Pediatric Pulmonary Medicine Researchers Seek Answers on COVID-19 Effects

January 18, 2021

Researchers in the UPMC Children’s Hospital of Pittsburgh Division of Pediatric Pulmonary Medicine have been actively investigating important questions about how COVID-19 affects pediatric patients and the provision of care during the pandemic.

Erick Forno, MD, MPH, ATSF, was the senior author of two papers. The first study1 was designed to characterize the clinical presentation and health care utilization of pediatric COVID-19 patients in western Pennsylvania who were treated at UPMC Children’s (CHP) and its affiliated Children’s Community Pediatrics (CCP) practice network. 

Dr. Forno, along with colleagues in pulmonology, infectious diseases, hospitalist medicine, adolescent medicine, and the CCP, examined all of the pediatric COVID-19 cases treated at UPMC Children’s and CCP between March 11, 2020, and August 20, 2020, and found that while most cases were deemed mild, about 5% required hospitalization. Of the cases requiring hospitalization (n=22), 5 required treatment in the PICU, including all 3 cases that presented with multi-system inflammatory syndrome in children (MIS-C). African-American and Hispanic/Latino patients were 5.8 times more likely to need hospitalization compared to white patients, and they also were more likely to have preexisting conditions. 

The second paper2, co-authored with Jose A. Castro-Rodriguez, MD, from the Department of Pediatric Pulmonology at Pontificia Universidad Católica de Chile, Santiago, Chile, is a systematic review of the literature to date on whether children with asthma or other respiratory disorders are more at risk for COVID-19 infection or a more severe manifestation of the disease should they contract the virus. Given that the literature and investigations to date on these questions are limited, Drs. Forno and Castro-Rodriquez advocate for a more robust research response to expand the evidence base on these crucial, unanswered questions. One of the goals of the UPMC Children’s/CCP COVID-19 registry (which is ongoing and now includes more than 1,500 patients) is precisely to better answer questions like these on how COVID-19 affects children with asthma and other diseases.

Daniel Weiner, MD, medical director of the Pulmonary Function Laboratory and Director of the Antonio J. and Janet Palumbo Cystic Fibrosis Center at UPMC Children’s was part of a multicenter, multidisciplinary task force3 whose objective was to develop plans and consensus guidelines for how to resume elective pulmonary and sleep medicine-related services amid the COVID-19 pandemic. The task force was jointly formed by the American Thoracic Society (ATS) and the Association of Pulmonary, Critical Care and Sleep Division Directors. While the discussion and planning recommendations in the paper are extensive, it is clear that institutions must remain nimble and flexible to adapt to a continually changing pandemic situation in order to provide critical care to pediatric pulmonary patients whose care cannot wait or be disrupted due to extenuating circumstances. 

References

1. Freeman MC, Gaietto K, DiCicco LA, Rauenswinter S, Squire JR, Aldewereld Z, Rapsinski G, Iagnemma J, Campfield BT, Wolfson D, Kazmerski TM, Forno E. A Comprehensive Clinical Description of Pediatric SARS-CoV-2 Infection in Western Pennsylvania. medRxiv. 2020 Dec 16: 2020.12.14.20248192.

2. Castro-Rodriguez JA, Forno E. Asthma and COVID-19 in Children: A Systematic Review and Call for Data. Pediatr Pulmonol. 2020 Sep; 55(9): 2412-2418.

3. Wilson KC, Kaminsky DA, Michaud G, et al. Restoring Pulmonary and Sleep Services as the COVID-19 Pandemic Lessens. From an Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society-coordinated Task Force. Ann Am Thorac Soc. 2020 Nov; 17(11): 1343-1351.