More complaints than findings - Long-term pulmonary function in children and adolescents after COVID-19

Knoke, Leona; Schlegtendal, Anne; Maier, Christoph; Eitner, Lynn; Luecke, Thomas; Brinkmann, Folke

doi:10.1101/2021.06.22.21259273

Cited by 10 publications

(18 citation statements)

References 26 publications

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“…In this study, correlation of clinical symptoms with spirometry showed only mild reduction in FEF25-75z in adults who had reported cough during acute infection. Some previous studies have reported mild reduction of spirometry parameters (20,45) in symptomatic patients, others did not (36,46). All studies show spirometry parameters in the normal ranges-as does the study reported here.…”

Section: Discussionsupporting

confidence: 84%

“…A Swiss study found no changes in spirometry in milder cases 4 months after SARS-CoV-2 infection ( 19 ). Regarding children and adolescents, one study reported no changes in spirometry or CO-diffusion capacity 2 months after SARS-CoV-2 infection in seven children ( 35 ) and one pre-print reports no abnormalities in spirometry or multiple breath washout in 73 children and adolescent 2.6 months after infection ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary Function and Persistent Clinical Symptoms in Children and Their Parents 12 Months After Mild SARS-CoV-2 Infection

Bode

Haendly²,

Fabricius³

et al. 2022

Front. Pediatr.

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BackgroundPulmonary involvement is the leading cause of morbidity and mortality after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Long-term impairment has been reported in adults with severe infection. However, most infections cause only mild symptoms or are even asymptomatic, especially in children. There is insufficient evidence regarding pulmonary outcome measures in mild SARS-CoV-2. The objectives of this study were to determine spirometry parameters after SARS-CoV-2 infection and correlate those with reported persisting symptoms in children, adolescents, and adults.MethodsData on clinical symptoms during acute infection as well as SARS-CoV-2 serology results were recorded. Twelve months after infection, spirometry was performed and information on persisting symptoms was collected using a structured questionnaire. 182 participants (108 SARS-CoV-2 positive) from 48 families were included; 53 children (< 14 years), 34 adolescents and young adults (14–25 years), and 95 adults.ResultsSpirometry values did not significantly differ between the particular subgroups of the cohort (adults, adolescents, children; infected and non-infected individuals). Adults reported more symptoms during acute infection as well more persisting fatigue (29.7% of participants), reduced physical resilience (34.4%), and dyspnea (25.0%) 12 months after infection than adolescents (fatigue 26.7%, reduced physical resilience 20%, and 0% dyspnea) and children (4%, 0%, 0%, respectively). There was no correlation between persistent subjective symptoms and spirometry results.DiscussionChildren and adolescents are less affected than adults by acute SARS-CoV-2 as well as by post-infection persistent symptoms. Spirometry was not able to demonstrate any differences between healthy individuals and participants who had suffered from mild SARS-CoV-2 12 months after the infection.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Pulmonary Function and Persistent Clinical Symptoms in Children and Their Parents 12 Months After Mild SARS-CoV-2 Infection

Bode

Haendly²,

Fabricius³

et al. 2022

Front. Pediatr.

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“…The controls were chosen in a very different way among studies, which might have introduced significant heterogeneity. The following were the different definitions of controls: 1) children with other infections (e.g., common cold, pharyngotonsillitis, gastrointestinal, urinary tract infections, pneumonia of bacteria or unknown origin) 16 ; 2) children with no antibodies testing 18 mixed with other children with other infections 16 ; 3) children with a negative antibody test 19 , 4) children with a negative PCR test that were symptomatic 20 ; and 5) children who did not have a positive test recorded in the database 14 .…”

Section: Resultsmentioning

confidence: 99%

“…Several studies adjusted their OR by age, sex, ethnicity, socioeconomic status, and comorbidities 20 . However age and sex 14 only adjusted for sex, only age 16 only adjusted for age, and Knoke et al did not adjust, or by OR without adjusting previous conditions 18 (Supplemental Figures 2 and 3).…”

Section: Resultsmentioning

confidence: 99%

Long-COVID in Children and Adolescents: A Systematic Review and Meta-analyses

López-Léon

Wegman-Ostrosky

Valle

et al. 2022

Preprint

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Objective: To estimate the prevalence of long COVID in children and adolescents and identify the full spectrum of signs and symptoms present after acute SARS-CoV-2 infection. Methods: Two independent investigators searched PubMed and Embase in order to identify observational studies that met the following criteria: 1) a minimum of 30 patients, 2) ages ranged from 0 to 18 years, 3) published in English, 4) published before February 10th, 2022, and 5) meets the National Institute for Healthcare Excellence (NICE) definition of long COVID, which consists of both ongoing (4 to 12 weeks) and post COVID 19 (≥12 weeks) symptoms. For COVID symptoms reported in two or more studies, random-effects meta-analyses were performed using the MetaXL software to estimate the pooled prevalence, and Review Manager (RevMan) software 5.4 was utilized to estimate the Odds Ratios (ORs) with a 95% confidence interval (CI). Heterogeneity was assessed using I2 statistics. The Preferred Reporting Items for Systematic Reviewers and Meta-analysis (PRISMA) reporting guideline was followed (registration PROSPERO CRD42021275408). Results: The literature search yielded 68 articles for long COVID in children and adolescents. After screening, 21 studies met the inclusion criteria and were included in the systematic review and meta-analyses. A total of 80,071 children and adolescents with COVID-19 were included. The prevalence of long COVID was 25.24% (95% CI 18.17-33.02), and the most prevalent clinical manifestations were mood symptoms (16.50%; 95% CI 7.37-28.15), fatigue (9.66%; 95% CI 4.45-16.46), and sleep disorders (8.42%; 95% CI 3.41-15.20). When compared to controls, children infected by SARS-CoV-2 had a higher risk of persistent dyspnea (OR 2.69 95%CI 2.30-3.14), anosmia/ageusia (OR 10.68, 95%CI 2.48, 46.03), and/or fever (OR 2.23, 95%CI 1.22-4.07). The main limitation of these meta-analyses is the probability of bias, which includes lack of standardized definitions, recall, selection, misclassification, nonresponse and/or loss of follow-up, and the high level of heterogeneity. Conclusion: These meta-analyses provide an overview of the broad symptomatology of long COVID in minors, which may help improve management, rehabilitation programs, and future development of guidelines and therapeutic research for COVID-19.

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“…We acknowledge support by the Open Access Publication Funds of the Ruhr-University Bochum. The manuscript was deposited as a preprint in medRxiv with a slightly different title and wording ( 36 ). This work is part of the thesis of Leona Knoke.…”

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confidence: 99%

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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More complaints than findings - Long-term pulmonary function in children and adolescents after COVID-19

Cited by 10 publications

References 26 publications

Pulmonary Function and Persistent Clinical Symptoms in Children and Their Parents 12 Months After Mild SARS-CoV-2 Infection

Pulmonary Function and Persistent Clinical Symptoms in Children and Their Parents 12 Months After Mild SARS-CoV-2 Infection

Long-COVID in Children and Adolescents: A Systematic Review and Meta-analyses

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

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