Emerging research has revealed the long-term consequences of SARS-CoV-2 infection in children, specifically regarding gastrointestinal (GI) symptoms. A recent study conducted by Fondazione Policlinico Universitario A. Gemelli IRCCS-Italy and Università Cattolica del Sacro Cuore investigated the temporal evolution of GI symptoms in children infected with SARS-CoV-2 over an 18-month follow-up period. The study also explored the potential therapeutic role of lactoferrin in alleviating persistent GI symptoms.
Long COVID, or post-COVID condition (PCC), is a recognized prolonged aftermath of SARS-CoV-2 infection that affects both adults and children. Approximately 40% of patients experience at least one symptom of long COVID, and around one-quarter of children exhibit symptoms even a year after the initial infection. Long COVID manifests in various clinical manifestations, impacting multiple organ systems, including the respiratory, cardiovascular, neurocognitive, musculoskeletal, and gastrointestinal systems.
The GI system is a specific target among the different systems affected by SARS-CoV-2, with symptoms reported throughout the spectrum of infection. The exact pathophysiology of acute and chronic GI symptoms in children remains unclear, but potential mechanisms include persistent viral presence in the gut, local inflammation, subcellular damage, immunity-triggered inflammation, and alterations in the microbiota. GI inflammation may also contribute to dysautonomia and postural orthostatic tachycardia syndrome (POTS).
Despite significant progress in understanding long COVID in adults, research on pediatric long COVID has lagged behind. The temporal evolution of GI symptoms in children, especially over an extended period, remains unexplored. However, certain strategies such as probiotics and lactoferrin have been proposed as possible therapeutic options based on potential pathogenetic mechanisms.
A retrospective study involving 1224 pediatric patients, conducted by Italian researchers, aimed to investigate the temporal evolution of GI symptoms in children with SARS-CoV-2 over an 18-month follow-up period. The study also explored the role of lactoferrin in improving GI symptoms compared to untreated children. The results showed that 14.1% of children presented with GI symptoms during acute infection, with a subsequent decrease over the follow-up periods. Children treated with oral lactoferrin for three months showed a trend toward fewer persisting GI symptoms at six months compared to untreated children.
This study represents a pioneering effort in understanding the long-term evolution of GI symptoms in children with SARS-CoV-2 and exploring the potential efficacy of lactoferrin in managing these symptoms. Lactoferrin’s immunomodulatory effects, impact on the gut microbiome, and effects on plasminogen provide a multifaceted rationale for its potential efficacy. However, larger prospective trials, especially in children with long COVID characterized by GI symptoms, are needed to determine the therapeutic role of lactoferrin and explore its potential as a preventative therapeutic approach.
The findings of this study, published in the journal Children, lay the groundwork for future research in the management of long COVID in children. It is crucial to conduct larger prospective trials to determine the effectiveness of lactoferrin and improve the quality of life for children affected by long COVID.