COVID-19 and Pulmonary Hypertension in Children: What Do We Know So Far?

Abstract

The interplay between coronavirus disease 2019 (COVID-19) and pulmonary hypertension (PH) in children is unknown. Adults with PH are at potential risk for severe complications and high mortality due to associated comorbidities. It is difficult to extrapolate the outcomes of COVID-19 in adults to pediatric PH patients. Overall, a small number of COVID-19 cases is reported in patients with preexisting PH. Several factors may be responsible for the low incidence of COVID-19 in children with PH. Pulmonary hypertension is a rare disease, testing is not universal, and patients may have followed more rigorously the Center for Disease Control’s guidelines recommended for personal protection with mask-wearing, social distancing, and hand sanitization through ongoing health education. The small number of COVID-19 cases in patients with preexisting PH does not support that PH is protective for COVID-19. However, medications used to treat PH may have some protection against COVID-19. This review discusses the pathophysiology of PH occurring with COVID-19, differences between children and adults with COVID-19, strategies for management of preexisting PH in children during the ongoing pandemic, and its impact within the field of PH.

Outcomes of COVID‐19 infection in pediatric pulmonary hypertension: A single‐center experience

“…As vulnerable as the PH population was initially feared to be, 1 to date, these patients have been less affected than patients with other comorbidities 2,5 . Our program is a large pediatric center, of which 8% have had diagnosed COVID‐19 disease, 3% have required hospitalization, and 0.3% have died due to this illness.…”

COVID-19 in Children: Respiratory Involvement and Some Differences With the Adults

“…Some cases are classified as moderate disease due to radiological findings, although the symptoms are few ( 2 , 7 , 59 ). The recovery is faster probably due to lower affectation and a better immune response ( 60 ), but complications in the presence of co-morbidities are more likely ( 10 , 61 , 62 ). Although mortality in cases requiring pediatric intensive care units (PICU) is low ( 12 , 63 ), an increase is being observed.…”

Covid-19-induced pulmonary hypertension in children, and the use of phosphodiesterase-5 inhibitors

“…However, drugs for treating PH may may protect children against infection. 31 Some putative instruments related with PH in COVID-19 start when the limiting of the ACE2 receptor and protein spike of SARS-CoV-2, bringing about serious provocative responses prompting diffuse pneumonic alveolar harm, apoplexy, endothelitis, angiogenesis and endothelial brokenness. [31][32][33][34][35][36][37] Hemodynamic status in patients with ARDS is comparable with expansion in the diastolic pneumonic slope (the contrasts between the pressing factor of diastolic aspiratory corridor and aspiratory supply route wedge) >7 and pneumonic vascular obstruction (PVR) >3 Wood units.…”

“…If an antigen test shows a negative results, nevertheless the clinical COVID-19 is suspected, an antibody screening must be conducted. 31 High-resolution CT (HRCT) capable for measuring changes in pulmonary blood volume and show prominent abnormalities according to "Pruning" of blood vessels and evaluate pulmonary vascular dysfunction. HRCT findings are highly related with increased pulmonary vascular resistance.…”

“…Phosphodiesterase-5 inhibitors (PDEI), especially sildenafil, may reduce angiotensin type I (AT-1) receptors and degrade proinflammatory cytokines and infiltration of inflammatory cell in alveoli. 31 There are currently many studies examining the effect of sildenafil for treating the PH in COVID-19, but mainly for adults and only a few reports of cases for children. Sildenafil is a potent inhibitor of phosphodiesterase-5, which can accumulate and increase the activity of cyclic guanosine monophosphate (cGMP) that works synergistically with NO.…”