A single-center, retrospective study of COVID-19 features in children: a descriptive investigation

Abstract

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.

Keywords: COVID-19; Children; Clinical features; Computerized tomography; Coronavirus; Epidemiology; Pediatric; SARS-CoV-2.

Fig. 1

Flow chart for patient selection. Group A: 43 children with COVID-19 exposure history, positive CT, and positive PCR. Group B: seven children with COVID-19 exposure history, negative CT, and positive PCR. Group C: 26 children with COVID-19 exposure history, positive CT, and persistently negative PCR results

Fig. 2

Chest CT images depicting typical radiographic findings of COVID-19 pneumonia in children. 2A A unilateral chest CT from a 14-year-old boy with a cough. Ground-glass opacities under and parallel to the pleura (thick green arrow) in the inferior lobes of the left lungs. Ground-glass opacities distributed along the bronchovascular bundle (thin green arrow). 2B Bilateral ground-glass opacities with vascular thickening (arrowheads) in the subpleural area from a 13-year-old boy with a fever and a cough. 2C Local patchy shadowing (green arrow) image from a 6 month-old girl with a fever and a cough. 2D Lesions in the lower lobe of both lungs (green arrows) on chest CT obtained from a 15-year-old boy with a fever and a cough

Fig. 3

Chest CT findings at initial presentation and at discharge. 3A, 3B Chest CT scans obtained from a 1-year-old boy, presenting with fever and diarrhea, at arrival (3A) and after (3B) treatment. The first CT scan shows a large, patchy shadow in the left inferior lobe (green arrow). The second CT scan shows no lesions. The patient was hospitalized for 17 days prior to discharge. 3C, 3D Chest CT scans from a 4-month-old girl, who presented with a fever and a cough at arrival. The first CT scan reveals multiple ground-glass opacities under the pleura in the left superior lobe (green arrows). The second CT scan reveals that the range of original lesions was enlarged and extended to the center. The girl was hospitalized for 13 days and subsequently discharged. 3E, 3F Chest CT scans from a 14-year-old boy, presenting with rhinorrhea and a cough, at arrival and discharge. The first CT scan reveals a patchy shadow in the left middle lobe (arrowhead). There were no obvious changes in the areas of pulmonary consolidation on the second CT scan. The boy was hospitalized for 11 days and then discharged