Chest radiograph in hospitalized children with COVID-19. A review of findings and indications.

PURPOSE: Many articles have been published regarding chest-imaging in COVID-19, but fewer studies have been published in pediatric populations. COVID-19 symptoms in children are generally milder and radiological tests have fewer positive findings. Indications for chest imaging in pediatric COVID-19 patients remain unclear. This study aims to describe the chest radiographs performed in COVID-19 patients in a pediatric hospital, to review the current chest X-ray indications and to develop an specific age-adjusted protocol for chest-imaging in children with COVID-19. METHODS: Retrospective study in hospitalized pediatric COVID-19 patients in Navarre, Spain. Between March and December 2020, 44 children were included (mean age 3.8-year-old, 50 % males). Demographic information, cause of admission, symptoms, and clinical evolution were described. Chest imaging technique performed, indications and findings were analyzed. A literature review was performed searching for current COVID-19 pediatric chest-imaging indications. RESULTS: Chest X-rays were performed in 35 patients (80 % of admissions) and most common indications were fever and respiratory symptoms. 53 % of the chest X-rays were considered "normal" and the classical bilateral diffuse interstitial pattern, described in adults, was only present in 22 %. All patients with pathological chest X-rays were symptomatic and reported fever (100 %) and fever tended to be longer (fever duration: 4.25 vs. 2.46 days p:0.048) in patients with pathological radiographs. We present a specific protocol for chest-imaging in pediatric COVID-19 cases. CONCLUSIONS: COVID-19 clinical manifestations and radiological findings are milder and less specific in children. Imaging should not be used as a screening tool or a routine complementary test in pediatric COVID-19 patients, not even in hospitalized cases.

Epidemiología de la infección SARS-CoV-2 en Navarra (España) / Epidemiology of SARS-CoV-2 infection in Navarre (Spain)

INTRODUCCIÓN: desde el inicio de la epidemia de COVID-19, se han publicado numerosos estudios, pero la información sobre el impacto de la infección por SARS-CoV-2 en población pediátrica es todavía limitada. La incidencia y características en población pediátrica siguen siendo inciertas, por lo que se necesitan más estudios para entender el COVID-19 pediátrico. MATERIAL Y MÉTODOS: estudio multicéntrico retrospectivo en el que se describen la incidencia y características clínicas de los niños con COVID-19 confirmada en Navarra (España) durante la primera ola epidémica (28 de febrero-31 de mayo de 2020). RESULTADOS: la incidencia acumulada de COVID-19 pediátrico en Navarra en tres meses fue de tres casos por 1000 niños. De los 309 casos confirmados, el 85,7% tenían contacto domiciliario positivo; el 32,1% fueron asintomáticos; los síntomas fueron variados y solo el 15,8% tenían presentación "típica" de fiebre y síntomas respiratorios; 49% recibió atención telefónica y solo 11,6% requirió estudio complementario. Trece pacientes ingresaron en hospital (4,2%), dos fueron casos moderados (un cuadro respiratorio que requirió oxigenoterapia y un cuadro convulsivo tratado con antiepilépticos) y uno grave con el síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2 que ingresó en la unidad de cuidados intensivos (UCIP). Evolución favorable en todos los casos sin secuelas. Un 45,2% no necesitó tratamiento, el resto tratados con analgésicos, inhaladores o antibióticos en caso de sobreinfección; 2,3% recibió hidroxicloroquina. CONCLUSIONES: los reportes epidemiológicos son importantes para mejorar el conocimiento sobre COVID-19 en niños, ayudando a los pediatras a reconocer y tratar mejor la enfermedad

INTRODUCTION: since the recent outbreak of coronavirus disease 2019 (COVID-19), extensive research has been performed, but information on the impact of SARS-CoV-2 infection in children is still limited. Incidence and clinical features in pediatric population remain unclear and studies are needed to further understand pediatric COVID-19. METHODS: in this multi-centre retrospective study, we describe the incidence and clinical characteristics of children with laboratory-confirmed COVID-19 in Navarre, Spain, during the first epidemic wave (February 28th - May 31st, 2020). RESULTS: pediatric COVID-19 cumulative incidence in Navarre during these 3 months was three per 1000 children. Of the 309 confirmed cases, 85.7% reported a positive household contact. We found that 32.1% of the patients were asymptomatic; symptoms were diverse and only 15.8% presented the "classic" fever and respiratory involvement. Of the total, 49% received telephone assistance, only 11.6% needed any complementary studies. Thirteen cases were admitted to the hospital (4.2%), from which only two were moderate cases (one respiratory that required oxygen and one epileptic) and one was a severe case presenting Multisystem Syndrome-Temporally associated with SARS-CoV-2 who needed intensive care. All patients had a favourable outcome without sequelae. Up to 45.2% did not require treatment, the rest received analgesics, inhaled medication or antibiotics in the case of coexisting bacterial infection; 2.3% received Hydroxychloroquine. CONCLUSIONS: epidemiological reports are important for improving the current knowledge of COVID-19 in children, helping pediatricians to better recognize and adequately treat this disease

SARS-CoV-2 infection in children requiring hospitalization: the experience of Navarra, Spain.

BACKGROUND: Coronavirus disease 2019 in children, or pediatric COVID-19, initially was described as an acute respiratory syndrome similar to the adult presentation but with less severe manifestations. METHODS: We describe the clinical characteristics, disease presentation, treatments and outcomes of all pediatric cases with COVID-19 admitted to the reference hospitals in Navarra, Spain during the first wave of the COVID-19 outbreak (February-May 2020). RESULTS: We found a low number of hospitalized cases in infants and children compared to adults with a hospitalization ratio of 1:180. Most of these hospitalized cases did not suffer from severe disease. Over 80% of infections reported household contacts, and the mother was the known-contact in 83% of these cases. 72% of hospitalized cases were previously healthy children. We describe how symptoms in pediatric cases are nonspecific and how COVID-19 can be presented with a wide range and variety of symptoms. Respiratory symptoms are not always present, and severe neurological and cardiac features can occur in previously healthy children. CONCLUSION: Epidemiological description and case reports will be key to a better recognition and to adequate treatment of pediatric patients with COVID-19.

Case Report: Benign Infantile Seizures Temporally Associated With COVID-19.

Background: Non-febrile illness seizures may present in previously healthy children as afebrile seizures associated with minor infections, such as mild gastroenteritis or respiratory tract infections, and are linked to a genetic predisposition. For the novel human coronavirus SARS-CoV-2, causing COVID-19, fever, cough, and gastrointestinal complaints are the most common symptoms in children, and a hyperimmune response may be present. No detailed temporally associated neurological complications have been documented in pediatric case series so far. Case description: We present the case of a 3-months-old girl with non-febrile repeated seizures in a COVID-19 family setting. The infant started with a mild fever and cough that lasted for 2 days. At day 6 from onset, the girl presented with two focal motor seizures with impaired consciousness and awareness. All investigations ruled out signs of meningo-encephalitis or active epilepsy, including normal electroencephalogram and cerebral magnetic resonance imaging. PCR from nasal and throat swabs was positive for SARS-CoV-2. Remarkably, blood ferritin and D-dimer levels were increased. At day 9, the infant presented another afebrile motor seizure, and levetiracetam dose was modified there was a favorable response within 3 months of the follow-up. Much interest has been raised with regards to host genetic determinants to disease severity and susceptibility to COVID-19. We thus performed whole exome sequencing, revealing a pathogenic frameshift mutation in the PRRT2 gene in both the mother and the infant. The mother had presented two late infantile febrile convulsions with normal outcome afterwards. Discussion: The hyperimmune response described in adult cases with COVID-19 can be seen in infants, even in the absence of respiratory symptoms. Moreover, COVID-19 may present in infants as non-febrile seizures, triggering early onset seizures in infants with a genetic predisposition. In this pandemic situation, precision medicine using massive sequencing can shed light on underlying molecular mechanisms driving the host response to COVID-19.