Pulmonary dysfunction in pediatric patients after acute COVID-19 infection
A recent study posted to the medRxiv* preprint server examined the pulmonary dysfunction persistent in pediatric populations post-acute coronavirus disease 2019 (COVID-19) infection.
Several studies suggest that COVID-19 manifests with milder symptoms in children as compared to adults; however, newly emerging evidence indicates the occurrence of acute symptoms and sequelae post severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients as well. In light of this evidence, it is essential to exhaustively study the characteristics of COVID-19 manifestations in adolescents and children.
About the study
The present study investigated pulmonary dysfunction by characterizing both functional and morphological alterations in the lung parenchyma in pediatric patients after acute SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) tests.
A cross-sectional, single-center trial initiated by investigators was conducted involving PCR-positive COVID-19 patients of ages ranging from five to less than 18 years. A control group with children and adolescents belonging to the same age group was also included in the study. They had negative serological antibody results post hoc, negative medical history, and no prior COVID-19 vaccination.
Participants with Long-COVID were identified on the basis of symptoms persistent for at least 12 weeks and belonging to one of the classifications of persistent symptoms from acute COVID-19 infection or related treatment, symptoms leading to a novel health problem, occurrence of new symptoms post-acute COVID-19 but indicated to be COVID-19 sequelae, and worsening of a pre-existing condition.
Blood samples were collected from the study cohorts to examine blood count, C-reactive protein (CRP), interleukin 6 (IL-6), and SARS-CoV-2 antibodies. Low-field magnetic resonance imaging (LF-MRI) was performed for all participants to facilitate the visualization of morphological features, perfusion, and the ventilation of the lung.
Results
The study results showed that from 9 August 2021 to 30 December 2021, 91 pediatric patients tested PCR-positive for COVID-19, and 17 healthy controls were screened for the study, among which 54 COVID-19 patients and nine controls were eligible for the study. In the study cohort of patients infected with SARS-CoV-2, 11.5±3.2 years was the mean age, 47.6±17.9kg was the mean weight, while 155.7±17.3cm was the mean height. Also, a total of 44% of the participants were female, and 46% of patients were reported to have Long-COVID.
With respect to COVID-19 symptoms, a total of 9% of patients had headaches, 28% had dyspnea, 2% had pneumonia, 7% had anosmia, 2% had ageusia, 7% had fatigue, 11% had impaired attention, 2% had limb pain, 30% had shortness of breath. In contrast, four PCR-positive patients reported no symptoms of acute COVID-19 infection.
Among the individuals scanned with LF-MRI, only one recovered SARS-CoV-2 patient had morphological alterations with pulmonary consolidations, while the other patients showed no morphological changes.
In the comparison of healthy controls with recovered patients and Long-COVID patients, the team observed an increase in perfusion defects from 6.5±5.0% to 19.5±19.1% to 21.6±18.6%, ventilation defects from 12.8±3.6% to 22.1±8.1% to 24.6±10.0%, and combined defects from 0.5±0.8% to 3.9±4.7% to 5.4±6.6%, respectively.
They also observed a decrease in the unaffected lung parenchyma from 81.2±6.1% in healthy controls to 60.8±19.1% in post-acute COVID-19 patients. Further, normal functional lung parenchyma was decreased from 81.2±6.1% to 62.0±18.7% to 59.9±19.8 in healthy controls, recovered patients, and Long-COVID patients, respectively.
According to the laboratory assessments, four COVID-19 patients had negative SARS-CoV-2 spike protein and negative SARS-CoV-2 nucleocapsid antibody levels. In comparison, two post-acute COVID-19 patients showed the presence of spike protein antibodies in the absence of nucleocapsid antibodies. Notably, all the healthy controls showed negative nucleocapsid and spike protein antibody levels.
Conclusion
The study findings showed that acute COVID-19 could cause extensive damage to the pulmonary system, including perfusion, ventilation, and combined defects in children. Manifestations of pulmonary dysfunction were persistent in pediatric patients even after months post-infection.
The study illustrated that functional lung changes are prevalent in acute COVID-19-infected children and adolescents. Further monitoring of persistent pulmonary damage in these young populations is essential to incorporate additional care in COVID-19-related clinical routine care.
*Important notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
