Incidence and risk factors for long COVID in children with COVID-19 pneumonia.

BACKGROUND AND OBJECTIVE: There are only a few reports of long COVID including pulmonary function in children after COVID-19 pneumonia. We determined the incidence of long COVID and abnormal pulmonary function in those children and identify risk factors. METHODS: This cohort study enrolled children admitted with COVID-19 pneumonia during 2021-2022. We gathered clinical characteristics during admission and at follow-up 3 months after. RESULTS: We determined the incidence of long COVID at 39.7% (95% confidence interval [CI]: 30.7%-49.1%). All severe pneumonia cases consistently reported persistent symptoms. Exercise intolerance, cough, and fatigue were the three most common persistent symptoms in 26 (22.4%), 21 (18.1%), and 18 (15.5%) of the patients, respectively. At the follow-up, 21 cases (18.1%) demonstrated persistent abnormal chest radiographs. Three cases (6.9%) demonstrated restrictive ventilatory defects. Among those, one case (2.3%) demonstrated concomitant diffusion defect. Three cases (6.0%) demonstrated exercise-induced hypoxemia after the 6-minute walk test. Comparing spirometry variables between children with long COVID and without revealed significant difference of FEF25-75 (z score) between two groups. Age [adjusted OR (95% CI): 1.13 (1.05-1.22), p value 0.002], allergic diseases [adjusted OR (95% CI): 4.05 (1.36-12.06), p value 0.012], and living in polluted areas [adjusted OR (95% CI): 2.73 (1.18-6.33), p value 0.019] were significantly associated with long COVID. CONCLUSION: A significant percentage of children developed long COVID after COVID-19 pneumonia. We should give additional attention to those who have exercise intolerance, chronic cough, or fatigue, especially older children, severe cases, children with allergic diseases, and those living in polluted areas.

Impact of respiratory care training and family support using telemedicine on tracheostomized children admitted with respiratory infection after discharge.

OBJECTIVE: Children with tracheostomies usually require a long hospital stay, high healthcare costs and caregiver burden. With the help of telemedicine, this study attempted to determine how home respiratory care training and family support affected admission days, admission costs, ICU admission rates, and caregivers' confidence. METHODS: We enrolled children with tracheostomies who were admitted between 2020 and 2022 with respiratory infections. Before discharge, we evaluated the knowledge and skills of the caregivers and gave them practice in home respiratory care while providing them with structured feedback using a checklist, a peer-to-peer mentor assignment, a virtual home visit, teleeducation, and teleconsultation via a mobile application. We compared the admission days, admission costs, and ICU admission rates one year following the program with the historical control one year earlier. RESULTS: Forty-eight children with tracheostomies were enrolled. Thirteen percent of those had a 1-year readmission. The median [IQR] number of admission days decreased from 55 [15-140] to 6 [4-17] days (p value < 0.001). The median [IQR] admission costs decreased from 300,759 [97,032 - 1,132,323] to 33,367 [17,898-164,951] baht (p value < 0.001). The ICU admission rates decreased from 43.8% to 2.1% (p value < 0.001). Immediately after the program, caregivers' confidence increased from 47.9% to 85.5% (p value < 0.001). CONCLUSIONS: This respiratory care training and telehealth program decreased admission days, admission costs, and ICU admission rates for children with tracheostomies admitted with respiratory infections. The confidence of caregivers was also increased immediately after the program.

Effect of Threshold Inspiratory Muscle Training on Functional Fitness and Respiratory Muscle Strength Compared to Incentive Spirometry in Children and Adolescents With Obesity: A Randomized Controlled Trial.

Background: To determine the effect of threshold inspiratory muscle training (IMT) on functional fitness and respiratory muscle strength (RMS) compared to incentive spirometry (IS) in children/adolescents with obesity. Methods: A total of 60 obese children/adolescents aged 8-15 years were randomized into the threshold IMT group (n = 20), the IS group (n = 20), or the control group (n = 20). The IMT group performed 30 inspiratory breaths with the intensity set at 40% of baseline maximal inspiratory pressure (MIP) twice daily for 8 weeks; the IS group performed 30 breaths with sustained maximum inspiration twice daily for 8 weeks; and, the control group was assigned no training device for 8 weeks. Six-min walk test (6-MWT), RMS, and spirometry were compared between baseline and 8 weeks. Results: Six-MWT distance (528.5 ± 36.2 vs. 561.5 ± 35.2 m, p = 0.002) and MIP (121.2 ± 26.8 vs. 135.3 ± 32.1%Predicted, p = 0.03) were significantly improved after 8 weeks of IMT training. There was no significant difference in any evaluated pulmonary function parameters between baseline and 8 weeks in the IS or control groups; however, 6-MWT distance demonstrated a trend toward significant improvement in the IS group (526.9 ± 59.1 vs.549.0 ± 50.6 m, p = 0.10). No significant difference among groups was found for any variable relative to change from baseline to post-training. Conclusion: Eight weeks of threshold IMT training significantly improved both inspiratory muscle strength (MIP) and functional fitness (6-MWT) in children/adolescents with obesity. Eight weeks of IS training yielded a trend toward significantly improved functional fitness.

Tuberculosis-immune reconstitution inflammatory syndrome in HIV-negative children.

Even though tuberculosis-immune reconstitution inflammatory syndrome (TB-IRIS) is usually found in HIV-positive patients receiving antiviral treatment, it can also occur in HIV-negative patients especially if they have risk factors. We report a unique case of TB-IRIS in an immunocompetent child presenting with new onset of pleuritic chest pain after receiving anti-TB drugs. TB-IRIS should be considered as a differential diagnosis in case of clinical deterioration or appearance of new typical lesions despite appropriate anti-TB treatment for more than 2 weeks in the absence of persistently active TB or any other alternative causes. This will prevent physicians from misdiagnosis as superimposed infections, treatment failure or TB relapse.