Pulmonary Dysfunction after Pediatric COVID-19

The study by Heiss et al. (2022) investigated pulmonary dysfunction in children and adolescents after COVID-19 infection, focusing on those who have recovered and those with Long COVID. The study used low-field-strength MRI to assess lung parenchyma changes compared to healthy controls​​.

Methods: The study, conducted between August and December 2021 at a single academic medical center, involved a cross-sectional clinical trial using low-field-strength MRI. It primarily aimed to identify the frequency of morphologic changes in MRI and secondary outcomes like MRI-derived functional proton ventilation and perfusion parameters. Clinical symptoms, time from positive COVID-19 test results, and serologic parameters were compared with imaging results​​.

Participants: The study included 54 participants post-COVID-19 infection (29 recovered, 25 with Long COVID) and nine healthy controls. The average age was around 11 years. The study noted morphologic abnormalities in one recovered participant and significant differences in ventilated and perfused lung parenchyma (ventilation-perfusion match) between the groups​​.

Results:

  • Ventilation-perfusion (V/Q) match was significantly higher in healthy controls (81%) compared to the recovered group (62%) and the Long COVID group (60%).
  • Participants with less time since COVID-19 infection showed lower V/Q match compared to never-infected healthy controls.
  • The study demonstrated persistent pulmonary dysfunction in children and adolescents who recovered from COVID-19 and those with Long COVID​​.

Discussion: The study expanded the understanding of pediatric post-acute COVID-19 disease, highlighting that children and adolescents experience widespread functional lung alterations post-COVID-19. The study also discussed the possible pathophysiological mechanisms behind these observations, including direct endothelial damage and a prothrombotic milieu. However, it acknowledged several limitations, such as a lack of comparison with other reference standards like V/Q scintigraphy, the reliance on free breathing in the MRI technique, and potential selection bias.

In conclusion, the study underlined the need for further surveillance of persistent pulmonary damage in children and adolescents post-COVID-19, suggesting the potential role of lung MRI in routine clinical care for these cases​​.

Read More: https://pubs.rsna.org/doi/10.1148/radiol.221250

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