Chest X‐ray lung imaging features in pediatric COVID‐19 and comparison with viral lower respiratory infections in young children

Abstract

Rationale Chest radiography (CXR) is a noninvasive imaging approach commonly used to evaluate lower respiratory tract infections (LRTIs) in children. However, the specific imaging patterns of pediatric coronavirus disease 2019 (COVID‐19) on CXR, their relationship to clinical outcomes, and the possible differences from LRTIs caused by other viruses in children remain to be defined. Methods This is a cross‐sectional study of patients seen at a pediatric hospital with polymerase chain reaction (PCR)‐confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (n = 95). Patients were subdivided in infants (0–2 years, n = 27), children (3–10 years, n = 27), and adolescents (11–19 years, n = 41). A sample of young children (0–2 years, n = 68) with other viral lower respiratory infections (LRTI) was included to compare their CXR features with the subset of infants (0–2 years) with COVID‐19. Results Forty‐five percent of pediatric patients with COVID‐19 were hospitalized and 20% required admission to intensive care unit (ICU). The most common abnormalities identified were ground‐glass opacifications (GGO)/consolidations (35%) and increased peribronchial markings/cuffing (33%). GGO/consolidations were more common in older individuals and perihilar markings were more common in younger subjects. Subjects requiring hospitalization or ICU admission had significantly more GGO/consolidations in CXR (p < .05). Typical CXR features of pediatric viral LRTI (e.g., hyperinflation) were more common in non‐COVID‐19 viral LRTI cases than in COVID‐19 cases (p < .05). Conclusions CXR may be a complemental exam in the evaluation of moderate or severe pediatric COVID‐19 cases. The severity of GGO/consolidations seen in CXR is predictive of clinically relevant outcomes. Hyperinflation could potentially aid clinical assessment in distinguishing COVID‐19 from other types of viral LRTI in young children.

Efficacy of Clinical and Chest Radiography Features in Predicting Patient Prognosis in Children with COVID-19

“…In the same study, it was noted that the rate of RT-PCR positivity was low, especially in throat swabs taken from mild cases. In addition, viral RNA could not be detected in some cases with typical viral pneumonia findings with GGO on CT GGOs/consolidations (35%) and increased peribronchial marking/cuffing (33%) [35].…”

Machine Learning Early Prediction of Respiratory Syncytial Virus (RSV) in Pediatric Hospitalized Patients

“…8 The utility of machine learning algorithms (MLAs) to discriminate between COVID-19 and other viral lower respiratory infections in pediatric patients has been established in previous research. 9 To guide appropriate use of RSV testing, we have developed a MLA to identify pediatric patients who have RSV upon hospital admission. We present a clinically useful MLA that uses individualized demographics and vital signs data that are routinely collected early upon hospital admission.…”

Developing artificial intelligence technology for pediatric pulmonology: Lessons from COVID‐19

“…What is the feasibility of AI for pediatric pulmonology? The clinical and lung imaging heterogeneity of viral infections in newborns, infants, children, and adolescents 4 , 5 has been a barrier for the adaptation of AI tools developed for adults. Notably, a recent study by Dayan et al 6 using federated learning (also known as collaborative learning) showed promise for the pediatric population.…”

“…This is generally true for COVID‐19, although differences between how the disease affects children and adults are well known. 4 , 5 In fact, COVID‐19 may not be the ideal model as the disease is generally mild in children and a large database of severely affected children will be required to develop an algorithm to predict a severe outcome. Even among children, lung imaging features of COVID‐19 vary by age, for example, ground glass opacities are more common in older individuals, whereas perihilar markings are more common in younger subjects.…”

“…Even among children, lung imaging features of COVID‐19 vary by age, for example, ground glass opacities are more common in older individuals, whereas perihilar markings are more common in younger subjects. 4 , 5 These age‐related changes reflect the different pathogenesis of viral respiratory infections in children compared with older people. Although we remain excited about the potential of learning from adult data how to better treat children, conducting large pediatric‐centered studies is essential to provide even better insight into the distinctive needs of treating children.…”