Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy.
Pediatr Pulmonol. 2024 Feb;59(2):472-481. doi: 10.1002/ppul.26779. Epub 2023 Dec 13.
A significant percentage of patients who survived the Coronavirus Infection Disease 2019 (COVID-19) showed persistent general and respiratory symptoms even months after recovery. This condition, called Post-Acute Sequelae of COVID-19 or Long-Covid syndrome (LCS), has been described also in children with positive history for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Little is known about the pathophysiologic mechanisms underlying this syndrome. The aim of this study was to investigate any difference between children with LCS and asymptomatic peers with previous COVID-19 in terms of lung function and lung ultrasound (LUS) patterns. Secondly, we tested associations between lung function abnormalities and LUS findings with Long-Covid.
We carried out a prospective, descriptive, observational study including 58 children aged 5-17 years: 28 with LCS compared to 30 asymptomatic children with previous COVID-19. We collected demographic data, history of asthma, allergy or smoke exposure, and acute COVID-19 symptoms. After a median period of 4.5 months (1%-95% range 2-21) since the infection, lung function was assessed by spirometry, body plethysmography, diffusion lung capacity for carbon monoxide (DLCO). Airways inflammation was investigated by fractional exhaled nitric oxide (FeNO). LUS was performed independently by two experienced clinicians.
We found that children with LCS were older than controls (mean (SD) 12 (4.1) vs. 9.7 (2.6); p = .04). Children with LCS complained more frequently fatigue (46.4%), cough (17.9%), exercise intolerance (14.3%) and dyspnea (14.3%). Lung function was normal and similar between the two groups. The frequency of LUS abnormalities was similar between the two groups (43.3% children with LCS vs. 56.7% controls; p = .436). Children with LCS showed lower FeNO values (log difference -0.30 (CI 95% -0.50, -0.10)), but no association of LCS with a lower lung function and abnormal LUS findings was found.
LCS seems to be more frequent in older age children. Lung functional and structural abnormalities were not different between children with LCS and asymptomatic subjects with previous COVID-19. In addition, children with LCS showed lower FeNO values than controls, suggesting its potential role as a marker in LCS. However, further and larger studies are needed to confirm our findings.
即使在康复后数月，仍有很大比例的 COVID-19 患者持续存在全身和呼吸系统症状。这种情况被称为 COVID-19 后急性后遗症或长期 COVID 综合征（LCS），也在 SARS-CoV-2 感染史阳性的儿童中被描述过。对于这种综合征的病理生理机制知之甚少。本研究旨在比较 LCS 患儿与无症状 COVID-19 患儿的肺功能和肺部超声（LUS）模式是否存在差异。其次，我们测试了肺功能异常与 LUS 发现与长期 COVID 之间的关联。
我们进行了一项前瞻性、描述性、观察性研究，纳入了 58 名 5-17 岁的儿童：28 名 LCS 患儿与 30 名无症状 COVID-19 患儿。我们收集了人口统计学数据、哮喘、过敏或吸烟史以及急性 COVID-19 症状。在感染后中位数 4.5 个月（1%-95%范围 2-21）后，通过肺量计、体描法、一氧化碳弥散量（DLCO）评估肺功能。通过呼出气一氧化氮分数（FeNO）评估气道炎症。由两位经验丰富的临床医生独立进行 LUS。
我们发现，与对照组相比，LCS 患儿年龄更大（平均值（标准差）12（4.1）vs. 9.7（2.6）；p=0.04）。LCS 患儿更常抱怨疲劳（46.4%）、咳嗽（17.9%）、运动不耐受（14.3%）和呼吸困难（14.3%）。两组肺功能均正常且相似。两组的 LUS 异常频率相似（43.3%的 LCS 患儿 vs. 56.7%的对照组；p=0.436）。LCS 患儿的 FeNO 值较低（对数差-0.30（95%CI-0.50，-0.10）），但 LCS 与肺功能较低和 LUS 异常发现之间无关联。
LCS 在年龄较大的儿童中更为常见。LCS 患儿与无症状 COVID-19 患儿的肺功能和结构异常无差异。此外，与对照组相比，LCS 患儿的 FeNO 值较低，提示其可能作为 LCS 的标志物。然而，需要进一步更大规模的研究来证实我们的发现。
