Imaging characteristics of coronavirus disease 2019 (COVID-19) in pediatric cases: a systematic review and meta-analysis

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Abstract

Background

The confirmed coronavirus disease 2019 (COVID-19) cases, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have exceeded 21 million (with more than 775,000 fatalities), and the number of children with COVID-19 is also increasing. This study aimed to summarize the chest imaging characteristics of pediatric COVID-19 cases and provide a reference for the diagnosis and control of pediatric COVID-19.

Methods

The study protocol was registered in PROSPERO, number CRD42020177391. Studies related to pediatric COVID-19 imaging manifestations were accessed from PubMed, Web of Science, and the Cochrane library databases, without language limitations. The publication date was limited to April 1, 2020, and it was updated on May 1 and May 27, 2020. Data normalization was determined with the Freeman-Tukey double arcsine transformation. Summarized incidences with 95% confidence intervals of various imaging manifestations were assessed by random-effects models. Heterogeneity was assessed with meta-regression and subgroup analyses, robustness with sensitivity analyses; and publication biases with Egger’s test.

Results

Twenty-three with 517 cases were included in this study. The summarized incidence of chest computed tomography abnormalities in pediatric COVID-19 cases was 70%, which was lower than what has been seen in adults. The incidence of halo signs in pediatric COVID-19 cases was 26%, which is rarely seen in adult COVID-19 cases. The incidences of ground-glass opacities (GGOs), GGOs and consolidations, consolidations, reverse halo signs, crazy paving signs, pleural effusion, bronchopneumonia-like signs, air bronchograms, and increased lung markings were 40%, 25%, 10%, 2%, 4%, 1%, 15%, 12%, and 31%, respectively. Pericardial effusions were found in the computed tomography images of adult COVID-19 cases but were scarcely seen in the computed tomography images of pediatric COVID-19 cases. The incidences of bilateral lesions, unilateral lesions, and peripheral lesions were 35%, 22%, and 26%, respectively.

Conclusions

Chest computed tomography imaging of pediatric COVID-19 cases resulted in various abnormalities that were milder than those of adults. This study will hopefully provide a reference to help identify pediatric COVID-19 cases.

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Most cited references 38

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Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

Dawei Wang, Bo Hu, Fangfang Zhu … (2020)

In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.

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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

Zunyou Wu, Jennifer M. McGoogan (2020)

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Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding

Roujian Lu, Xiang Zhao, Juan Li … (2021)

Summary Background In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. Methods We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus. Findings The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues. Interpretation 2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. Funding National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.

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Author and article information

Journal

Journal ID (nlm-ta): Transl Pediatr

Journal ID (iso-abbrev): Transl Pediatr

Journal ID (publisher-id): TP

Title: Translational Pediatrics

Publisher: AME Publishing Company

ISSN (Print): 2224-4336

ISSN (Electronic): 2224-4344

Publication date (Print and electronic): January 2021

Publication date (Print): January 2021

Volume: 10

Issue: 1

Pages: 1-16

Affiliations

[1 ]Department of Clinical Epidemiology, Shengjing Hospital of China Medical University , Shenyang, China;

[2 ]Clinical Research Center, Shengjing Hospital of China Medical University , Shenyang, China;

[3 ]Department of Pathology, the First Hospital of China Medical University , Shenyang, China

Author notes

Contributions: (I) Conception and design: YH Zhao, QJ Wu; (II) Administrative support: YH Zhao, Q Chang; (III) Provision of study materials or patients: YH Zhao, Q Chang, QJ Wu; (IV) Collection and assembly of data: ST Zang, X Han, Q Cui; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Yu-Hong Zhao, MD, PhD. Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Shenyang 110004, China. Email: zhaoyuhong@ 123456sj-hospital.org .

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ORCID: 0000-0001-5047-0500.

Article

Publisher ID: tp-10-01-1

DOI: 10.21037/tp-20-281

PMC ID: 7882282

PubMed ID: 33633932

SO-VID: 8cc5ec50-585c-4078-8c8e-c84943695517

License:

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

History

Date received : 05 September 2020

Date accepted : 04 December 2020

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