Introduction: The clinical spectrum of SARS-CoV-2 infection is well-established. However, understanding its long-term implications, especially in infants, remains limited. We aimed to evaluate pulmonary function tests in infants (iPFT) several months after a documented SARS-CoV-2 infection. Methods: An observational case-control study was performed. iPFT results in infants with persistent respiratory complaints several months after a SARS-CoV-2 infection were compared to a registry of patients assessed at our center between 2008 and 2019 using the Mann–Whitney U and Fisher’s exact tests. Excluded from the study were infants with chronic diseases and extreme prematurity. Results: iPFT data from sixteen infants with respiratory complaints and a history of SARS-CoV-2 infection and 475 controls were evaluated in the study. The median time between the SARS-CoV-2 infection and iPFT evaluation was 5.5 months (IQR=2.8-8.0). There were no differences between cases and controls in clinical characteristics and reason for iPFT evaluation. iPFT results showed no significant differences between cases and controls in lung volumes, compliance, or resistance. Expiratory airflow limitation was observed in both groups, with better low lung volume flows in the SARS-CoV-2 group. Categorization according to iPFT physiologic alteration and bronchodilator responsiveness were similar in the two groups. Conclusion: This study provides the first comprehensive iPFT data in infants following a SARS-CoV-2 infection. The findings suggest that SARS-CoV-2 infection does not cause unique long-term effects on pulmonary function in infants with chronic respiratory symptoms. Further studies in larger cohorts, particularly in infants with severe acute SARS-CoV-2 infection, are warranted to validate these findings.

Background: The marked heterogeneity in CF disease complicates selection of those most likely to benefit from existing or emergent treatments. Objective: We aimed to predict progression of bronchiectasis in preschool children with CF. Methods: Using data collected up to three years of age, in the Australian Respiratory Early Surveillance Team for CF (AREST CF) cohort study, clinical information, chest computed tomography (CT) scores and biomarkers from bronchoalveolar lavage were assessed in a multivariable linear regression model as predictors for CT bronchiectasis at age 5-6. Results: Follow-up at 5-6 years was available in 171 children. Bronchiectasis prevalence at 5-6 was 134/171 (78%) and median bronchiectasis score 3 (range 0-12). The internally validated multivariate model retained eight independent predictors accounting for 37% (Adjusted R2) of the variance in bronchiectasis score. The strongest predictors of future bronchiectasis were: pancreatic insufficiency, repeated intravenous treatment courses, recurrent lower respiratory infections in the first 3 years of life and lower airway inflammation. Dichotomizing the resulting prediction score at a bronchiectasis score of above the median resulted in a diagnostic odds ratio of 13 (95% CI 6.3-27) with a positive and negative predictive values of 80% (95%CI 72%-86%) and 77% (95% CI 69%-83%) respectively. Conclusion: Early assessment of bronchiectasis risk in children with CF is feasible with reasonable precision at a group level, which can assist in high-risk patient selection for interventional trials. The unexplained variability in disease progression at individual patient level remains high, limiting the use of this model as a clinical prediction tool.