Severe respiratory viral infections in children with history of asymptomatic or mild COVID-19.

Importance: The spectrum of complications of COVID-19 in children, including the effect of COVID-19 on later viral infection, is not known.

Objective: To examine the features of children hospitalized for respiratory illness with history of prior COVID-19.

Design: Retrospective observational case series at a single pediatric quaternary medical center in New York City. Data were obtained from review of medical records.

Participants: Children with prior mild or asymptomatic COVID-19 and no known risk factors for severe respiratory disease, who were hospitalized at our center for acute respiratory illness from October 2020 to May 2021, were reviewed.

Main Outcomes And Measures: Co-morbidities, history of prior COVID-19 symptoms, respiratory viral panel findings, acuity of illness, degree of respiratory decompensation based on support and interventions required, duration of hospitalization, and overall clinical course were assessed from the medical record.

Results: This study included 5 patients (median age, 4 years; age range: 0.8-9 years; 4 [80%] male). All had positive COVID-19 serology, 1 (20%) had mild symptoms, while the others had no symptoms of prior Sars-CoV-2 infection, 3 (60%) had asthma, and the remaining had no co-morbidities. All were admitted between April and May 2021. Two were re-admitted for respiratory symptoms in the subsequent 3 months.

Conclusions And Relevance: This case series describes a possible association between severe lower respiratory tract infection and prior mild COVID-19 in children. Larger cohort studies describing the respiratory effects of prior COVID-19 in children are needed.