key: cord-0792508-dn9nlcgs authors: Xia, Wei; Shao, Jianbo; Guo, Yu; Peng, Xuehua; Li, Zhen; Hu, Daoyu title: Clinical and CT features in pediatric patients with COVID‐19 infection: Different points from adults date: 2020-03-05 journal: Pediatr Pulmonol DOI: 10.1002/ppul.24718 sha: ac260f8010890afa10735bb4baf7fdc452664187 doc_id: 792508 cord_uid: dn9nlcgs PURPOSE: To discuss the different characteristics of clinical, laboratory, and chest computed tomography (CT) in pediatric patients from adults with 2019 novel coronavirus (COVID‐19) infection. METHODS: The clinical, laboratory, and chest CT features of 20 pediatric inpatients with COVID‐19 infection confirmed by pharyngeal swab COVID‐19 nucleic acid test were retrospectively analyzed during 23 January and 8 February 2020. The clinical and laboratory information was obtained from inpatient records. All the patients were undergone chest CT in our hospital. RESULTS: Thirteen pediatric patients (13/20, 65%) had an identified history of close contact with COVID‐19 diagnosed family members. Fever (12/20, 60%) and cough (13/20, 65%) were the most common symptoms. For laboratory findings, procalcitonin elevation (16/20, 80%) should be pay attention to, which is not common in adults. Coinfection (8/20, 40%) is common in pediatric patients. A total of 6 patients presented with unilateral pulmonary lesions (6/20, 30%), 10 with bilateral pulmonary lesions (10/20, 50%), and 4 cases showed no abnormality on chest CT (4/20, 20%). Consolidation with surrounding halo sign was observed in 10 patients (10/20, 50%), ground‐glass opacities were observed in 12 patients (12/20, 60%), fine mesh shadow was observed in 4 patients (4/20, 20%), and tiny nodules were observed in 3 patients (3/20, 15%). CONCLUSION: Procalcitonin elevation and consolidation with surrounding halo signs were common in pediatric patients which were different from adults. It is suggested that underlying coinfection may be more common in pediatrics, and the consolidation with surrounding halo sign which is considered as a typical sign in pediatric patients. wild spread to other 24 countries, such as Japan, Singapore, Thailand, North Korea, and so on. 3 In the early days of a COVID-19 infection outbreak, pediatric patients were rather rare, who were thought to be not susceptible to it. However, along with the emerging of familial aggregation, children suffered from COVID-19 infection were gradually appeared. Also, neonates who born to mothers with COVID-19 infection were in concern. As a pediatric group is usually susceptible to upper respiratory tract infection, because of their developing immune system, the delayed presence of pediatric patients is confusing. Otherwise, under the circumference of wildly spread of COVID-19 and low detection rate by pharyngeal swab COVID-19 nucleic acid test, how to distinguish it from other common respiratory tract infection pathogens in pediatric patients is still a problem. Whether it shares the same imaging pattern of adults is also an important issue. As the clinical and imaging features of pediatric patients with COVID-19 infection were limited, we would like to present a series of 20 cases who have been identified by the pharyngeal swab COVID-19 nucleic acid test. Twenty pediatric inpatients with COVID-19 infection confirmed by pharyngeal swab COVID-19 nucleic acid test from 23 January to 8 February in Wuhan Children's Hospital were included in this study. All the patients are in accordance to the "Diagnosis and Treatment Protocol for COVID-19 (Fifth Revised Edition)" distributed by the National Health Commission. 4 Clinical charts data including demography information, contact history, previous history, clinical symptoms, laboratory findings, and coinfection which defined as a concurrent infection of a patient with two or more pathogens simultaneously. The hospital stays were updated to 18 February 2020. The chest computed tomography (CTs) were obtained from all subjects, as the plain chest X-ray cannot exclude the existence of pulmonary lesions, especially for the patients without symptoms and mild cases. For all the patients, noncontrast chest CT studies were performed on SOMATOM Definiton AS 128 unit (Siemens medical system; Siemens, Germany) with the following parameters: 12 0 kV, 100 to 150 mA, 0.6-mm collimation, and 1:1 pitch. The scanning range covered from lung apex to diaphragm on axial plane taken under free breathing with the patients in the supine position. Thinsection CT images were reconstructed with 1.25-mm collimation with a standard algorithm and then sent to the picture archiving and communication system (PACS) for analyzing. CT images were evaluated using a lung window with a window level of −600 HU and window width of 1500 HU, and the soft-tissue window with a window level of 40 HU and window width of 300 HU. If necessary, 0.50 mL/kg body mass of 10% chloral hydrate was taken orally before the examination. All the images were stored in PACS and reviewed by two experienced pediatric radiologists. The CT features were evaluated as follows: (a) ground-glass opacities, (b) consolidations with surrounding halo sign, (c) nodules, (d) fine mesh shadow, (e) pleural effusion, (f) lymphadenopathy, (g) unilateral or bilateral, (h) subpleural or nonsubpleural, and (i) residual fiber strips. Pharyngeal swab samples of all the subjects in this group were collected, and the COVID-19 RNA was identified by a reverse transcription-polymerase chain reaction. The protocol for this retrospective study was approved by the Ethics Committee of Wuhan Children's Hospital and the written informed consent was waived for emerging infectious diseases. Most of the children did not have positive pulmonary signs, moist rales were found in three cases (3/20, 15%), retraction signs were found in one case (1/20, 5%), and cyanosis was found in one case (1/20, 5%). Laboratory findings were shown in Table 2 . Critical stage: In the case of further development of the lesion, the chest CT showed that the consolidation lesions were diffuse and involved both lungs, presenting as a "white lung" change, accompanied by air bronchogram sign. The lesion density was heterogeneous, accompanied by ground-glass opacities and pleural thickening ( Figure 1C ). Recovery stage: After treatment, a chest CT follow-up was obtained in six cases. Lesions were completely absorbed in two cases (2/20, 10%) (Figures 2A and 2D) , consolidations turned into groundglass opacities and gradually decreased in three cases (3/20, 15%) ( Figures 2B and 2E) , and residual fiber strip remained in three cases (3/20, 15%) ( Figures 2C and 2F ). All the patients had been treated in the isolation ward of Wuhan Children's Hospital. Eighteen patients were cured and discharged with an average stay of 12.9 days (8-20 days). Two asymptomatic neonates were still under observation because of positive results from the pharyngeal swab COVID-19 nucleic acid test, with negative CT findings. COVID-19 viral pneumonia is an acute infectious respiratory disease caused by a novel coronavirus. By the beginning of February 2020, nearly 30 000 cases had been confirmed nationwide, while the actual number would be larger. 5 The virus can be transmitted by an infected person or an asymptomatic carrier and is a highly contagious disease. Respiratory droplets are the main route of transmission, but can also be transmitted by contact and digestive tract. 6 The incubation period is about 1 to 14 days, and is supposed could be up to 24 days. Crowds are generally susceptible to COVID-19. Most of the cases are mild, but the elderly or those with underlying diseases are more likely to T A B L E 3 CT imaging findings in 20 patients with COVID-19 pneumonia in early stage PCT is a marker for bacterial infection which could be induced by bacteriotoxin but suppressed by interferon. 9 It is worth noting that the PCT was elevated in 80% cases in this study, no matter coinfection evidence existed or not, which is not common in adult patients. It may suggest that routine antibacterial treatment should be considered in pediatric patients, as the coinfection was common in our cases (40%). In most cases of this study, abnormal laboratory results may prompt clinicians to further screen the nucleic acid detection of Clinical features of patients infected with 2019 novel coronavirus in Wuhan A novel coronavirus from patients with pneumonia in China Novel coronavirus (2019-nCoV) early-stage importation risk to Europe General Office of the National Health Commission of China. Diagnosis and Treatment Protocol for 2019-nCoV Britons to be evacuated as scientists estimate 44 000 cases of 2019-nCOV in the city Pattern of early human-to-human transmission of Wuhan The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health-the latest 2019 novel coronavirus outbreak in Wuhan, China Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis Chest CT findings in 2019 novel coronavirus (2019-nCoV) infections from Wuhan, China: key points for the radiologist. Radiology Emerging coronavirus 2019-nCoV pneumonia Differentiation of bacterial and viral pneumonia in children Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults The authors declare that there are no conflict of interests. http://orcid.org/0000-0002-4224-3057Yu Guo http://orcid.org/0000-0002-2296-3276