Abstract:
Background: While COVID-19 has been extensively studied in adults and older children, little is known about the long-term respiratory sequelae in neonates infected perinatally. Given that alveolarization continues during the first years of life, neonatal COVID-19 may affect subsequent lung development.
Objective: To evaluate clinical outcomes and pulmonary function in infants with a history of perinatal SARS-CoV-2 infection at 6- and 12-month follow-up.
Methods: This prospective, observational pilot study included term and preterm infants diagnosed with COVID-19 at birth and followed at a tertiary neonatal unit. Participants underwent serial clinical assessments and pulmonary function testing (tidal breathing analysis and multiple-breath nitrogen washout) in line with ERS/ATS standards. Control comparisons were made with published pre-pandemic normative data.
Results: Of 36 eligible infants with neonatal COVID-19, 14 (38.9%) were enrolled. Median age at first assessment was 6 months. Twelve of 14 (85.7%) had at least one abnormal tidal breathing parameter, most frequently reduced tidal volume/kg and altered minute ventilation. Respiratory rate was significantly higher in infants with abnormal test results (p=0.030). Nitrogen washout, performed in three infants, revealed impaired ventilation distribution (elevated LCI) in two cases. No clear associations with perinatal factors such as gestational age, birth weight, or delivery mode were identified. Clinically, recurrent wheezing episodes and use of bronchodilators were noted in 21% of participants.
Conclusion: Preliminary findings suggest that perinatal COVID-19 may be associated with subtle but measurable respiratory function abnormalities persisting during infancy. These alterations could represent early markers of long-term pulmonary morbidity. Larger multicentre studies are warranted to confirm these results and explore potential mechanisms.
