A Comparative Evaluation of the Clinical Course, Laboratory Data and Chest CT scan Findings in Pediatric Patients with Covid-19 and Their Prognostic Value in Disease Outcome Estimation

Document Type : original article

Authors

1 Department of Radiology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

2 Department of Pediatrics,Faculty of medicine,Kashan University of Medical Sciences, Kashan, Iran

3 Student Research Committee, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

4 Associate professor of pediatrics diseases, Department of Pediatrics, School of Medicine, Infectious Diseases Research Center, Shahid Beheshti Hospital, Kashan University of Medical Sciences

5 Department of Radiology, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Background: Most research on children and adolescents with COVID-19, had limited sample sizes and little clinical, laboratory, and radiological findings. The purpose of this research was to examine the features of children and adolescents with COVID-19 infection.
Methods: This analytical retrospective study was conducted on children (1 to 12 years old) and adolescents (13 to 19 years old) with COVID-19 in Shahid Beheshti Hospital, Kashan, Iran. The data were then collected, entered into SPSS and analyzed.
Results: In the adolescent group, the frequency of dyspnea (47.1 % vs. 11.9%), cough (67.1 % vs. 39.2%), lethargy (42.9 % vs. 25.9%), headache (35.7 % vs. 10.5%), myalgia (38.6 % vs. 14%), and chest pain (12.9 % vs. 0.7%) were significantly higher than those in children (p<0.05). Furthermore, in terms of laboratory findings, the normal range of neutrophils (13.8% vs. 1.4%), Cr (95% vs. 75.7%), and CRP (77.9% vs. 58%) were higher in children. Moreover, we found that the CT severity score among adolescent patients was significantly higher than that in children (4.84 ± 5.21 vs. 1.76 ± 3.25, p=0.006). Also, the frequency of consolidation (61.3 % vs. 19%), and ground-glass opacity (58.1 % vs. 28.6%) among adolescents were significantly higher compared to child cases (p<0.05) while only the frequency of mosaic pattern of pulmonary parenchymal attenuation was significantly higher among children (p=0.035).
Conclusion: This research found milder clinical, biochemical, and radiological symptoms in children with COVID-19 than adolescents. However, radiological examinations showed greater rates of pulmonary parenchymal mosaic attenuation, which might help early diagnosis of COVID-19.

Keywords

References

  1. Soltani-Zangbar MS, Hajivalili M, Daneshdoust D, Ghadir S, Savari G, Zolfaghari M, Aghebati-Maleki L, Oloufi S, Nouri N, Amini N, Mehdizadeh A, Ghasemi Moghadam H, Mahmoodpoor A, Ahmadian Heris J, Yousefi M. SARS-CoV2 infection induce miR-155 expression and skewed Th17/Treg balance by changing SOCS1 level: A clinical study. Cytokine. 2023 Sep; 169:156248. doi: 10.1016/j.cyto.2023.156248. Epub 2023 Jun 8. PMID: 37307689; PMCID: PMC10247889.
  2. Mahmoodnia L, Asgari Savadjani S, Mostafavi L, Sotoudehnia Korani S, Mohammad Alizadeh F, Chenarani Moghadam MS, Jahantigh HR, Neshat S, Shirbacheh A, Baharani J, Masomi R, Golestani Hotkani Z. IgA vasculitis nephritis (Schönlein-Henoch purpura with nephritis) following COVID-19 vaccination. J Nephropathol. 2023; 12 (2):e21447. DOI: 10.34172/jnp.2023.21447.
  3. Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Tami S. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. (2020) 69:422–6. 10.15585/mmwr.mm6914e4.
  4. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. (2020) 323:1239–42. 10.1001/jama.2020.2648.
  5. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID‐19 among Children in China. Pediatrics. 2020; 145(6):e202007.
  6. Pathak EB, Salemi JL, Sobers N, Menard J, Hambleton IR. COVID‐19 in children in the United States: intensive care admissions, estimated total infected, and projected numbers of severe pediatric cases in 2020. J Public Health Manage Pract: JPHMP. 2020; 26(4):325‐333.
  7. Howard-Jones AR, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, Kuek S, McMullan BJ, Tosif S, Wurzel D, Bowen AC, Danchin M, Koirala A, Sharma K, Yeoh DK, Britton PN. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022 Jan; 58(1):46-53. doi: 10.1111/jpc.15811. Epub 2021 Oct 25. PMID: 34694037; PMCID: PMC8662268.
  8. Oualha M, Bendavid M, Berteloot L, Corsia A, Lesage F, Vedrenne M, Salvador E, Grimaud M, Chareyre J, Marcellus Cd, Dupic L, Saint Blanquat Ld, Heilbronner C, Drummond D, Castelle M, Berthaud R, Angoulvant F, Toubiana J, Pinhas Y, Frange P, Chéron G, Fourgeaud J, Moulin F, Renolleau S. “Severe and fatal forms of COVID-19 in children,” Archives de Pediatrie, vol. 27, no. 5, pp. 235–238, 2020.
  9. Ong JSM, Tosoni A, Kim Y, Kissoon N, Murthy S. “Coronavirus disease 2019 in critically ill children: a narrative review of the literature,” Pediatric Critical Care Medicine, vol. 21, no. 7, pp. 662–666, 2020.
  10. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. “Epidemiology of COVID-19 among children in China,” Pediatrics, vol. 145, no. 6, 2020.
  11. Tsabouri S, Makis A, Kosmeri C, Siomou E. “Risk factors for severity in children with coronavirus disease 2019,” Pediatric Clinics of North America, vol. 68, no. 1, pp. 321–338, 2021.
  12. Parcha V, Booker KS, Kalra R Kuranz S, Berra L, Arora G, Arora P. A retrospective cohort study of 12,306 pediatric COVID‐19 patients in the United States. Sci. Rep. 2021; 11: 10231.
  13. Götzinger F, Santiago‐García B, Noguera‐Julián A, Lanaspa M, Lancella L, Calò Carducci FI, Gabrovska N, Velizarova S, Prunk P, Osterman V, Krivec U, Vecchio AL, Shingadia D, Soriano-Arandes A, Melendo S, Lanari M, Pierantoni L, Wagner N, L'Huillier AG, Heininger U, Ritz N, Bandi S, Krajcar N, Roglić S, Santos M, Christiaens C, Creuven M, Buonsenso D, Welch SB, Bogyi M, Brinkmann F, Tebruegge M; ptbnet COVID-19 Study Group. COVID‐19 in children and adolescents in Europe: A multinational, multicentre cohort study. Lancet Child Adolesc Health 2020; 4: 653–61.
  14. Foust AM, Phillips GS, Chu WC, Daltro P, Das KM, Garcia-Peña P, Kilborn T, Winant AJ, Lee EY. International expert consensus statement on chest imaging in pediatric COVID?19 patient management: imaging findings, imaging study reporting and imaging study recommendations. Radiol Cardiothorac Imaging. 2020; 2:e200214. (Epub ahead of print). DOI: https://doi.org/10.1148/ryct.2020200214.Crossref Google Scholar.
  15. Li W, Cui H, Li K, Fang Y, Li S. Chest computed tomography in children with COVID-19 respiratory infection. Pediatr Radiol 50, 796–799 (2020). https://doi.org/10.1007/s00247-020-04656-7.
  16. Azadbakht J, Haghi-Aminjan H, Farhood B. Chest CT findings of COVID-19-infected patients, are there differences between pediatric and adult patients? A systematic review. Egypt J Radiol Nucl Med 51, 145 (2020). https://doi.org/10.1186/s43055-020-00261-8.
  17. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 among Children in China. Pediatrics 2020; 145.
  18. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, Zhang W, Wang Y, Bao S, Li Y, Wu C, Liu H, Liu D, Shao J, Peng X, Yang Y, Liu Z, Xiang Y, Zhang F, Silva RM, Pinkerton KE, Shen K, Xiao H, Xu S, Wong GWK; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 Infection in Children. N Engl J Med 2020; 382:1663.
  19. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA 2020; 323:1313.
  20. CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:422.
  21. Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J 2020; 39:355.
  22. de Lusignan S, Dorward J, Correa A, Jones N, Akinyemi O, Amirthalingam G, Andrews N, Byford R, Dabrera G, Elliot A, Ellis J, Ferreira F, Bernal JL, Okusi C, Ramsay M, Sherlock J, Smith G, Williams J, Howsam G, Zambon M, Joy M, Hobbs FDR. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study. Lancet Infect Dis 2020; 20:1034.
  23. Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72? 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323:1239.
  24. Statistica. Distribution of Coronavirus cases in Italy as of August 25, 2020, by age group. Available at: https://www.statista.com/statistics/1103023/coronavirus-cases-distribution-by-age-group-italy/ (Accessed on September 04, 2020).
  25. Age distribution of coronavirus (COVID-19) cases in South Korea as of August 21, 2020. https://www.statista.com/statistics/1102730/south-korea-coronavirus-cases-by-age/ (Accessed on August 25, 2020).
  26. Posfay-Barbe KM, Wagner N, Gauthey M, Moussaoui D, Loevy N, Diana A, L'Huillier AG. COVID-19 in Children and the Dynamics of Infection in Families. Pediatrics 2020; 146.
  27. Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, Holden KA, ead JM, Dondelinger F, Carson G, Merson L, Lee J, Plotkin D, Sigfrid L, Halpin S, Jackson C, Gamble C, Horby PW, Nguyen-Van-Tam JS, Ho A, Russell CD, Dunning J, Openshaw PJ, Baillie JK, Semple MG; ISARIC4C investigators. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020; 369:m1985.
  28. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, Burai Felix SE, Tie Y, Fullerton KE. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:759.
  29. Singhal S, Kumar P, Singh S, Saha S, Dey AB. Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis. BMC Geriatr. 2021 May 19; 21(1):321. doi: 10.1186/s12877-021-02261-3. PMID: 34011269; PMCID: PMC8133052.
  30. Qiu H, Wu J, Hong L Luo Y, Song O, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020; 20(6):689–696. https://doi.org/10.1016/S1473-3099(20)30198-5.
  31. Dong Y, Mo X, Hu Y Qi X, Jiang F, Jiang Z, Tong S. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020b; 145(6):e20200702. https://doi.org/10.1542/peds.2020-0702.
  32. Mustafa NM, Selim LA. Characterisation of COVID-19 pandemic in paediatric age group: a systematic review and meta-analysis. J Clin Virol. 2020; 128:104395. https://doi.org/10.1016/j.jcv.2020.104395.
  33. Leung C. Clinical characteristics of COVID-19 in children: are they similar to those of SARS? Pediatr Pulmonol. 2020. https://doi.org/10.1002/ppul.24855.
  34. Gonzalez Jimenez D, Rodríguez-Belvís MV, Ferrer Gonzalez P, Domínguez Ortega G, Segarra O, Medina Benitez E, Tirado DG, Romero RG, López RV, Crehuá-Gaudiza E, Queralt M, Palomino Pérez LM, Diaz Martin JJ. COVID-19 gastrointestinal manifestations are independent predictors of PICU admission in hospitalized pediatric patients. Pediatr Infect Dis J. (2020) 39:e459–62. 10.1097/INF.0000000000002935.
  35. Oba J, Carvalho WB, Silva CA, Delgado AF. Gastrointestinal manifestations and nutritional therapy during COVID-19 pandemic: a practical guide for pediatricians. Einstein (Sao Paulo). (2020) 18:eRW5774. 10.31744/einstein_journal/2020rw5774.
  36. Bitar RR, Alattas B, Azaz A, Rawat D, Miqdady M. Gastrointestinal manifestations in children with COVID-19 infection: Retrospective tertiary center experience. Front Pediatr. 2022 Dec 21; 10:925520. doi: 10.3389/fped.2022.925520. PMID: 36619504; PMCID: PMC9811669.
  37. Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcome of SARS-CoV-2 infection in children: a systematic review and meta-analysis. Indian pediatrics. 2020; 57(9):820-6.
  38. Patel NA. Pediatric COVID-19: Systematic review of the literature. American journal of otolaryngology. 2020; 41(5):102573.
  39. Henry BM, Lippi G, Plebani M. Laboratory abnormalities in children with novel coronavirus disease 2019. Clinical Chemistry and Laboratory Medicine (CCLM). 2020; 58(7):1135-8.
  40. Du W, Yu J, Wang H, Zhang X, Zhang S, Li Q, Zhang Z. Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China. Infection. 2020; 48(3):445-52.
  41. Du W, Yu J, Wang H, Zhang X, Zhang S, Li Q, Zhang Z. Clinical characteristics of COVID-19 in children compared with adults in Shandong Province, China. Infection. 2020; 48(3):445-52
  42. Kanne JP. Chest CT findings in 2019 novel coronavirus (2019‐nCoV) infections from Wuhan, China: key points for the radiologist. Radiology. 2020.
  43. Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, Ling Y, Jiang Y, Shi Y. Emerging coronavirus 2019‐nCoV pneumonia. Radiology. 2020.
  44. Virkki R, Juven T, Rikalainen H, Svedstrom E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax. 2002; 57:438‐441.
  45. Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020 May; 55(5):1169-1174. doi: 10.1002/ppul.24718. Epub 2020 Mar 5. PMID: 32134205; PMCID: PMC7168071.
Journal of Pediatric Perspectives
Volume 11, Issue 10
October 2023
Pages 18327-18339

Files

Share

How to cite

Statistics