Pediatric Gastrointestinal Outcomes During the Post-Acute Phase of COVID-19.
Overview
abstract
BACKGROUND: The impact of COVID-19 on gastrointestinal (GI) outcomes in children during the post-acute and chronic phases of the disease is not well understood. METHODS: We conducted a retrospective cohort study across twenty-nine healthcare institutions from March 2020 to September 2023, including 413,455 pediatric patients with confirmed SARS-CoV-2 infection and 1,163,478 controls without infection. Infection was confirmed via polymerase chain reaction (PCR), serology, antigen tests, or clinical diagnosis of COVID-19 and related conditions. We examined the incidence of predefined GI symptoms and disorders during the post-acute (28 to 179 days post-infection) and chronic (180 to 729 days post-infection) phases. The adjusted risk ratios (aRRs) were calculated using stratified Poisson regression, with stratification based on propensity scores. RESULTS: Our cohort comprised 1,576,933 patients, with females representing 48.0% of the sample. The analysis revealed that children with SARS-CoV-2 infection had an increased risk of developing at least one GI symptom or disorder in both the post-acute (8.64% vs. 6.85%; aRR 1.25, 95% CI 1.24-1.27) and chronic phases (12.60% vs. 9.47%; aRR 1.28, 95% CI 1.26-1.30) compared to uninfected peers. Specifically, the risk of abdominal pain was higher in COVID-19 positive patients during the post-acute phase (2.54% vs. 2.06%; aRR 1.14, 95% CI 1.11-1.17) and chronic phase (4.57% vs. 3.40%; aRR 1.24, 95% CI 1.22-1.27). INTERPRETATION: Children with a history of SARS-CoV-2 infection are at an increased risk of GI symptoms and disorders during the post-acute and chronic phases of COVID-19. This highlights the need for ongoing monitoring and management of GI outcomes in this population. RESEARCH IN CONTEXT: Evidence before this study: We searched PubMed, Scopus, and Google Scholar databases up to September 2023 for studies assessing the incidence and risk of gastrointestinal (GI) symptoms and disorders in children following viral infections, including COVID-19. We included studies published in any language and involving various methodologies (observational studies, cohort studies, and clinical trials). Our search terms included "COVID-19," "SARS-CoV-2," "gastrointestinal symptoms," "children," "post-acute," and "chronic." The evidence prior to this study suggested an increased risk of GI disorders in adults after viral infections but was less definitive for the pediatric population.Added value of this study: This study significantly extends the existing literature by specifically examining the risk of GI symptoms and disorders in the pediatric population during the post-acute and chronic phases of COVID-19. Using a large retrospective cohort design encompassing over 1.5 million children and adolescents from 29 healthcare institutions, our analysis provides robust evidence of increased GI symptoms like abdominal pain, diarrhea, and constipation among COVID-19 positive patients compared to non-infected peers. It is one of the largest studies of its kind and the first to provide such comprehensive data for the U.S. pediatric population, with follow-up extending up to two years post-infection.Implications of all the available evidence: The findings underscore the importance of monitoring children and adolescents for persistent GI symptoms following COVID-19, suggesting that these symptoms may be more common and prolonged than previously recognized. These insights are crucial for pediatric healthcare providers and could influence guidelines for the follow-up care of children recovering from COVID-19. The study also highlights the need for future research to explore the underlying mechanisms of post-acute and chronic GI symptoms in children to develop targeted interventions and improve long-term outcomes. AUTHORSHIP STATEMENT: Authorship has been determined according to ICMJE recommendations.
