Pediatric post-acute Covid-19: Persistent pulmonary dysfunction

A new study by German researchers from Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg and its University Hospital Erlangen along with experts from Hannover Medical School have found that many pediatric COVID-19 patients continue to develop lung issues and dysfunction despite recovery from COVID-19.

Many of these kids still experience persistent sequelae after SARS-CoV-2 infection and are now termed as long COVID Kids.

The study findings were published on a preprint server and are currently being peer reviewed. https://www.medrxiv.org/content/10.1101/2022.02.21.22270909v1
 

SARS-CoV-2 has emerged as a global pandemic causing more than 280 million documented infections and 5.4 million deaths until the end of 2021.1

In comparison to adults, there is common evidence that Covid-19 in children and adolescents has a milder course with recovery within weeks.2

This finding is compromised by a growing body of evidence for post-acute sequelae and symptoms in these age classes.2-4 While there is an increasing understanding of the multi-organ damage of Covid-19 beyond the acute phase of infection5, the nature, frequency and definition of post-acute sequelae in children and adolescents still remains undetermined with a discrepancy in clinical appearance and objective findings.6

A major proportion of pediatric studies have lately prioritized research in mental health issues during the Covid-19 pandemic7-10, while other studies have already raised concerns on ongoing disease manifestations, including increased thrombotic state, microangiopathy and inflammation.11-13

As the lung is a primary target of the SARS-CoV-2 virus,14 computed tomography aided in the diagnosis of pulmonary manifestation of Covid-19 in adults.15 Even three months after infection, angiographic imaging of pulmonary microcirculation still revealed widespread microangiopathy in over 65% of the patients.16

Such techniques using invasive procedures or ionization radiation are not feasible in children and also seem to have limited diagnostic value as lung parenchymal changes do present less obvious and pronounced.17-19 Therefore, there is an unmet clinical need to more precisely characterize pulmonary manifestations in children and adolescents after SARS-CoV 2 infection.

We used low-field magnetic resonance imaging (LF-MRI) for imaging of the pediatric lung. At low field strength, this technique has improved imaging quality of near air-tissue interfaces, without the need for ionizing radiation.20,21

The aim of the study was to characterize both morphologic and functional changes of lung parenchyma in PCR-proven SARS-CoV-2 pediatric post-acute Covid-19 patients in comparison to healthy controls.