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A single-center, retrospective study of COVID-19 features in children: a descriptive investigation
Huijing Ma1, Jiani Hu2, Jie Tian3
1Imaging Center, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, No.100 Hongkong Road, Wuhan, 430016, China.
Insights
COVID-19 in children presents unique laboratory and CT findings compared to adults. Chest CT effectively detects pneumonia but is less useful for assessing pediatric recovery, suggesting a need for child-specific discharge criteria.
Area of Science:
- Pediatric Infectious Diseases
- Radiology
- Pulmonology
Background:
- Limited research exists on COVID-19 in children, particularly regarding laboratory findings, CT characteristics, and recovery assessment.
- This study focuses on unique pediatric COVID-19 features at Wuhan Children's Hospital, a key outbreak location.
Purpose of the Study:
- To describe the laboratory findings, chest CT features, and clinical recovery patterns of pediatric COVID-19 patients.
- To evaluate the utility of CT scans in assessing recovery and informing discharge criteria for children with COVID-19.
Main Methods:
- Retrospective analysis of clinical, imaging, and laboratory data from 76 pediatric patients.
- Statistical analysis using Fisher exact test and Cox regression.
Main Results:
- Among 50 confirmed COVID-19 cases, 14% had initial negative PCR results. Common laboratory abnormalities included lymphopenia (16%) and elevated C-reactive protein (20%).
- Chest CT revealed abnormalities in 86% of patients, with common patterns like ground-glass opacity (67%) and subpleural lesions (95%). Lesions were often in lower lobes (65%), particularly posterior segments (78%).
- CT scans at discharge showed incomplete lesion absorption in 67% of patients, with 26% exhibiting unchanged or worsened lesions, questioning their utility for recovery assessment.
Conclusions:
- Pediatric COVID-19 exhibits distinct laboratory and CT findings compared to adults.
- Chest CT is valuable for diagnosing COVID-19 pneumonia in children but has limited utility in evaluating clinical recovery.
- Current Chinese discharge criteria, requiring significant lesion absorption on imaging, may not be suitable for pediatric COVID-19 patients, necessitating the development of pediatric-specific criteria.
Background:
Compared to adults, there are relatively few studies on COVID-19 infection in children, and even less focusing on the unique features of COVID-19 in children in terms of laboratory findings, locations of computerized tomography (CT) lesions, and the role of CT in evaluating clinical recovery. The objective of this study is to report the results from patients at Wuhan Children's Hospital, located within the initial center of the outbreak.
Methods:
Clinical, imaging, and laboratory data of 76 children were collected retrospectively and analyzed with the Fisher exact test and Cox regression statistical methods.
Results:
Among 50 children with a positive COVID-19 real-time reverse-transcriptase polymerase chain reaction (PCR), five had negative PCR results initially but showed positive results in subsequent tests. Eight (16%) patients had lymphopenia, seven (14%) with thrombocytopenia, four (8%) with lymphocytosis, two (4%) with thrombocytosis, ten (20%) with elevated C-reactive protein, four (8%) with hemoglobin above, and six (12%) with below standard reference values. Seven (14%) of the 50 had no radiologic evidence of disease on chest CT. For the 43 patients who had abnormal CT findings, in addition to previously reported patterns of ground-glass opacity (67%), local patchy shadowing (37%), local bilateral patchy shadowing (21%), and lesion location of lower lobes (65%), other CT features include that an overwhelming number of pediatric patients had lesions in the subpleural area (95%) and 22 of the 28 lower lobe lesions were in the posterior segment (78%). Lesions in most of the 15 patients (67%) who received chest CT at discharge were not completely absorbed, and 26% of these pediatric patients had CT lesions that were either unchanged or worse.
Conclusions:
There were a few differences between COVID-19 children and COVID-19 adults in terms of laboratory findings and CT characteristics. CT is a powerful tool to detect and characterize COVID-19 pneumonia but has little utility in evaluating clinical recovery for children. These results oppose current COVID-19 hospital discharge criteria in China, as one requirement is that pulmonary imaging must show significant lesion absorption prior to discharge. These differences between pediatric and adult cases of COVID-19 may necessitate pediatric-specific discharge criteria.
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