Highlights
- •Most of the episodes of acute lower-respiratory diseases were not related to SARS-CoV-2 infection.
- •Human-rhinovirus/enterovirus was the main detection during the pandemics.
- •SARS-CoV-2 was mainly found causing pneumonia in older children.
- •Bronchiolitis is possible, but SARS-CoV-2 was found causing a minority of these respiratory episodes.
- •Clinicians should be aware that SARS-CoV-2 infection could be the agent of lower-respiratory disease in paediatric patients with lymphopenia.
Summary
Objective
Methods
Results
Conclusions
Keywords
Introduction
- Pagani G.
- Conti F.
- Giacomelli A.
- et al.
- Katal S.
- Johnston S.K.
- Johnston J.H.
- et al.
Centro de Coordinación de Alertas y Emergencias Sanitarias (Ministerio de Sanidad). Información científica-técnica Enfermedad por coronavirus, COVID-19. 17 April 2020. [Available at: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/20200417_ITCoronavirus.pdf]
Total (n = 110) | SARS-CoV-2 (+) (n = 7) | SARS-CoV-2 (-) (n = 103) | p-value | |
---|---|---|---|---|
Age (year-old) * median (interquartile-range) Proportions between the groups (SARS-CoV-2(+) Vs SARS-CoV-2(-)) were compared using Pearson Chi-square o Fisher exact test. For continuous variables, the Mann-Whitney U test was performed. NNCC: nasal cannula; HFNO: high-flow nasal cannula; NIV: non-invasive ventilation; IMV: invasive mechanical ventilation; RSV: respiratory syncytial virus; HRV: human rhinovirus; EV: enterovirus. | 3.7 (0.9–8.4) | 16.8 (11.7–17.6) | 3.5 (0.9–7.5) | 0.004 |
Sex (males) | 55 (50%) | 4 (51%) | 51 (49%) | 1 |
Previously healthy (n) | 47 (43%) | 5 (71%) | 42 (41%) | 0.236 |
- Pulmonary conditions | 45 (41%) | 0 (0%) | 45 (44%) | 0.040 |
- Neurologic condition | 13 (12%) | 0 (0%) | 13 (13%) | 1 |
- Cardiovascular conditions | 4 (3.6%) | 1 (14%) | 3 (3%) | 0.234 |
- Haematologic malignancy | 2 (2%) | 1 (14%) | 1 (1%) | 0.124 |
Ethnicity (Caucasian) (n) | 64 (58%) | 5 (71%) | 59 (57%) | 0.657 |
Household confirmed contacts (n with > 1 confirmed contact) | 6 (5%) | 3 (43%) | 3 (2%) | 0.003 |
Symptoms at hospital admission (n): | ||||
- Cough | 105 (95%) | 6 (86%) | 99 (96%) | 0.285 |
- Wet cough | 61 (55%) | 2 (29%) | 59 (57%) | 0.238 |
- Fever | 80 (73%) | 7 (100%) | 73 (71%) | 0.186 |
- Gastrointestinal | 21 (19%) | 2 (29%) | 19 (18%) | 0.618 |
- Exanthem | 4 (4%) | 1 (14%) | 3 (3%) | 0.236 |
Time-lag from the onset of symptoms to hospital admission (days) * median (interquartile-range) Proportions between the groups (SARS-CoV-2(+) Vs SARS-CoV-2(-)) were compared using Pearson Chi-square o Fisher exact test. For continuous variables, the Mann-Whitney U test was performed. NNCC: nasal cannula; HFNO: high-flow nasal cannula; NIV: non-invasive ventilation; IMV: invasive mechanical ventilation; RSV: respiratory syncytial virus; HRV: human rhinovirus; EV: enterovirus. | 4 (2–7) | 7 (4–9) | 4 (2–7) | 0.052 |
HbSat at admission (%) * median (interquartile-range) Proportions between the groups (SARS-CoV-2(+) Vs SARS-CoV-2(-)) were compared using Pearson Chi-square o Fisher exact test. For continuous variables, the Mann-Whitney U test was performed. NNCC: nasal cannula; HFNO: high-flow nasal cannula; NIV: non-invasive ventilation; IMV: invasive mechanical ventilation; RSV: respiratory syncytial virus; HRV: human rhinovirus; EV: enterovirus. | 94 (92–96) | 94 (91–96) | 94 (92–96) | 0.909 |
Chest-X-ray at admission (n/total in whom the test was performed) | ||||
- Normal | 12 / 80 | 0 / 7 | 12 / 72 | 0.587 |
- Lobar pneumonia | 22 / 80 | 4 / 7 | 18 / 72 | 0.089 |
- Interstitial pneumonia | 39 / 80 | 2 / 7 | 37 / 72 | 0.431 |
- Pleural effusion | 6 / 80 | 1 / 7 | 5 / 72 | 0.442 |
Required respiratory support during admission (n): | ||||
- NNCC | 78 (71%) | 4 (57%) | 74 (72%) | 0.413 |
- HFNO | 14 (13%) | 0 (0%) | 14 (14%) | 0.592 |
- NIV | 7 (6%) | 1 (14%) | 6 (6%) | 0.380 |
- MV | 2 (2%) | 1 (14%) | 1 (1%) | 0.125 |
Length of fever (days) * median (interquartile-range) Proportions between the groups (SARS-CoV-2(+) Vs SARS-CoV-2(-)) were compared using Pearson Chi-square o Fisher exact test. For continuous variables, the Mann-Whitney U test was performed. NNCC: nasal cannula; HFNO: high-flow nasal cannula; NIV: non-invasive ventilation; IMV: invasive mechanical ventilation; RSV: respiratory syncytial virus; HRV: human rhinovirus; EV: enterovirus. | 4 (2–6) | 5 (3–11) | 4 (2–6) | 0.231 |
Length of oxygen requirements (days) * median (interquartile-range) Proportions between the groups (SARS-CoV-2(+) Vs SARS-CoV-2(-)) were compared using Pearson Chi-square o Fisher exact test. For continuous variables, the Mann-Whitney U test was performed. NNCC: nasal cannula; HFNO: high-flow nasal cannula; NIV: non-invasive ventilation; IMV: invasive mechanical ventilation; RSV: respiratory syncytial virus; HRV: human rhinovirus; EV: enterovirus. | 2 (1–4) | 4 (2–11) | 2 (1–4) | 0.097 |
PICU admission (n) | 11 (10%) | 2 (29%) | 9 (95) | 0.145 |
Need for inotropes (n) | 2 (2%) | 2 (29%) | 0 (0%) | 0.004 |
Other viral pathogens (n/total tested) | ||||
- RSV | 4 / 69 | 0 / 4 | 4 / 65 | 1 |
- Parainfluenza 1 | 1 / 32 | 1 / 4 | 0 / 28 | 0.125 |
- Parainfluenza 4 | 1 / 32 | 0 / 4 | 1 / 28 | 1 |
- Influenza A | 3 / 70 | 0 / 4 | 3 / 66 | 1 |
- Influenza B | 6 / 70 | 1 / 4 | 5 / 66 | 0.307 |
- Pre-pandemic coronaviruses | 1 / 32 | 0 / 4 | 1 / 28 | 1 |
- HRV/EV | 11 / 32 | 1 / 4 | 10 / 28 | 1 |
- Adenovirus | 2 / 32 | 0 / 4 | 2 / 28 | 1 |
- Metapneumovirus | 2 / 32 | 0 / 4 | 2 / 28 | 1 |
Clinical classification: | ||||
- Bronchiolitis | 29 (26%) | 1 (14%) | 28 (27%) | 0.520 |
- Bronchospasm/viral-induced wheezing | 33 (30%) | 0 (0%) | 33 (32%) | 0.134 |
- Viral pneumonia | 23 (21%) | 4 (57%) | 19 (18%) | 0.030 |
- Bacterial suspected pneumonia | 25 (23%) | 2 (29%) | 23 (22%) | 0.737 |
Analytical features at admission * :median (interquartile-range) Proportions between the groups (SARS-CoV-2(+) Vs SARS-CoV-2(-)) were compared using Pearson Chi-square o Fisher exact test. For continuous variables, the Mann-Whitney U test was performed. NNCC: nasal cannula; HFNO: high-flow nasal cannula; NIV: non-invasive ventilation; IMV: invasive mechanical ventilation; RSV: respiratory syncytial virus; HRV: human rhinovirus; EV: enterovirus. | ||||
- Haemoglobin (g/L) | 11.7 (10.9–12.7) | 12,4 (11.6–12.7) | 11,7 (10.8–12.9) | 0.417 |
- Leukocytes (cells x 109 /L) | 11.6 (6.9–18.2) | 5.5 (3.1–7.9) | 13.8 (7.2–19.4) | 0.001 |
- Lymphocytes (cells x 109 /L) | 2.4 (10.5–3.7) | 0.7 (0.4- 1.7) | 2.8 (1.1–4.1) | 0.007 |
- Neutrophiles (cells x 109 /L) | 7.0 (3.9–12.5) | 3.4 (1.5–5.8) | 7.5 (4.3–12.6) | 0.010 |
- Platelets (cells x 109 /L) | 338 (243–448) | 164 (127–262) | 355 (264–468) | 0.012 |
- C-reactive protein (mg/L) | 37 (13–81) | 48 (15–138) | 36 (12–82) | 0.662 |
- Procalcitonin (ng/mL) | 0.24 (0.08–0.95) | 0.06 (0.04–2.42) | 0.25 (0.09–1.01) | 0.098 |
- D-dimer (mg/L) | 0.95 (0.67–1.91) | 0.80 (0.49–4.22) | 1.09 (0.76–2.58) | 0.602 |
- Ferritin (µg/L) | 183 (88–449) | 350 (144–2580) | 99 (85–269) | 0.072 |
- Alanine transaminase (UI/L) | 13 (8–20) | 38 (17–89) | 13 (8–17) | 0.064 |
- Aspartate Aminotransferase (UI/L) | 24 (18–38) | 50 (21–57) | 24 (18–33) | 0.229 |
- Creatinine (mg/dL) | 0.51 (0.42–0.64) | 0.77 (0.67–0.93) | 0.48 (0.40–0.59) | 0.007 |
Hospital stay (days) * median (interquartile-range) Proportions between the groups (SARS-CoV-2(+) Vs SARS-CoV-2(-)) were compared using Pearson Chi-square o Fisher exact test. For continuous variables, the Mann-Whitney U test was performed. NNCC: nasal cannula; HFNO: high-flow nasal cannula; NIV: non-invasive ventilation; IMV: invasive mechanical ventilation; RSV: respiratory syncytial virus; HRV: human rhinovirus; EV: enterovirus. | 3 (2–5) | 11 (3–16) | 3 (2–5) | 0.024 |
- Katal S.
- Johnston S.K.
- Johnston J.H.
- et al.
- Mansbach J.M.
- Hasegawa K.
- Piedra P.A.
- et al.
Authorship
Funding
Ethics statement
Appendix. Supplementary materials
References
- Seroprevalence of SARS-CoV-2 significantly varies with age: preliminary results from a mass population screening.J Infect. 2020; (S0163-4453(20)30629-0)https://doi.org/10.1016/j.jinf.2020.09.021
- Viral pneumoniae in children: incidence and aetiology.Paediatr Respir Rev. 2004; 5: S197-S200https://doi.org/10.1016/s1526-0542(04)90037-1
- COVID-19 pandemic-a focused review for clinicians.Clin Microbiol Infect. 2020; 26: 842-847https://doi.org/10.1016/j.cmi.2020.04.023
- Imaging findings of SARS-CoV-2 infection in pediatrics: a systematic review of coronavirus disease 2019 (COVID-19) in 850 patients.Acad Radiol. 2020; (S1076-633230454-2)https://doi.org/10.1016/j.acra.2020.07.031
- Childhood COVID-19: a multicentre retrospective study.Clin Microbiol Infect. 2020; 26 (-4): 1260.e1https://doi.org/10.1016/j.cmi.2020.06.015
- Children with Covid-19 in pediatric emergency departments in Italy.N Engl J Med. 2020; 383: 187-190https://doi.org/10.1056/NEJMc2007617
Centro de Coordinación de Alertas y Emergencias Sanitarias (Ministerio de Sanidad). Información científica-técnica Enfermedad por coronavirus, COVID-19. 17 April 2020. [Available at: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/20200417_ITCoronavirus.pdf]
- Delayed acute bronchiolitis in infants hospitalized for COVID‐19.Pediatr Pulmonol. 2020; 55: 2211-2212https://doi.org/10.1002/ppul.24946
- Children hospitalized for coronavirus disease 2019 (COVID-19): a multicenter retrospective descriptive study.J Infect. 2020; 81: e74-e75https://doi.org/10.1016/j.jinf.2020.04.045
- Severe coronavirus bronchiolitis in the pre–COVID-19 Era.Pediatrics. 2020; 146e20201267https://doi.org/10.1542/peds.2020-1267