Protracted respiratory findings in children post‐SARS‐CoV‐2 infection

Dobkin, Shoshana Leftin; Collaco, Joseph M.; McGrath‐Morrow, Sharon A.

doi:10.1002/ppul.25671

Cited by 46 publications

(106 citation statements)

References 22 publications

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“…Pulmonary function was normal in 75% of our participants, including children and adolescents with persistent respiratory symptoms. This finding is in line with the results of Lefkin Dobkin et al, who found primarily normal results on body plethysmography and diffusion capacity for 15 children with ongoing respiratory symptoms ( 9 ). In our cohort, LCI 2.5% , FEV 1 , DLCO, and DLCO/VA had no significant differences between patients and controls.…”

Section: Discussionsupporting

confidence: 91%

“…Bottino et al performed spirometry and diffusion capacity testing in seven children approximately 2 months after recovery from mild SARS-CoV-2 infection and did not detect any abnormalities ( 8 ). Lefkin Dobkin et al came to a similar conclusion in their study, finding primarily normal results on body plethysmography and diffusion capacity testing for 15 children with ongoing respiratory symptoms approximately 3 months after COVID-19 ( 9 ). A case report described ventilation-perfusion inhomogeneities as possible causes of dyspnea in children and adolescents after COVID-19 ( 10 ).…”

Section: Introductionsupporting

confidence: 57%

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Pulmonary Function and Long-Term Respiratory Symptoms in Children and Adolescents After COVID-19

et al. 2022

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BackgroundPersistent respiratory symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults are frequent, and there can be long-term impairment of pulmonary function. To date, only preliminary evidence is available on persistent respiratory sequelae of SARS-CoV-2 in children and adolescents. Our objective was to examine the long-term effects of symptomatic and asymptomatic SARS-CoV-2 infections on pulmonary function in this age group in a single-center, controlled, prospective study.MethodsParticipants with serological or polymerase chain reaction-based evidence of SARS-CoV-2 infection were recruited from a population-based study of seroconversion rates. Multiple-breath washout (MBW), body plethysmography, and diffusion capacity testing were performed for children and adolescents. Participants were interviewed about their symptoms during the acute phase of infection and long-lasting symptoms. Cases were compared with SARS-CoV-2 seronegative controls from the same population-based study with and without history of respiratory infection within 6 months prior to assessment. Primary endpoints were differences in pulmonary function, including diffusion capacity and MBW, between participants with and without evidence of SARS-CoV-2 infection. Secondary endpoints included correlation between lung function and long-lasting symptoms as well as disease severity.FindingsIn total, 73 seropositive children and adolescents (5–18 years) were recruited after an average of 2.6 months (range 0.4–6.0) following SARS-CoV-2 infection. Among 19 patients (27.1%) who complained of persistent or newly emerged symptoms since SARS-CoV-2, 8 (11.4%) reported respiratory symptoms. No significant differences were detected in frequency of abnormal pulmonary function when comparing cases with 45 controls, including 14 (31.1%) with a history of previous infection (SARS-CoV-2: 12, 16.4%; controls: 12, 27.7%; odds ratio 0.54, 95% confidence interval 0.22–1.34). Only two patients with persistent respiratory symptoms showed abnormal pulmonary function. Multivariate analysis revealed reduced forced vital capacity (p = 0.012) in patients with severe SARS-CoV-2 infection.InterpretationPulmonary function is rarely impaired in children and adolescents after SARS-CoV-2 infection, except from those with severe infection, and did not differ between SARS-CoV-2 and other previous infections, suggesting that SARS-CoV-2 is not more likely to cause pulmonary sequelae than other infections. The discrepancy between persisting respiratory symptoms and normal pulmonary function suggests a different underlying pathology such as dysfunctional breathing.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionsupporting

confidence: 57%

Pulmonary Function and Long-Term Respiratory Symptoms in Children and Adolescents After COVID-19

et al. 2022

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“… 32 Although spirometry was mostly normal for children with long-term respiratory symptoms after severe SARS-CoV-2 infection, as in this case, PIBO may occur in children with risk factors. 33 Therefore, spirometry testing should be considered early in children with severe COVID-19 who have risk factors for respiratory complications.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Postinfectious Bronchiolitis Obliterans After Coronavirus Disease 2019 in a 10-Year-Old Child

et al. 2022

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Coronavirus disease 2019 (COVID-19) is usually less severe in children and adolescents than in adults. However, it can cause severe respiratory illness in a small proportion of children with risk factors. Here, we report a rare case of a 10-year-old boy with postinfectious bronchiolitis obliterans that developed after pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This patient was previously healthy apart from a high body mass index (BMI, 30.13; 99.6th percentile for the age bracket), history of preterm birth (35 weeks), and low birth weight (1,850 g). He had persistent exertional dyspnea after recovering from SARS-CoV-2-related pneumonia. Spirometry revealed obstructive lung disease with the following results: predicted forced vital capacity (FVC% pred ), 71%; forced expiratory volume in 1 second (FEV 1 % pred ), 63%; FEV 1 /FVC, 0.81; and forced expiratory flow 25-75 % pred , 55%. Chest computed tomography showed multifocal areas of parenchymal hyperlucency and mosaic attenuation in both lungs. This case suggests that careful observation of children with obesity and low birth weight is necessary after recovery from SARS-CoV-2-related pneumonia.

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“…There is evidence that adults and children with established type 1 and type 2 diabetes mellitus, particularly those with Black race, have a higher incidence of diabetic ketoacidosis during COVID-19 illness [6][7][8]. There is mixed evidence in asthma with multiple studies reporting worsening asthma symptoms and rates of hospitalization during COVID-19 illness [9][10][11][12][13] while other studies report a protective or neutral effect [14][15][16][17][18]. Obesity predisposes children to increased severity of COVID-19 and is a risk factor for critical illness in adolescents with COVID-19 [19,20].…”

Section: Introductionmentioning

confidence: 99%

Healthcare utilization following SARS-CoV-2 infection in children and adolescents with chronic conditions: An EHR-based Cohort Study from the RECOVER Program

Pajor

Lorman

Razzaghi

et al. 2022

Preprint

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Background Chronic medical conditions are a risk factor for moderate or severe COVID-19 in children, but little is known about post-acute sequelae of SARS-CoV-2 infection (PASC) in children with chronic medical conditions (CMCs). To understand whether SARS-CoV-2 infection led to potential exacerbation of underlying chronic disease in children, we explored whether children with CMCs had increased healthcare utilization in the post-acute (28 days after infection) period compared to children with CMCs without SARS-CoV-2 infection. Methods We conducted a retrospective, matched-cohort study using electronic health record data collected from 8 pediatric health care systems participating in the PEDSnet network. We included children <21 years of age with a wide array of chronic conditions, defined by the presence of diagnostic codes, who were diagnosed with COVID-19 between March 1, 2020 and February 28, 2022. Cohort entry was defined by presence of a positive SARS-CoV-2 PCR test (polymerase chain reaction or antigen) or diagnostic codes for COVID-19, PASC or MIS-C. A comparison cohort of patients testing negative or without these conditions was matched using a stratified propensity score model and exact matching on age group, race/ethnicity, institution, test location, and month of cohort entry. A negative binomial model was used to examine our primary outcome: composite and setting-specific (inpatient, outpatient, ED) utilization rate ratios between the positive and comparison cohorts. Secondary outcomes included time to first utilization in the post-acute period, and utilization stratified by severity at cohort entry. Results We identified 748,692 patients with at least one chronic condition, 78,744 of whom met inclusion criteria for the COVID-19 cohort. 96% of patients from the positive cohort were matched. Cohorts were well-balanced for chronic condition clusters, total number of conditions, time since first diagnosis, baseline utilization, cohort entry period, age, sex, race/ethnicity and test location. We found that among children with chronic medical conditions, those with COVID-19 had higher healthcare utilization than those with no recorded COVID-19 diagnosis or positive test, with utilization rate ratio of 1.21 (95% CI: 1.18-1.24). The utilization was highest for inpatient care with utilization rate ratio of 2.03 (95% CI: 1.85-2.23) but the utilization was increased across all settings. Hazard ratios estimated in time-to-first-utilization analysis mirrored these results. Patients with severe or moderate acute COVID-19 illness had greater increases in utilization in all settings than those with mild or asymptomatic disease. Conclusions We found that care utilization in all settings was increased following COVID-19 in children with chronic medical conditions in the post-acute period, particularly in the inpatient setting. Increased utilization was correlated with more severe COVID-19. Additional research is needed to better understand the reasons for higher care utilization by studying condition-specific outcomes in children with chronic disease.

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Protracted respiratory findings in children post‐SARS‐CoV‐2 infection

Cited by 46 publications

References 22 publications

Pulmonary Function and Long-Term Respiratory Symptoms in Children and Adolescents After COVID-19

Pulmonary Function and Long-Term Respiratory Symptoms in Children and Adolescents After COVID-19

A Case Report of Postinfectious Bronchiolitis Obliterans After Coronavirus Disease 2019 in a 10-Year-Old Child

Healthcare utilization following SARS-CoV-2 infection in children and adolescents with chronic conditions: An EHR-based Cohort Study from the RECOVER Program

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