Comparison of pneumonia features in children caused by SARS-CoV-2 and other viral respiratory pathogens
Rut Del Valle1, Álvaro Ballesteros2, Cristina Calvo3
1Pediatrics Department, Pediatrics Research Group, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, Madrid, Spain.
Insights
Pneumonia in children caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) differs from other viral pneumonias. COVID-19 patients were older, with fewer symptoms but a higher need for respiratory support.
Area of Science:
- Pediatric infectious diseases
- Respiratory medicine
- Virology
Background:
- Pneumonia is a common complication of coronavirus disease 2019 (COVID-19) in hospitalized children.
- Understanding the specific characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated pneumonia in pediatric populations is crucial for effective management.
Purpose of the Study:
- To compare the clinical and radiological features of community-acquired pneumonia (CAP) caused by SARS-CoV-2 with CAP from other viral etiologies in hospitalized children.
- To identify differentiating factors and overlaps in presentation between SARS-CoV-2-associated CAP and other viral CAP in children.
Main Methods:
- A retrospective cohort study was conducted involving 80 hospitals in the Spanish Pediatric National Cohort.
- Included were 151 children with SARS-CoV-2-associated CAP and 138 with CAP due to other viral pathogens.
- Clinical data, radiological findings, and treatment requirements were compared between the groups.
Main Results:
- Children with SARS-CoV-2-associated CAP were older, presented with cough, fever, or dyspnea, and frequently had lymphopenia (43%).
- Radiological findings included condensation and infiltrates; 15% required pediatric intensive care unit (PICU) admission.
- Compared to other viral CAP, SARS-CoV-2 cases showed lower C-reactive protein (CRP) levels, less wheezing, but a greater need for mechanical ventilation (MV).
Conclusions:
- SARS-CoV-2-associated CAP in children exhibits distinct features compared to other viral CAP, including older age, less wheezing, and lower CRP levels.
- While some clinical presentations overlap, making etiological differentiation challenging, COVID-19 pneumonia in children generally has a good prognosis.
- Increased need for respiratory support, such as continuous positive airway pressure (CPAP) or MV, was noted in SARS-CoV-2 cases.
Background:
Pneumonia is a frequent manifestation of coronavirus disease 2019 (COVID-19) in hospitalized children.
Methods:
The study involved 80 hospitals in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spanish Pediatric National Cohort. Participants were children <18 years, hospitalized with SARS-CoV-2 community-acquired pneumonia (CAP). We compared the clinical and radiological characteristics of SARS-CoV-2-associated CAP with CAP due to other viral etiologies from ValsDance (retrospective) cohort.
Results:
In total, 151 children with SARS-CoV-2-associated CAP and 138 with other viral CAP were included. Main clinical features of SARS-CoV-2-associated CAP were cough, fever, or dyspnea. Lymphopenia was found in 43% patients and 15% required admission to the pediatric intensive care unit (PICU). Chest X-ray revealed condensation (42%) and other infiltrates (58%). Compared with CAP from other viral pathogens, COVID-19 patients were older, with lower C-reactive protein (CRP) levels, less wheezing, and greater need of mechanical ventilation (MV). There were no differences in the use of continuous positive airway pressure (CPAP) or HVF, or PICU admission between groups.
Conclusion:
SARS-CoV-2-associated CAP in children presents differently to other virus-associated CAP: children are older and rarely have wheezing or high CRP levels; they need less oxygen but more CPAP or MV. However, several features overlap and differentiating the etiology may be difficult. The overall prognosis is good.
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