616 - Exploring the Influence of Pre-Existing Conditions On Patients With Pediatric Long COVID

Poster Number: 616
Publication Number: 616.225

Erin Y. Chen, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Laura A. Malone, Kennedy Krieger Institute/Johns Hopkins, Baltimore, MD, United States

Background: Pediatric post-acute sequelae of SARS-CoV-2 (PASC) or “long COVID” is a complex multisystemic disease that negatively affects children’s quality of life. PASC is challenging to diagnose and treat due to its variable presentation, time course, and severity, and more research is needed to improve the care of children with PASC.

Objective: Here we explored the association between pre-existing conditions, symptoms, and outcomes in children with PASC to ascertain if particular pre-existing conditions influence the phenotypic presentation, symptomatology, or clinical course of pediatric PASC. Studying this can help guide the screening and treatment of children with PASC.

Design/Methods: We completed a single center retrospective chart review of 75 patients from the Pediatric Post-COVID-19 Rehabilitation Clinic at the Kennedy Krieger Institute. Descriptive analyses, single-factor ANOVAs, and linear regressions were done to assess the association between pre-existing conditions, PASC symptoms, and quality of life as measured by the PedsQL™.

Results: No pre-existing condition out of the 67 we observed was associated with a specific PASC symptom. Children with pre-existing mood disorders had lower initial PedsQL™ scores (42.3 +/- 16.8) than those without (59.6 +/- 18.6, p=0.001). However, pre-existing mood disorders did not affect the change in PedsQL™ between follow-up visits (pre-existing mood disorders vs. no pre-existing mood disorders: 4.34 +/- 5.6 vs. 4.26 +/- 17.1, p = 0.99). Instead, we found that the change in the Fatigue PedsQL™ was associated with the change in the PedsQL™ Core, suggesting that fatigue symptoms may significantly contribute to the overall quality of life in children with PASC (Adjusted R² = 0.46, p = 0.001). Anecdotally, we also observed that certain factors (e.g., low mood, self-harm, COVID-19 reinfection, inability to return to pre-COVID activities) were more common in those with worsening PedsQL™ scores over time, but these need to be investigated further.

Conclusion(s): We concluded that there seems to be a unique pathogenesis for PASC, as no pre-existing conditions were associated with PASC symptoms in children. However, pre-existing mood disorders may exacerbate the initial severity of PASC, and fatigue symptoms during PASC significantly contribute to overall patient quality of life. Therefore, we recommend that children with pre-existing mood disorders who contract SARS-CoV-2 should be followed closely to facilitate earlier interventions if they do develop PASC. Also, we propose that children with PASC may benefit from focused management of fatigue and mental health symptoms.