Children face elevated health risks after COVID infection

PHILADELPHIA—Long COVID can result in increased risk for a variety of serious health problems for young people, including those affecting the kidney, gut, and cardiovascular system, according to a group of new studies led by investigators at the Perelman School of Medicine at the University of Pennsylvania.

“While most public attention has focused on the acute phase of COVID-19, our findings reveal children face significant long-term health risks that clinicians need to monitor,” said senior author Yong Chen, PhD, a professor in the Department of Biostatistics and Epidemiology. The studies were conducted under the Researching COVID to Enhance Recovery (RECOVER) Initiative, a special project sponsored by the National Institutes of Health (NIH) that includes more than two dozen health care institutions. These medical centers pooled de-identified data from electronic health records dating back to the start of the COVID pandemic.

Kidney disease

Young patients with positive SARS-CoV-2 tests had a 17 percent higher risk of developing chronic kidney disease tested at stage 2 or higher, indicating mild kidney damage that still functioned well, and 35 percent higher risk of chronic kidney disease at stage 3 or higher, meaning there is mild to severe damage impacting kidney function, from one month to two years after infection.

Published in JAMA Network Open, the analysis covered electronic health records for 1,900,146 individuals under the age of 21. The researchers compared kidney-related outcomes in the post-acute phase in those who had positive SARS-CoV-2 tests to outcomes in individuals who had negative tests and no documented SARS-CoV-2 infection during the 2020-23 study period.

Patients with pre-existing chronic kidney disease who had a positive SARS-CoV-2 test had a 15 percent higher risk of developing any of several other kidney-related adverse outcomes, including a major decline in kidney filtration rate, dialysis, or kidney transplant. Children and adolescents who experienced a documented kidney injury during the acute phase of infection also had an elevated (29 percent higher) risk of adverse kidney outcomes from three to six months after infection, compared to those with no acute kidney injury.

Gastrointestinal effects

Another study published in JAMA Network Open, examined gastrointestinal problems such as abdominal pain, diarrhea, and irritable bowel syndrome in 1,576,933 children and adolescents.

Patients who had a positive SARS-CoV-2 test—compared to those with a negative test—had a 25 percent increased risk of developing at least one gastrointestinal symptom or disorder in the post-acute phase, and a 28 percent increased risk in the “chronic phase” from six months to two years after the SARS-CoV-2 test.

Cardiovascular risk

Researchers found that those with SARS-CoV-2 infections had significantly higher risks of developing one or more cardiovascular conditions—including arrhythmias, heart inflammation, chest pain, palpitations, and hypertension—compared to those with negative tests and no documented history of SARS-CoV-2 infection. These risks were elevated regardless of whether the patient had a congenital heart defect (CHD).

While children with CHDs had higher absolute risks, the relative increase in risk of developing cardiovascular conditions associated with SARS-CoV-2 infection was consistent (a 63 percent increase) across both groups. However, among children without CHD, the risk of heart inflammation in the post-acute phase was strikingly higher—nearly tripled—in those who had SARS-CoV-2 infection.

The researchers examined post-acute cardiovascular problems in 1,213,322 pediatric patients and findings were published in Nature Communications.

Outcomes along racial and ethnic lines

There were some specific differences in post-acute outcomes for different racial and ethnic groups.

Researchers found, for example, that Asian American Pacific Islander (AAPI) children and adolescents, compared to non-Hispanic Whites, had mildly higher rates of developing any long-COVID outcomes in the post-acute phase after severe or non-severe COVID.

The data also showed that Hispanic patients had a greater risk of hair loss after severe COVID, while non-Hispanic Black patients had a mildly lower risk of long-COVID skin symptoms after severe COVID.

The researchers analyzed records pulled from 225,723 children and adolescents, comparing AAPIs, non-Hispanic Blacks, and Hispanics, to non-Hispanic Whites. The work was published in Nature Communications.

“Overall, these findings underscore the fact that clinicians need to monitor pediatric patients for long COVID signs and symptoms—and need to be prepared to treat these conditions”, Chen said.

These studies were funded principally by the National Institutes of Health (OT2HL161847-01).

Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System (UPHS) and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.

The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $580 million awarded in the 2023 fiscal year. Home to a proud history of “firsts,” Penn Medicine teams have pioneered discoveries that have shaped modern medicine, including CAR T cell therapy for cancer and the Nobel Prize-winning mRNA technology used in COVID-19 vaccines.

The University of Pennsylvania Health System cares for patients in facilities and their homes stretching from the Susquehanna River in Pennsylvania to the New Jersey shore. UPHS facilities include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Doylestown Health, Lancaster General Health, Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, chartered in 1751. Additional facilities and enterprises include Penn Medicine at Home, GSPP Rehabilitation, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.

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