Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C

Aline B. Maddux, Laura Berbert, Cameron C. Young, Leora R. Feldstein, Laura D. Zambrano, Suden Kucukak, Margaret M. Newhams, Kristen Miller, Madyson M. FitzGerald, Jie He, Natasha B. Halasa, Natalie Z. Cvijanovich, Laura L. Loftis, Tracie C. Walker, Stephanie P. Schwartz, Shira J. Gertz, Keiko M. Tarquinio, Julie C. Fitzgerald, Michele Kong, Jennifer E. SchusterElizabeth H. Mack, Charlotte V. Hobbs, Courtney M. Rowan, Mary A. Staat, Matt S. Zinter, Katherine Irby, Hillary Crandall, Heidi Flori, Melissa L. Cullimore, Ryan A. Nofziger, Steven L. Shein, Mary Glas Gaspers, Janet R. Hume, Emily R. Levy, Sabrina R. Chen, Manish M. Patel, Mark W. Tenforde, Edie Weller, Angela P. Campbell, Adrienne G. Randolph

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


OBJECTIVES: To evaluate risk factors for postdischarge sequelae in children and adolescents hospitalized for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C).

METHODS: Multicenter prospective cohort study conducted in 25 United States pediatric hospitals. Patients <21-years-old, hospitalized May 2020 to May 2021 for acute COVID-19 or MIS-C with follow-up 2 to 4 months after admission. We assessed readmissions, persistent symptoms or activity impairment, and new morbidities. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).

RESULTS: Of 358 eligible patients, 2 to 4 month survey data were available for 119 of 155 (76.8%) with acute COVID-19 and 160 of 203 (78.8%) with MIS-C. Thirteen (11%) patients with acute COVID-19 and 12 (8%) with MIS-C had a readmission. Thirty-two (26.9%) patients with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, persistent symptoms (aRR, 1.29 [95% CI, 1.04-1.59]) and activity impairment (aRR, 1.37 [95% CI, 1.06-1.78]) were associated with more organ systems involved. Patients with MIS-C and pre-existing respiratory conditions more frequently had persistent symptoms (aRR, 3.09 [95% CI, 1.55-6.14]) and those with obesity more frequently had activity impairment (aRR, 2.52 [95% CI, 1.35-4.69]). New morbidities were infrequent (9% COVID-19, 1% MIS-C).

CONCLUSIONS: Over 1 in 4 children hospitalized with acute COVID-19 or MIS-C experienced persistent symptoms or activity impairment for at least 2 months. Patients with MIS-C and respiratory conditions or obesity are at higher risk of prolonged recovery.

Original languageEnglish (US)
Article numbere2022057798
Issue number3
StatePublished - Sep 1 2022

Bibliographical note

Publisher Copyright:
© 2022 American Academy of Pediatrics. All rights reserved.


  • Adolescent
  • Adult
  • Aftercare
  • COVID-19/complications
  • Child
  • Hospitalization
  • Humans
  • Obesity
  • Patient Discharge
  • Prospective Studies
  • SARS-CoV-2
  • Systemic Inflammatory Response Syndrome
  • United States/epidemiology
  • Young Adult

PubMed: MeSH publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Multicenter Study
  • Journal Article
  • Research Support, N.I.H., Extramural


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