Pulmonary Dysfunction after Pediatric COVID-19

Abstract

Background Long COVID occurs in lower frequency in children and adolescents than in adults. Morphologic and free-breathing phase-resolved functional low-field MRI may identify persistent pulmonary manifestations after SARS-CoV-2 infection. Purpose To characterize both morphologic and functional changes of lung parenchyma on low-field MRI in children and adolescents with post COVID-19 compared with healthy controls. Materials and Methods Between August and December 2021, a cross-sectional, prospective clinical trial using low-field MRI was performed in children and adolescents from a single academic medical center. The primary outcome was the frequency of morphologic changes on MRI. Secondary outcomes included MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, the duration from positive RT-PCR test and serological parameters were compared with imaging results. Nonparametric tests for pairwise and corrected tests for groupwise comparisons were applied to assess differences in healthy controls, recovered participants and with long COVID. Results A total of 54 participants post COVID-19 infection (mean age, 11 years ±3 [SD], 56 males) and 9 healthy controls (mean age, 10 years ±3 [SD], 70 males) were included: 29 (54%) in the COVID-19 group had recovered from infection and 25 (46%) were classified as having long COVID on the day of enrollment. Morphologic abnormality was identified in one recovered participant. Both ventilated and perfused lung parenchyma (V/Q match) was reduced from 81±6.1% in healthy controls to 62±19% ( P =.006) in the recovered group and 60±20% ( P =.003) in the long COVID group. V/Q match was lower in post COVID patients with infection less than 180 days (63±20%, P =.03), 180 to 360 days (63±18%, P =0.03) and 360 days ago (41±12%, P <.001) as compared with the never-infected healthy controls (81±6.1%). Conclusion Low-field MRI showed persistent pulmonary dysfunction in both children and adolescents recovered from COVID-19 and with long COVID. ClinicalTrials.gov : NCT04990531

A population-based serological study of post-COVID syndrome prevalence and risk factors in children and adolescents

“…The pandemic-related difficulties to meet psychological and physical developmental needs may have been exacerbated by persistent symptoms, further preventing children from going about their daily activities and worsening their mental health. Most declared persistent symptoms among seropositives were abdominal pain, trouble concentrating, smell loss, dripping nose, muscle pain, breathing difficulties, headache and constipation, in agreement with the recent literature 4,15,16 . The severity of symptoms reported by parents was, on average, slightly higher in seropositive children, suggesting that persistent symptoms following a SARS-CoV-2 infection might be more severe and represent a more substantial burden on their daily life 14,17 .…”

Long COVID: major findings, mechanisms and recommendations

“…Long-term pulmonary dysfunction is found in children with long COVID and those who have recovered from COVID-19 (ref. 210 ). Children with long COVID were more likely to have had attention deficit hyperactivity disorder, chronic urticaria and allergic rhinitis before being infected 34 .…”

Diagnosis and management of post-COVID (Long COVID) in children: a moving target

“…Although the role of these findings is still not established, the hypothesis is that these events may lead to abnormalities in the peripheral circulation and tissue oxygenation, contributing to symptoms like fatigue and PEM. In children, two studies have documented abnormalities in lung perfusion, which somehow may support such hypotheses [51 ▪ ,52 ▪▪ ].…”

“…With the growing evidence of chronic endothelitis and microclots in adults with PCC, inclusion of children as well in research settings testing them would be welcome. So far, indirect evidence of chronic endothelitis have been documented by two independent paediatric studies in Italy and Germany, using lung Single Photon Emission Computed Tomography (SPECT) or MRI, respectively [51 ▪ ,52 ▪▪ ].…”