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. 2023 Jun;108(6):498-505.
doi: 10.1136/archdischild-2022-324455. Epub 2022 Sep 2.

Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review

Julian Hirt  1   2 , Perrine Janiaud  1 , Viktoria Luise Gloy  1 , Stefan Schandelmaier  1   3 , Tiago V Pereira  4   5 , Despina Contopoulos-Ioannidis  6 , Steven N Goodman  7   8   9 , John Ioannidis  7   8   9   10   11 , Klaus Munkholm  12   13 , Lars G Hemkens  14   9   11
Affiliations

Robustness of reported postacute health outcomes in children with SARS-CoV-2 infection: a systematic review

Julian Hirt et al. Arch Dis Child. 2023 Jun.

Abstract

Objective: To systematically assess the robustness of reported postacute SARS-CoV-2 infection health outcomes in children.

Methods: A search on PubMed and Web of Science was conducted to identify studies published up to 22 January 2022 that reported on postacute SARS-CoV-2 infection health outcomes in children (<18 years) with follow-up of ≥2 months since detection of infection or ≥1 month since recovery from acute illness. We assessed the consideration of confounding bias and causality, as well as the risk of bias.

Results: 21 studies including 81 896 children reported up to 97 symptoms with follow-up periods of 2.0-11.5 months. Fifteen studies had no control group. The reported proportion of children with post-COVID syndrome was between 0% and 66.5% in children with SARS-CoV-2 infection (n=16 986) and between 2.0% and 53.3% in children without SARS-CoV-2 infection (n=64 910). Only two studies made a clear causal interpretation of an association between SARS-CoV-2 infection and the main outcome of 'post-COVID syndrome' and provided recommendations regarding prevention measures. The robustness of all 21 studies was seriously limited due to an overall critical risk of bias.

Conclusions: The robustness of reported postacute SARS-CoV-2 infection health outcomes in children is seriously limited, at least in all the published articles we could identify. None of the studies provided evidence with reasonable certainty on whether SARS-CoV-2 infection has an impact on postacute health outcomes, let alone to what extent. Children and their families urgently need much more reliable and methodologically robust evidence to address their concerns and improve care.

Keywords: COVID-19; infectious disease medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Proportions of children with reported main postacute health outcomes. Orange-coloured: estimates and 95% CIs for children with SARS-CoV-2 infection; blue-coloured: estimates and CIs for children without SARS-CoV-2 infection in the six controlled studies. No data reported for children without SARS-CoV-2 infection.
Figure 2
Figure 2
Summary of risk of bias assessment.
See this image and copyright information in PMC

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