects of COVID-19 in Hospitalized and Non-Hospitalized Pediatric Patients: A Prospective Study

Öz

Aim: The global COVID-19 pandemic caused by SARS-CoV-2 has led to both acute and long-term health consequences worldwide. Long COVID, characterized by persistent symptoms lasting weeks or months after recovery from the acute infection, has been increasingly reported. This study aims to evaluate the long-term symptoms of COVID-19 in hospitalized and non-hospitalized pediatric patients, following WHO criteria for Long COVID. Methods: This prospective study was conducted between June 2020 and June 2021 at Sancaktepe Training and Research Hospital. A total of 60 children with PCR-confirmed COVID-19 were included. The study participants were divided into three groups: Group 1 (30 children followed up in the outpatient clinic), Group 2 (30 children hospitalized in the pediatric intensive care unit (PICU)), and Group 3 (30 children without a prior COVID-19 infection as the control group). Parents completed a questionnaire assessing symptoms persisting for 12 weeks after diagnosis. Results: Group 2 experienced significantly more symptoms during both the acute and post-acute periods, including fatigue, shortness of breath, fever, weight loss, muscle/joint pain, and neuropsychiatric symptoms such as anxiety, sleep disturbances, and headache. Fatigue was particularly prevalent among hospitalized children, with anxiety and sleep disturbances also being significantly more common in the same group. Conclusions: Long COVID is a significant concern for pediatric patients. Fatigue, anxiety, sleep disorders, and headache were the most frequent persistent symptoms. These findings emphasize the need for continued surveillance and targeted rehabilitation strategies to address the long-term effects of COVID-19 on children's physical and mental health.

Anahtar Kelimeler

• Long COVID-19
• pediatric patient
• SARS-CoV-2
• MIS-C
• PASC

Hastanede Yatan ve Yatmayan Pediatrik Hastalarda COVID-19'un Uzun Dönemli Etkileri: Prospektif Bir Çalışma

Öz

Amaç: SARS-CoV-2 ‘nin neden olduğu küresel COVID-19 pandemisi akut ve uzun vadeli sağlık sorunlarına yol açmıştır. Akut enfeksiyondan iyileştikten sonra semptomların haftalar veya aylarca devam etmesi ile karakterize olan Long COVID, artan şekilde bildirilmektedir. Bu çalışma, COVID-19'un hastanede yatan ve yatmayan pediyatrik hastalardaki uzun vadeli semptomlarını, Long COVID için WHO kriterlerini takip ederek değerlendirmeyi amaçlamaktadır. Yöntem: Bu prospektif çalışma, Haziran 2020-Haziran 2021 tarihleri arasında Sancaktepe Eğitim ve Araştırma Hastanesi'nde gerçekleştirildi. PCR ile doğrulanan COVID-19 tanısı konmuş toplam 60 çocuk dahil edildi. Çalışma katılımcıları üç gruba ayrıldı: 1. Grup (poliklinikten takip edilen 30 çocuk), 2. Grup (çocuk yoğun bakım ünitesinde yatan 30 çocuk) ve 3. Grup (kontrol grubu olarak COVID-19 enfeksiyonu geçirmemiş 30 çocuk). Ebeveynler, tanıdan sonra 12 hafta boyunca devam eden semptomları değerlendiren bir anketi doldurdular. Bulgular: Grup 2, hem akut hem de post-akut dönemlerde önemli ölçüde daha fazla semptom yaşadılar; bunlar arasında yorgunluk, nefes darlığı, ateş, kilo kaybı, kas/eklem ağrısı ve anksiyete, uyku bozuklukları ve baş ağrısı gibi nöropsikiyatrik semptomlar yer almaktadır. Yorgunluk, hastanede yatan çocuklar arasında özellikle yaygındı, anksiyete ve uyku bozuklukları da aynı grupta önemli ölçüde daha yaygındı. Sonuçlar: Long COVID pediyatrik hastalar için önemli bir kaynağıdır. Yorgunluk, anksiyete, uyku bozuklukları ve baş ağrısı en sık devam eden semptomlar arasındaydı. Bu bulgular, COVID-19'un çocukların fiziksel ve zihinsel sağlıkları üzerindeki uzun vadeli etkileri ile başa çıkmak için devam eden gözetim ve hedeflenmiş rehabilitasyon stratejilerinin gerekliliğini vurgulamaktadır.

Anahtar Kelimeler

• Uzun COVID-19
• pediatrik hasta
• SARS-CoV-2
• MIS-C
• PASC

Kaynakça

1. 1. Ciotti M, Angeletti S, Minieri M, et al. COVID-19 Outbreak: An Overview. Chemotherapy 2019;64(5-6):215-23.
2. 2. Seery V, Raiden S, Penedo JMG, et al. Persistent symptoms after COVID-19 in children and adolescents from Argentina. Int J Infect Dis 2023;129:49-56.
3. 3. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med 2021;27(4):601-15.
4. 4. Wang Y, Alcalde-Herraiz M, Güell KL, et al. Refinement of post-COVID condition core symptoms, subtypes, determinants, and health impacts: a cohort study integrating real-world data and patient-reported outcomes. EBioMedicine 2025;111:105493.
5. 5. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1
6. 6. Bowe B, Xie Y, Al-Aly Z. Postacute sequelae of COVID-19 at 2 years. Nat Med 2023;29(9):2347-57.
7. 7. Couzin-Frankel J. Clues to long COVID. Science 2022;376(6599):1261-65.
8. 8. Lopez-Leon S, Wegman-Ostrosky T, Ayuzo Del Valle NC, et al. Long-COVID in children and adolescents: a systematic review and meta-analyses. Sci Rep 2022;12(1):9950.

9. 9. Nittas V, Gao M, West EA, et al. Long COVID Through a Public Health Lens: An Umbrella Review. Public Health Rev 2022;43:1604501.
10. 10. Demirbuğa A, Hançerli Törün S, Kaba Ö, et al. COVID-19 Nedeniyle Hastanede Yatan Çocuk Hastalarda Uzun Dönem Etkilerin ve Uzamış COVID Sıklığının Değerlendirilmesi [Long COVID in Children: A Pediatric Center Experience]. Mikrobiyol Bul 2023;57(1):60-70. Turkish.
11. 11. World Health Organization (WHO) (2023) A clinical case definition for post COVID-19 condition in children and adolescents by expert consensus. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post-COVID-19-condition-CA-Clinical-case-definition-2023-1
12. 12. Bloise S, Isoldi S, Marcellino A, et al. Clinical picture and long-term symptoms of SARS-CoV-2 infection in an Italian pediatric population. Ital J Pediatr 2022;48(1):79.
13. 13. Calcaterra V, Tagi VM, D'Auria E, et al. Long-term effects of SARS-CoV-2 infection in hospitalized children: findings from an Italian single-center study. Ital J Pediatr 2024;50(1):27.
14. 14. Morello R, Martino L, Buonsenso D. Diagnosis and management of post-COVID (Long COVID) in children: a moving target. Curr Opin Pediatr 2023;35(2):184-92.
15. 15. Mohandas S, Jagannathan P, Henrich TJ, et al. RECOVER Mechanistic Pathways Task Force. Immune mechanisms underlying COVID-19 pathology and post-acute sequelae of SARS-CoV-2 infection (PASC). Elife 2023;12:e86014.
16. 16. Rojas M, Rodríguez Y, Acosta-Ampudia Y, et al. Autoimmunity is a hallmark of post-COVID syndrome. J Transl Med 2022;20(1):129.
17. 17. Ayoubkhani D, Bermingham C, Pouwels KB, et al. Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study. BMJ 2022;377:e069676.
18. 18. Sivan M, Greenhalgh T, Milne R, Delaney B. Are vaccines a potential treatment for long covid? BMJ 2022;377:o988.
19. 19. Behnood SA, Shafran R, Bennett SD, et al. Persistent symptoms following SARS-CoV-2 infection amongst children and young people: A meta-analysis of controlled and uncontrolled studies. J Infect 2022;84(2):158-70.
20. 20. Selvakumar J, Havdal LB, Drevvatne M, et al. Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Nonhospitalized Adolescents and Young Adults. JAMA Netw Open 2023;6(3):e235763.
21. 21. Ashkenazi-Hoffnung L, Shmueli E, Ehrlich S, et al. Long COVID in Children: Observations From a Designated Pediatric Clinic. Pediatr Infect Dis J 2021;40(12):e509-e511.
22. 22. Camporesi A, Morello R, La Rocca A, et al. Characteristics and predictors of Long Covid in children: a 3-year prospective cohort study. EClinicalMedicine 2024;76:102815.
23. 23. Thors V, Bjornsdottir KL, Love TJ, Haraldsson A. Long COVID in Icelandic Children: A Matched Cohort Study of Nonspecific Symptoms Following SARS-CoV-2 Infection. Pediatr Infect Dis J 2024;43(3):226-33.
24. 24. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep 2021;11(1):16144.
25. 25. Stephenson T, Pinto Pereira SM, Shafran R, et al. Physical and mental health 3 months after SARS-CoV-2 infection (long COVID) among adolescents in England (CLoCk): a national matched cohort study. Lancet Child Adolesc Health 2022;6(4):230-9. Erratum in: Lancet Child Adolesc Health 2022;6(7):e21.
26. 26. Pezzini A, Padovani A. Lifting the mask on neurological manifestations of COVID-19. Nat Rev Neurol 2020;16(11):636-44.
27. 27. Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19(9):767-83.
28. 28. Paniz-Mondolfi A, Bryce C, Grimes Z, et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). J Med Virol 2020;92(7):699-702.
29. 29. Pellegrino R, Chiappini E, Licari A, Galli L, Marseglia GL. Prevalence and clinical presentation of long COVID in children: a systematic review. Eur J Pediatr 2022;181(12):3995-4009.
30. 30. Zheng YB, Zeng N, Yuan K, et al. Prevalence and risk factor for long COVID in children and adolescents: A meta-analysis and systematic review. J Infect Public Health 2023;16(5):660-72.
31. 31. Basaca DG, Jugănaru I, Belei O, et al. Long COVID in Children and Adolescents: Mechanisms, Symptoms, and Long-Term Impact on Health-A Comprehensive Review. J Clin Med 2025;14(2):378.
32. 32. Guido CA, Lucidi F, Midulla F, et al.; Long-Covid Group of Department of Maternal Sciences. Neurological and psychological effects of long COVID in a young population: A cross-sectional study. Front Neurol 2022;13:925144.
33. 33. Miraglia Del Giudice M, Klain A, Dinardo G, et al. Behavioral and Sleep Disorders in Children and Adolescents following COVID-19 Disease: A Case-Control Study. Children (Basel) 2023;10(7):1189.
34. 34. Loades ME, Chatburn E, Higson-Sweeney N, et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry 2020;59(11):1218-39.