Introduction: Although prolonged respiratory symptoms following SARS-CoV-2 infection have been reported in adults, there is a paucity of literature describing post-acute symptoms in pediatric patients following COVID-19. In this study we describe health data and respiratory findings in pediatric patients presenting with complaints of persistent respiratory symptoms following acute COVID-19 infection. Methods: This study included patients referred to Pulmonary Clinic at the Children’s Hospital of Philadelphia between December 2020 and April 2021 (n=29). Inclusion criteria included a history of SARS-CoV-2 RNA positivity or confirmed close household contact. A retrospective chart review was performed and demographic, clinical, imaging, and functional test data were collected. Results: The mean age at presentation to clinic was 13.1 years (range: 4-19 years). Patients had persistent respiratory symptoms ranging from 1.3 to 6.7 months post-acute infection. Persistent dyspnea and/or exertional dyspnea were present in nearly all (96.6%) of the patients at the time of clinic presentation. Other reported chronic symptoms included cough (51.7%) and exercise intolerance (48.3%). Fatigue was reported in 13.7% of subjects. Many subjects were overweight or obese (62.1%) and eleven subjects had a prior history of asthma. Lung function was normal in most patients. The six-minute walk test (6MWT) revealed exercise intolerance and significant tachycardia in two-thirds of children tested. Conclusion: Exertional dyspnea, cough and exercise intolerance were the most common respiratory symptoms in children with post-acute COVID-19 respiratory symptoms seen in an outpatient pulmonary clinic. Lung function, however, was mostly normal, and exertional intolerance was frequently demonstrated using the 6MWT.

Rationale: Bronchopulmonary dysplasia (BPD) is a major complication of premature birth and the most common cause of chronic lung disease in infancy. Previous studies have shown that children with a history of BPD have impaired lung function in childhood compared to their term counterparts. However, little is known about potential modifiable factors that alter lung function trajectories and subsequent respiratory morbidity in this population. Objectives: To identify potential modifiable risk factors for the development of impaired lung function in patients with a history of prematurity and BPD. Methods: Growth parameters (birth, 2yo, 6yo) and pulmonary function testing (6yo) were retrospectively reviewed for subjects (n=598) recruited from an outpatient BPD clinic who were born ≤36 weeks gestation and were ≥5 years of age. Results: Of the 598 recruited subjects, 88 (14.7%) performed adequate pulmonary function testing at approximately six years of age. The mean FEV1% predicted was 84.5% with lower values associated with lower median household income, Nissen fundoplication, and higher weight percentiles at 2yo. The mean FVC % predicted was 94.2% with lower values associated with higher amounts of oxygen required at time of initial hospital discharge, Nissen fundoplication, and higher weight percentiles at 2yo. Conclusions: Our study found that children with BPD have different long-term pulmonary trajectories than full-term controls. Supplemental oxygen, lower income, and Nissen fundoplication at discharge were associated with lower lung function at 6 years of age. Prospective studies should focus on modifiable risk factors that could minimize the impact of BPD on later lung function.