Penn Medicine researchers have discovered that COVID-19 infection can lead to significant long-term health risks in children and adolescents, affecting multiple organ systems for years after the initial infection. The findings, part of the National Institutes of Health's RECOVER initiative, reveal concerning patterns of chronic organ damage that clinicians should monitor in pediatric patients.
Extensive Multi-Organ Impact
"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, from the Perelman School of Medicine at the University of Pennsylvania.
The retrospective cohort study analyzed data from 19 health institutions, tracking children and adolescents younger than 21 years old from March 2020 to May 2023. Researchers compared outcomes between those with positive SARS-CoV-2 tests and those with negative tests or no documented infection.
Kidney Function Deterioration
The analysis revealed concerning kidney-related outcomes in the post-acute phase of COVID-19 infection. Children who tested positive for SARS-CoV-2 had a 17% higher risk of developing stage 2 or higher chronic kidney disease, which represents mild kidney damage that still functions relatively well. More alarmingly, these patients showed a 35% higher risk of chronic kidney disease at stage 3 or higher, indicating mild to severe damage that impacts kidney function.
For children with pre-existing kidney disease, a positive COVID-19 test was associated with a 15% higher risk of developing additional kidney-related adverse outcomes, including major decline in kidney filtration rate, dialysis, or kidney transplant. Those who experienced kidney injury during the acute infection phase faced a 29% higher risk of adverse kidney outcomes 3 to 6 months after infection.
Gastrointestinal System Complications
In a related study published in JAMA Network Open, investigators examined gastrointestinal conditions among over 1.5 million children and adolescents. The findings showed that compared to those with negative SARS-CoV-2 tests, children with positive tests had a 25% higher risk of developing at least one gastrointestinal symptom or disorder in the post-acute phase.
This elevated risk persisted into the chronic phase, from 6 months to 2 years after the SARS-CoV-2 test, with a 28% higher risk of gastrointestinal issues including abdominal pain, diarrhea, and irritable bowel syndrome.
Cardiovascular System Vulnerabilities
Perhaps most concerning were the findings published in Nature Communications regarding cardiovascular risks. Children and adolescents with SARS-CoV-2 infections showed significantly higher risks of developing one or more cardiovascular conditions, including arrhythmias, heart inflammation, chest pain, palpitations, and hypertension.
These elevated risks were present regardless of whether the patient had a congenital heart defect (CHD). While children with CHDs had higher absolute risks, the relative increase in risk (63%) of developing cardiovascular conditions was consistent across both groups. Among children without pre-existing heart defects, the risk of heart inflammation in the post-acute phase was nearly tripled compared to those without a SARS-CoV-2 infection.
Racial and Ethnic Disparities
The research also identified differences in post-acute outcomes across racial and ethnic groups. Asian American Pacific Islander (AAPI) children and adolescents showed mildly higher rates of developing any long-COVID outcomes in the post-acute phase after both severe and non-severe COVID-19 compared to non-Hispanic White children.
Hispanic patients demonstrated a higher risk of hair loss after severe COVID-19 infection, while non-Hispanic Black patients had a slightly lower risk of long COVID skin symptoms following severe infection.
Clinical Implications
These findings collectively underscore the importance of long-term monitoring for pediatric patients who have had COVID-19. "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 emphasized.
The research highlights that COVID-19's impact on children extends far beyond the acute infection phase, with potential consequences for organ systems that may manifest months or even years later. Healthcare providers should remain vigilant for these delayed complications, particularly in high-risk populations and those who experienced severe initial infections.
