Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic
Authors: Riccardo Lubrano, Silvia Bloise, Alessia Testa, Alessia Marcellino, Anna Dilillo, Saverio Mallardo, Sara Isoldi, Vanessa Martucci, Maria Sanseviero, Emanuela Del Giudice, Concetta Malvaso, Donatella Iorfida, Flavia Ventriglia
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older. <h3>Objective</h3> To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress. <h3>Design, Setting, and Participants</h3> This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged &gt;24 months to ≤144 months). Data were analyzed from May through June 2020. <h3>Interventions</h3> All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes. <h3>Main Outcomes and Measures</h3> Changes in respiratory parameters during the use of surgical masks were evaluated. <h3>Results</h3> Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco<sub>2</sub>; 33.0 [32.0-34.0] mm Hg;<i>P</i>for Kruskal Wallis = .59), oxygen saturation (Sao<sub>2</sub>; 98.0% [97.0%-99.0%];<i>P</i>for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min;<i>P</i>for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min;<i>P</i>for Kruskal Wallis = .69) or for group B in median (IQR) Petco<sub>2</sub>(36.0 [34.0-38.0] mm Hg;<i>P</i>for Kruskal Wallis = .97), Sao<sub>2</sub>(98.0% [97.0%-98.0%];<i>P</i>for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min;<i>P</i>for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min;<i>P</i>for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min;<i>P</i> &lt; .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min;<i>P</i> &lt; .05). <h3>Conclusions and Relevance</h3> This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao<sub>2</sub>or Petco<sub>2</sub>, including among children aged 24 months and younger.