Clinical, laboratory, and chest CT features of severe versus non-severe pediatric patients with COVID-19 infection among different age groups

Abstract

Background This study was performed with the intention of comparing the clinical, laboratory, and chest computed tomography (CT) findings between severe and non-severe patients as well as between different age groups composed of pediatric patients with confirmed COVID-19. Method This study was carried out on a total of 53 confirmed COVID-19 pediatric patients who were hospitalized in Namazi and Ali Asghar Hospitals, Shiraz, Iran. The patients were divided into two severe (n = 27) and non-severe (n = 28) groups as well as into other three groups in terms of their age: aged less than two years, aged 3–12 years and 13–17 years. It should be noted that CT scans, laboratory, and clinical features were taken from all patients at the admission time. Abnormal chest CT in COVID-19 pneumonia was found to show one of the following findings: ground-glass opacities (GGO), bilateral involvement, peripheral and diffuse distribution. Result Fever (79.2%) and dry cough (75.5%) were the most common clinical symptoms. Severe COVID-19 patients showed lymphocytosis, while the non-severe ones did not (P = 0.03). C-reactive protein (CRP) was shown to be significantly lower in patients aged less than two years than those aged 3–12 and 13–17 years (P = 0.01). It was shown also that O2 saturation experienced a significant increase as did patients’ age (P = 0.01). Severe patients had significantly higher CT abnormalities than non-severe patients (48.0% compared to 17.9%, respectively) (P = 0.02). Conclusion Lymphocytosis and abnormal CT findings are among the factors most associated with COVID-19 severity. It was, moreover, showed that the severity of COVID-19, O2 saturation, and respiratory distress were improved as the age of confirmed COVID-19 pediatric patients increased.

Iranian Pediatric COVID-19 Epidemiology and Clinical Characteristics

“…According to Chang et al's systematic literature (with last updates on 15 March 2020), as well as Ansel et al's systematic search (with last searched 14 May 2020) and Hoseinyazdi et al's pediatric study in Shiraz (March–May 2020), like ours, fever and cough were the most common clinical symptoms [ 19 – 21 ]. Although Chang et al's study reported few gastrointestinal symptoms (12%) [ 20 ], in our study, diarrhea and vomiting were reported in 22.3% and 30.3% of cases, respectively.…”

“…In our investigations, out of 240 patients, 34.16% had been shown with lymphopenia and only 2% had lymphocytosis. Based on Hoseinyazdi et al's pediatric study in Namazi and Ali-Asghar Hospitals, lymphocytosis has been shown in severe cases [ 21 ]. Additionally, another study by Du et al in Shandong Province in China found increased lymphocyte counts in children compared to adults [ 15 ].…”

“…In Hoseinyazdi's study, CRP levels were normal in patients under two years of age, whereas they were significantly higher in those aged over 3 years [ 21 ]. Also, in our study, the mean range of initial CRP was lower in the group under 1 years of age than that of those over this age.…”

Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review

“… 22 The results of the study showed that the hospitalization and intensive care time, lymphocytosis, and abnormal CT findings (ground-glass opacities and consolidation) of children in the critically ill group were higher than those in non-critically ill children, which are the most reliable factors related to the severity of COVID-19. 78 …”

Imaging findings in acute pediatric coronavirus disease 2019 (COVID-19) pneumonia and multisystem inflammatory syndrome in children (MIS-C)

“…These issues limit the meaningfulness of radiographic interpretations in pediatric COVID-19 disease. In a few studies, some data support a link between the severity of pulmonary opacities on imaging and indicators of clinical severity, such as degree of respiratory distress, need for hospital admission and intensive care stay, presence of underlying conditions, and patient fatalities [ 45 , 47 , 50 , 51 , 53 , 71 , 72 ]. Thus, while imaging might not play a primary diagnostic role in acute pediatric COVID-19, it remains an integral part of patient care, mainly to assess disease progression or anticipate a change in management, especially in children with critical illness and chronic comorbidities [ 20 , 41 , 43 , 45 , 48 ].…”