COVID-19 Does Not Severely Affect Children with PH, Texas Study Says
COVID-19 tends not to cause serious disease or death in children with pulmonary hypertension (PH), but its long-term consequences remain unknown, according to a study done at a center in Texas.
The study, “Outcomes of COVID-19 Infection in pediatric pulmonary hypertension: a single-center experience,” was published in the journal Pediatric Pulmonology.
Early on in the COVID-19 pandemic, it was clear that people with certain underlying conditions were especially vulnerable to the disease. While it was initially feared that people with PH would be very susceptible to COVID-19, emerging research has indicated that this probably isn’t the case for adults.
Much is still unknown about COVID-19. For example, little is understood about how the virus affects children. Likewise, there is scant data on outcomes for children with PH who get COVID-19.
Now, researchers reported on 23 cases of COVID-19 in children receiving care at the PH center at Texas Children’s Hospital. Among these children, the median age was 58 months (just under five years). Slightly less than half (48%) were Hispanic, while 22% were white, 17% were African-American, and 13% were Asian. Eleven patients were on respiratory support, such as a continuous nasal cannula.
The frequency of infections was higher among Hispanics than might be expected based on the hospital’s demographics of roughly one-third of the patients being Hispanic, the researchers noted.
“This finding is most likely due to our local demographics; however, SARS-CoV-2 [the virus that causes COVID-19] has been reported more frequently in racial minorities, Hispanics being the race/ethnic group most affected by this disease nationally,” they wrote.
Of the 23 patients, eight (35%) were hospitalized due to COVID-19. Among them, six had congenital heart disease, and the same number used respiratory support. A battery of statistical tests did not identify any factor significantly associated with an increased risk of hospitalization.
The median length of hospital stay was six days. One child, who had failing Fontan physiology (a form of heart failure), died.
Five children who developed COVID-19, and two who were hospitalized, have trisomy 21 (Down syndrome). Outcomes in these children were generally comparable to outcomes in children without trisomy 21, unlike previous data for adults.
“This study supports that COVID-19 disease does not typically or seriously affect pediatric patients with PH, and mortality due to this illness is rare,” the researchers concluded.
All but two of the 23 patients underwent a follow-up evaluation a median of 101 days after their COVID-19 infection. In most cases, assessments of heart health showed no substantial changes, though some children had marked worsening in assessments of physical and lung function after recovering from COVID-19.
PH-specific therapy (including therapies known as phosphodiesterase 5 inhibitors and endothelin receptor antagonists) was escalated in four children, two of whom were on dual therapy and two others on triple therapy. One patient required a temporary increase of nasal cannula respiratory support, with higher oxygen flow for five months post-COVID-19.
The scientists noted a need for more research, since “the long-term outcomes of COVID-19 disease remain unknown.”