Variation in Lung Function in Pediatric and Adolescent Population Post SARS-COV-2 Infection: Pediatric Pulmonary Practice Experience

ABSTRACT

Introduction: In our study, we are reporting pulmonary function testing (PFT) changes post recovery from SARS-CoV-2 infection in the pediatric and adolescents. This is a unique paper which may shed light on a matter of utter importance that has been poorly reported in the literature. Studies reviewing SARS-CoV-2 infection PFT, mostly from adult, had shown obstructive and restrictive impairment, small airway dysfunction, and decreased diffusion capacity for carbon monoxide (DLCO), which gives an overall assessment of the lung's ability of gas exchange likely due to SARS-CoV-2 triggered pulmonary vasculopathy. Restrictive pattern and decreased DLCO were the most frequently impaired PFT parameter. Method: This is a single-site retrospective charts review of children and adolescents, ages 6 to 22 years old, who presented to pediatric pulmonology outpatient after having a SARS-CoV-2 infection. They were either managed in the hospital and had at least one pulmonary symptom or they were managed as outpatient. Results: In our case series of 33 patients, mean age was 16.8 years, the majority were seen as an outpatient (78.7%, 26/33). PFT results were interpreted using ATS standard, 4 PFT were suboptimal, mean time from SARSCoV- 2 infection and PFT was 4.3 months. Among patients with optimal PFT, 72.4% (21/29) had abnormal PFT (table 1). Subjects with PFT changes, 9 previously healthy subjects had PFT changes post- SARS-CoV-2, compared to 12 patients who had history of asthma. All hospitalized patients had measured DLCO except one whom DLCO wasn't measured. Among all hospitalized patients, whose pulmonary imaging exhibited ground glass opacities, 2 patients had normal DLCO (42.8%, 2/6). The rate of low DLCO was higher inpatient than outpatient cases (42.9% vs. 4.5%, p<0.0369) with mean DLCO 71.2% predicted. All hospitalized patients with decreased DLCO had elevated lactate dehydrogenase (LDH) and D-dimer.The most common co-morbid conditions noted to have were asthma (55%, 16/29) and obesity/overweight (51.7%, 15/29). Subjects who were hospitalized, 71% (5/7) required supplemental oxygen;most common chest imaging findings were bilateral ground-glass opacity, or patchy infiltrates. LDH was elevated in 71% (5/7) whereas D-dimer was elevated in 85.7% (6/7). All received steroids, and 85.7% (6/7) received remdesivir. Conclusion: SARS-CoV-2 related pulmonary complications remains a topic of research and is poorly studied in pediatric population. Impaired DLCO could correlate imaging findings However;we didn't find that association in our report, which is limited by low sample size. PFT may be useful as an objective measure for post-COVID infection follow up. (Figure Presented).