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COVID-19 in children with underlying chronic respiratory diseases: survey results from 174 centres
Alexander Moeller1,2, Leo Thanikkel1,2, Liesbeth Duijts3,4
1Division of Respiratory Medicine and Childhood Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Children with asthma and cystic fibrosis tolerated SARS-CoV-2 infection well. However, children with bronchopulmonary dysplasia and other respiratory conditions faced significant risks, often requiring ventilatory support due to COVID-19.
Area of Science:
- Pediatric Respiratory Medicine
- Infectious Diseases
- Critical Care
Background:
- While most children infected with SARS-CoV-2 experience mild illness, the impact on those with chronic respiratory conditions remains less understood.
- Investigating potential exacerbations in pediatric patients with pre-existing lung diseases following SARS-CoV-2 infection is crucial.
Purpose of the Study:
- To assess the clinical outcomes and severity of coronavirus disease 2019 (COVID-19) in children with chronic respiratory illnesses.
- To identify specific pediatric respiratory conditions that place children at higher risk for severe COVID-19 outcomes.
Main Methods:
- A survey was distributed to members of the European Respiratory Society's Paediatric Assembly in April and May 2020.
- Data were collected from 174 centers, stratifying patients by asthma, cystic fibrosis (CF), bronchopulmonary dysplasia (BPD), and other respiratory conditions.
Main Results:
- Out of 945 pediatric COVID-19 cases, 49 involved children with asthma, with a minority requiring mechanical ventilation.
- Children with cystic fibrosis generally experienced mild COVID-19 symptoms.
- A significant proportion of children with bronchopulmonary dysplasia (6 out of 9) and other respiratory conditions (31 out of 33) required hospitalization and ventilatory support, including invasive ventilation.
Conclusions:
- SARS-CoV-2 infection appears well-tolerated in pediatric patients with asthma and cystic fibrosis.
- Children with bronchopulmonary dysplasia and other chronic respiratory conditions are at increased risk for severe COVID-19, necessitating ventilatory support.
Background:
Early reports suggest that most children infected with severe acute respiratory syndrome coronavirus 2 ("SARS-CoV-2") have mild symptoms. What is not known is whether children with chronic respiratory illnesses have exacerbations associated with SARS-CoV-2 virus.
Methods:
An expert panel created a survey, which was circulated twice (in April and May 2020) to members of the Paediatric Assembly of the European Respiratory Society (ERS) and via the social media of the ERS. The survey stratified patients by the following conditions: asthma, cystic fibrosis (CF), bronchopulmonary dysplasia (BPD) and other respiratory conditions.
Results:
In total 174 centres responded to at least one survey. 80 centres reported no cases, whereas 94 entered data from 945 children with coronavirus disease 2019 (COVID-19). SARS-CoV-2 was isolated from 49 children with asthma of whom 29 required no treatment, 19 needed supplemental oxygen and four children required mechanical ventilation. Of the 14 children with CF and COVID-19, 10 required no treatment and four had only minor symptoms. Among the nine children with BPD and COVID-19, two required no treatment, five required inpatient care and oxygen and two were admitted to a paediatric intensive care unit (PICU) requiring invasive ventilation. Data were available from 33 children with other conditions and SARS-CoV-2 of whom 20 required supplemental oxygen and 11 needed noninvasive or invasive ventilation.
Conclusions:
Within the participating centres, in children with asthma and CF, infection with SARS-CoV-2 was well tolerated, but a substantial minority of children with BPD and other conditions required ventilatory support indicating that these latter groups are at risk from SARS-CoV-2 infection.
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