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

Abstract

Background: Pulmonary 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.

Methods: Data 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.

Results: Spirometry 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.

Discussion: Children 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.

Keywords: COVID-19; SARS-CoV-2; adolescents; children; convalescence; spirometry.

FIGURE 1

Spirometry values in children (n = 53), adolescents and young adults (n = 34) and their parents (n = 95) 12 months after mild SARS-CoV-2 infection in n = 25/15/68 participants, respectively, and healthy family members as controls. SARS-CoV-2 negative (-) vs. positive (+) participants are visualized. All medians are in the normal range. Boxplots (medians, quartiles, minimum and maximum values) for normalized (z scores) spirometry parameters. (A) FVCz, (B) FEV1z, (C) FEV1z/FVCz, (D) FEF 25–75z, and (E) FEF 75z. FVC, forced vital capacity; FEV1, forced expiratory volume in 1 s; FEF25 75, mean flow between 25% and 75% of the forced vital capacity; FEF75, maximum expiratory flow at 75% expiration of forced vital capacity. Children 4–14 years, adolescents 14–25 years, adults > 25 years.

FIGURE 2

Diminished FEF 25–75 z-score in all seropositive participants with cough during acute SARS-CoV-2 infection 12 months after the infection. Median, quartiles, minimum and maximum values in participants without (n = 66) and with cough (n = 42) during SARS-CoV-2 infection are visualized. *p < 0.05. FEF25–75z, normalized mean flow between 25% and 75% of the forced vital capacity.

FIGURE 3

Self-reported persistent clinical symptoms in seropositive children, adolescents and young adults and their parents 12 months after SARS-CoV-2 infection. Data from questionnaires of n = 25 children, n = 14 adolescents, and n = 58 adults. *p < 0.05, **p < 0.001.