A Systematic Review of Persistent Clinical Features After SARS-CoV-2 in the Pediatric Population

CONTEXT: Long-term health effects after coronavirus disease 2019 (COVID-19) have been abstract increasingly reported but their prevalence and significance in the pediatric population remains uncertain. OBJECTIVE: To present the prevalence and characteristics of the long-term clinical features of COVID-19 (long COVID) in the global pediatric population. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, WHO COVID-19 database, google scholar, medRxiv, bioRxiv, and multiple national public health databases. STUDY SELECTION: Published articles and preprints from December, 2019 to December, 2022 investigating the epidemiology and characteristics of persistent clinical features at least 3 months after COVID-19 in children and adolescents (0–19 years old) were included. DATA EXTRACTION: Study characteristics and detailed description of long COVID were extracted into a predefined form. RESULTS: Twenty seven cohorts and 4 cross-sectional studies met the inclusion criteria and involved over 15 000 pediatric participants. A total of more than 20 persistent symptoms and clinical features were reported among children and adolescents. 16.2% (95% confidence interval 8.5% to 28.6%) of the pediatric participants experienced 1 or more persistent symptom(s) at least 3 months post COVID-19. Female gender might be associated with developing certain long COVID symptoms. LIMITATIONS: Included studies presented with great heterogeneity because of significant variations in the definition of “long COVID,” follow up duration, and method. There could be nonresponse and other potential bias. CONCLUSIONS: Persistent clinical features beyond 3 months among children and adolescents with proven COVID-19 are common and the symptom spectrum is wide. High-quality, prospective studies with proper controls are necessary in the future.