We recruited 64 pediatric patients in the COVID-19 cohort, among which 33 patients were from Shenzhen, six patients were from Guangzhou, ten patients were from Wuhan, ten patients were from Huangshi, four were from Zunyi and one was from Hangzhou. From December 15th to March 15th, 2020, a total of 4335 cases of children with CAP have been diagnosed in the 20 hospitals, of which 626 cases were clinically diagnosed with viral pneumonia, and finally 284 viral pneumonia cases with confirmed virus were included in the viral pneumonia cohort. The flow chart of recruiting participants was shown in Fig. 2.
The epidemiological and baseline characteristics of over all 348 participants were shown in Table 1. Thirty-one children (48.4%) in the COVID-19 cohort and 161 cases (56.7%) in the viral pneumonia cohort were males, no difference was found among two cohorts, while the age of children in the COVID-19 cohort was older (median 6.3 vs 3.2 years). The epidemiological exposure histories of 64 children with COVID-19 were as follows: 53 cases were contacted with confirmed family members, three cases were contacted with other confirmed cases, seven cases had travel or residence in epidemic area of Hubei province, and one case had no clear history of exposure. House hold exposure was higher in the COVID-19 cohort as compared to the viral pneumonia cohort (53/64 vs 23/284, P༜0.001). Twelve children with COVID-19 were asymptomatic and 12 cases were with mild symptom but without pneumonia. The prevalence of pneumonia in children with COVID-19 was 62.5% (40/64). The ratios of cases developing from SARS-CoV-2 infection to pneumonia were 4/6 for children younger than 1 year old, 11/20 for 1–5 years old, 15/23 for 6–10 years old, and 10/15 for 11–18 years old in our study, respectively. No statistic difference was found among different age groups (P = 0.701).
Table 1
Epidemiological and baseline characteristics of over all 348 participants
General data | COVID-19 cohort (N = 64) | Viral pneumonia cohort (N = 284) | P |
Age | | | |
Median (range) | 6.3 year (3 mon to 18 year) | 3.2 year (1 mon to 13 year) | ༜0.001 |
< 1 year [no. (%)] | 6/64 (9.4) | 44/284 (15.5) | ༜0.001 |
1–5 year [no. (%)] | 23/64 (35.9) | 220/284 (77.5) |
6–10 year [no. (%)] | 20/64 (31.2) | 19/284 (6.7) |
11–18 year [no. (%)] | 15/64 (18.8) | 1/284 (0.4) |
Gender [male (%)] | 31/64 (48.4) | 161/284 (56.7) | 0.230 |
Underlying chronic disease [no. (%)] | 2/64 (3.1) | 19/284 (6.7) | 0.279 |
Chronic lung disease (repeated wheezing) | 1/64 (1.6) | 14/284 (4.9) | 0.231 |
Heart disease | 0/64 (0.0) | 1/284 (0.4) | 1.000 |
Others | 1/64 (1.6) | 5/284 (1.8) | 1.000 |
Exposure history [no. (%)]* | | | |
Contacted with confirmed family members | 53/64 (82.8) | 23/284 (8.1) | ༜0.001 |
Contacted with other confirmed cases | 3/64 (4.7) | 15/284 (5.3) |
Travel or residence in epidemic area* | 7/64 (10.9) | 0/284 (0.0) |
No clear exposure history | 1/64 (1.6) | 246/284 (86.6) |
*No epidemic area was defined for other respiratory viruses. |
To ensure the comparability between cohorts, COVID-19 with pneumonia were filtered out (the COVID-19 pneumonia cohort) to compared to the viral pneumonia cohort in terms of clinical manifestations, the spectrum of disease severity and laboratory findings at admission (Table 2). There were no differences of gastrointestinal symptoms (3/40 vs 17/284) and dry cough (6/40 vs 35/284) between two cohorts, but the proportions of cases with fever (༞37.3℃, 22/40 vs 221/284), high fever (༞39.0℃, 3/40 vs 167/284), cough with sputum production (0/40 vs 229/284), rhinitis (1/40 vs 130/284), and wheezing (0/40 vs 43/284) were lower in the COVID-19 pneumonia cohort as compared with the viral pneumonia cohort (all P༜0.05). In addition, the duration of fever was shorter in the COVID-19 pneumonia cohort as compared to the viral pneumonia cohort [median (IQR), 2 (1-3.25) vs 4 (2–5) days, P = 0.004)].
Table 2
Symptoms, signs, disease severity, laboratory and radiographic findings of COVID-19 pneumonia and other viral pneumonia
Measures | COVID-19 pneumonia (N = 40) | Viral pneumonia (N = 284) | P |
Symptoms and signs | | | |
Fever [no. (%)] | 22/40 (55.0) | 221/284 (77.8) | ༜0.001 |
Duration of fever [days, median (IQR)] | 2.00 (1.00-3.25) | 4.00 (2.00–5.00) | 0.004 |
Highest temperature [no. (%)] | | | |
< 37.3 °C | 18/40 (45.0) | 63/284 (22.2) | ༜0.001 |
37.4–37.9 °C | 8/40 (20.0) | 8/284 (2.8) |
38.0–38.9 °C | 11/40 (27.5) | 46/284 (16.2) |
> 39.0 °C | 3/40 (7.5) | 167/284 (58.8) |
Cough [no. (%)] | 6/40 (15.0) | 256/284 (90.1) | ༜0.001 |
Dry cough [no. (%)] | 6/40 (15.0) | 35/284 (12.3) | 0.634 |
Cough with Sputum production [no. (%)] | 0/40 (0.0) | 229/284 (80.6) | ༜0.001 |
Sore throat [no. (%)] | 1/40 (2.5) | 8/284 (2.8) | 0.909 |
Rhinitis [no. (%)] | 1/40 (2.5) | 130/284 (45.8) | ༜0.001 |
Short of breath [no. (%)] | 1/40 (2.5) | 22/284 (7.7) | 0.226 |
Wheezing [no. (%)] | 0/40 (0.0) | 43/284 (15.1) | 0.017 |
Gastrointestinal symptoms [no. (%)] | 1/40 (2.5) | 17/284 (6.0) ( | 0.709 |
Fatigue or muscle aches [no. (%)] | 1/40 (2.5) | 12/284 (4.2) | 0.603 |
Neurological symptoms [no. (%)] | 2/40 (5.0) | 15/284 (5.3) | 0.940 |
Three depression sign [no. (%)] | 1/40 (2.5) | 36/284 (12.7) | 0.058 |
Low SaO2 of inhospital (༜95%) [no. (%)] | 1/40 (2.5) | 9/284 (3.2) | 0.819 |
Severity [no. (%)] | | | |
Moderate | 39/40 (97.5) | 246/284 (86.6) | 0.048 |
Server or critical | 1/40 (2.5) | 38/284 (13.4) |
Blood routine | | | |
WBC count [× 109/L; median (IQR)] | 5.3 (4.4–7.8) | 8.6 (6.3–12.1) | ༜0.001 |
< 5.5 × 109/L [no. (%)] | 19/40 (47.5) | 38/284 (13.4) | ༜0.001 |
Neutrophil count [× 109/L; median (IQR)] | 2.5 (1.9–3.3) | 3.2 (2.1–4.6) | 0.029 |
< 1.1 × 109/L [no. (%)] | 3/40 (7.5) | 12/284 (4.2) | 0.356 |
Platelet count [× 109/L; median (IQR)] | 253.0 (217.3–320.0) | 275.0 (209.0-350.0) | 0.410 |
< 120 × 109/L [no. (%)] | 1/40 (2.5) | 9/284 (3.2) | 0.819 |
Inflammatory indicators [no. (%)] | | | |
PCT (> 0.25 ng/mL) | 2/34 (5.9) | 78/209 (37.3) | ༜0.001 |
CRP (> 10 mg/L) | 5/38 (13.2) | 80/281 (28.5) | 0.045 |
ESR (> 20 seconds) | 5/36 (13.9) | 35/62 (56.5) | ༜0.001 |
IL-6 (> 20.9 ng/L) | 5/34 (14.7) | 62/168 (36.9) | 0.012 |
Blood biochemistry | | | |
LDH [U/L; median (IQR)] | 210.0 (187.0-482.4) | 349.0 (228.5-418.5) () | ༜0.001 |
> 300 U/L [no. (%)] | 13/26 (36.1) | 131/265 (49.4) | ༜0.001 |
ALT [U/L; median (IQR)] | 12.5 (9.25-24.0) | 17 (13–23) | 0.035 |
> 45 U/L [no. (%)] | 4/40 (10.0) | 18/275 (6.5) | 0.432 |
AST [U/L; median (IQR)] | 33.9 (19.8–41.3) | 37.0 (31.0–45.0) | 0.011 |
> 50 U/L [no. (%)] | 4/40 (10.0) | 36/276 (13.0) | 0.588 |
CK [U/L; median (IQR)] | 70.0 (57.0-91.8) | 110.5 (79.3-155.8) | ༜0.001 |
> 185 U/L [no. (%)] | 2/35 (5.7) | 48/276 (17.4) | 0.076 |
CK-MB (> 27 U/L) [no. (%)] | 5/35 (14.3) | 165/270 (61.1) | ༜0.001 |
Humoral immunity [g/L; median (IQR) ] | | | |
Ig G | 8.1 (4.8–10.6) | 8.4 (6.9–10.2) | 0.712 |
Ig M | 1.3 (1.0-1.6) | 1.3 (0.9–1.6) | 0.995 |
Ig A | 1.0 (0.5–1.3) | 0.9 (0.6–1.4) | 0.218 |
Cellular immunity | | | |
CD4+/CD8 + T cell [median (IQR)] | 1.2 (0.9–1.6) | 1.2 (0.9–1.8) | 0.534 |
< 0.96 [no. (%)] | 6/17 (35.3) | 4/16 (25.0) | 0.479 |
0.96–2.05 [no. (%)] | 10/17 (58.8) | 9/16 (56.2) |
> 2.05 [no. (%)] | 1/17 (5.9) | 3/16 (18.8) |
Coagulation | | | |
Fibrinogen [g/L; median (IQR)] | 2.5 (2.4-3.0) | 3.1 (2.4–3.9) | 0.114 |
D-dimer [mg/L; median (IQR)] | 0.32 (0.25–0.42) | 0.53 (0.33-1.00) | 0.004 |
> 0.5 mg/L [no. (%)] | 7/35 (20.0) | 18/29 (62.1) | 0.001 |
Prothrombin time [seconds; median (IQR)] | 11.2 (10.2–13.3) | 11.2 (10.3–13.0) | 0.113 |
APTT [seconds; median (IQR)] | 34.7 (31.3–36.4) | 31.6 (25.8–35.7) | 0.111 |
Co-infection [no. (%)] | | | |
Virus | 3/40 (7.5) | 22/284 (7.7) | 0.956 |
MP | 9/40 (22.5) | 61/284 (21.5) | 0.883 |
Secondary-infection with bacteria [no. (%)] | 0/40 (0.0) | 52/284 (18.3) | 0.003 |
Affected area on radiography [no. (%)] — no. (%) | | | |
Left lung lobe | 5/40 (12.5) | 18/202 (8.9) | 0.071 |
Right lung lobe | 14/40 (35.0) | 41/202 (20.3) |
Bilateral lung lobe | 21/40 (52.5) | 143/202 (70.8) |
CT images of the chest [no. (%)] | | | |
GGO | 18/40 (45.0) | 0/38 (0.0) | ༜0.001 |
Tiny nodules | 6/40 (15.0) | 2/38 (5.3) | 0.297 |
Consolidation | 5/40 (12.5) | 21/38 (55.3) | ༜0.001 |
Consolidation combined with GGO | 4/40 (10.0) | 1/38 (2.6) | 0.387 |
Cable shadow | 11/40 (27.5) | 18/38 (47.4) | 0.070 |
Light shadow | 6/40 (15.0) | 5/38 (13.2) | 0.815 |
Streak shadow | 6/40 (15.0) | 6/38 (15.8) | 0.923 |
Hydrothorax | 1/40 (2.5) | 1/38 (2.6) | 1.000 |
WBC: White blood cell; PCT: Procalcitonin; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; IL-6: Interleukin-6; LDH: Lactate dehydrogenase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CK: Creatine kinase; CK-MB: Creatine kinase – MB; APTT: Activated partial thromboplastin time; MP: Mycoplasma pneumonia; GGO: Ground-glass opacity. |
The denominator of the proportional count in the table was the total number of evaluated cases, and the numerator is the number of cases positive on this index. |
Only one child was in a critical condition in the COVID-19 pneumonia cohort, of whom the clinical manifestations including short of breath, neurological symptom (drowsiness), three depressions sign, low blood oxygen saturation and increased PCT, CRP, D-dimer and CK-MB on admission, and was received intubation and invasive ventilator-assisted ventilation immediately after admission.
The proportion of children who developed severe condition was lower in the COVID-19 pneumonia cohort as compared to the viral pneumonia cohort (1/40 vs 38/284, P = 0.048) and subgroup pneumonia caused by respiratory syncytial virus (RSV) (1/40 vs19/133, P = 0.041) and human adenovirus (1/40 vs7/25, P = 0.002), while no statistic difference was found as compared to pneumonia caused by influenza A and B (1/40 vs 5/57, P = 0.182) or parainfluenza virus (1/40 vs 3/29, P = 0.168). The comparison between children with COVID-19 pneumonia and pneumonia caused by other four common types of respiratory viruses was shown in the Table 3 (online only).
Table 3
(online only). The comparison between pneumonia caused by SARS-COV-2 and other four common kinds of respiratory viruses
Measures | COVID-19 pneumonia (N = 40) | RSV pneumonia (N = 133) | Influenza A and B pneumonia (N = 57) | Parainfluenza virus pneumonia (N = 29) | Human adenovirus pneumonia (N = 25) |
Age | | | | | |
Median (yr) | 7.0 | 2.6 | 4.0 | 3.4 | 3.9 |
< 1 year [no. (%)] | 4/40 (10.0) | 25/133 (18.8) | 6/57 (10.5) | 5/29 (17.2) | 1/25 (4.0) |
1–5 year [no. (%)] | 11/40 (27.5) | 108/133 (81.2) | 42/57 (73.7) | 23/29 (79.3) | 17/25 (68.0) |
6–10 year [no. (%)] | 15/40 (37.5) | 0/133 (0.0) | 8/57 (14.0) | 1/29 (3.4) | 7/25 (28.0) |
11–18 year [no. (%)] | 10/40 (25.0) | 0/133 (0.0) | 1/57 (1.8) | 0/29 (0.0) | 0/25 (0.0) |
Gender [male (%)] | 18/40 (45.0) | 73/133 (54.9) | 30/57 (52.6) | 19/29 (65.5) | 16/25 (64.0) |
Underlying chronic disease [no. (%)] | 2/40 (5.0) | 10/133 (7.5) | 3/57 (5.3) | 1/29 (3.4) | 2/25 (8.0) |
Chronic lung disease (repeated wheezing) | 1/40 (1.6) | 5/133 (3.8) | 2/57 (3.5) | 1/29 (3.4) | 2/25 (8.0) |
Heart disease | 0/40 (0.0) | 1/133 (0.8) | 0/57 (0.0) | 0/29 (0.0) | 0/25 (0.0) |
Others | 1/40 (1.6) | 4/133 (3.0) | 1/57 (1.8) | 0/29 (0.0) | 0/25 (0.0) |
Symptoms and signs | | | | | |
Fever [no. (%)] | 22/40 (55.0) | 105/133 (78.9) | 49/57 (86.0) | 15/29 (51.7) | 22/25 (88.0) |
Duration of fever [days; median (IQR)] | 2 (1–3) | 3 (2–5) | 4 (2.5-6) | 3 (2–4) | 5 (2-8.25) |
Highest temperature [no. (%)] | | | | | |
< 37.3 °C | 18/40 (45.0) | 28/133 (21.0) | 8/57 (14.0) | 14/29 (48.3) | 3/25 (12.0) |
37.4–37.9 °C | 8/40 (20.0) | 7/133 (5.3) | 0/57 (0.0) | 0/29 (0.0) | 0/25 (0.0) |
38.0–38.9 °C | 11/40 (27.5) | 23/133 (17.3) | 12/57 (21.0) | 4/29 (13.8) | 0/25 (0.0) |
> 39.0 °C | 3/40 (7.5) | 75/133 (56.4) | 37/57 (64.9) | 11/29 (37.9) | 22/25 (88.0) |
Cough [no. (%)] | 6/40 (15.0) | 119/133 (89.5) | 53/57 (93.0) | 26/29 (89.6) | 19/25 (76.0) |
Dry cough [no. (%)] | 6/40 (15.0) | 12/133 (9.0) | 8/57 (14.0) | 1/29 (3.4) | 6/25 (24.0) |
Cough with Sputum production [no. (%)] | 0/40 (0.0) | 119/133 (89.5) | 45/57 (78.9) | 25/29 (86.2) | 13/25 (52.0) |
Sore throat [no. (%)] | 1/40 (2.5) | 2/133 (1.5) | 5/57 (8.8) | 0/29 (0.0) | 1/25 (4.0) |
Rhinitis [no. (%)] | 1/40 (2.5) | 65/133 (48.9) | 21/57 (36.8) | 18/29 (62.1) | 8/25 (32.0) |
Short of breath [no. (%)] | 1/40 (2.5) | 13/133 (9.8) | 3/57 (5.3) | 1/29 (3.4) | 2/25 (8.0) |
Wheezing [no. (%)] | 0/40 (0.0) | 28/133 (21.0) | 3/57 (5.3) | 2/29 (6.9) | 2/25 (8.0) |
Gastrointestinal symptoms [no. (%)] | 1/40 (2.5) | 7/133 (5.3) | 4/57 (7.0) | 2/29 (6.9) | 1/25 (4.0) |
Fatigue or muscle aches [no. (%)] | 1/40 (2.5) | 2/133 (1.5) | 10/57 (17.5) | 0/29 (0.0) | 0/25 (0.0) |
Neurological symptoms [no. (%)] | 2/40 (5.0) | 8/133 (6.0) | 6/57 (10.5) | 0/29 (0.0) | 0/25 (0.0) |
Three depressions sign [no. (%)] | 1/40 (2.5) | 20/133 (15.0) | 3/57 (5.3) | 3/29 (10.3) | 5/25 (20.0) |
Low SaO2 of inhospital ( < = 95%) [no. (%)] | 1/40 (2.5) | 4/133 (3.0) | 1/57 (1.8) | 1/29 (3.4) | 3/25 (12.0) |
Symptom duration [Days; median (IQR)] | 5 (0–8) | 8 (5–10) | 8 (5–10) | 9 (6–11) | 9 (4–12) |
Severity [no. (%)] | | | | | |
Moderate | 39/40 (97.5) | 114/133 (85.7) | 52/57 (91.2) | 26/29 (89.7) | 18/25 (72.0) |
Server or critical | 1/40 (2.5) | 19/133 (14.3) | 5/57 (8.8) | 3/29 (10.3) | 7/25 (28.0) |
Blood routine | | | | | |
WBC [× 109/L; median (IQR)] | 5.3 (4.4–7.8) | 8.6 (6.3–11.5) | 7.0 (5.7–9.8) | 7.7 (6.0-12.3) | 9.3 (6.9–14.3) |
< 5.5 × 109/L [no. (%)] | 19/40 (47.5) | 17/133 (12.8) | 14/57 (24.6) | 4/29 (13.8) | 2/25 (8.0) |
Neutrophil count [× 109/L; median (IQR)] | 2.5 (1.9–3.3) | 3.5 (2.2–4.8) | 2.3 (1.6–3.9) | 3.3 (2.6–4.9) | 3.0 (1.8–4.4) |
< 1.1 × 109/L [no. (%)] | 3/40 (7.5) | 0/133 (0.0) | 10/57 (17.5) | 0/29 (0.0) | 1/25 (4.0) |
Platelet count [× 109/L; median (IQR)] | 253.0 (217.2.0-320.0) | 285.0 (224.0-366.8) | 246.5 (187.3-298.5) | 262.0 (173.5–325.0) | 259.0 (193.0-313.8) |
< 120 × 109/L [no. (%)] | 1/40 (2.5) | 5/133 (3.8) | 2/57 (3.5) | 1/29 (3.4) | 1/25 (4.0) |
Infection biomarkers[no. (%)] | | | | | |
PCT (> 0.25 ng/mL) | 2/34 (5.9) | 28/88 (31.8) | 15/46 (32.6) | 7/19 (36.8) | 14/21 (66.7) |
CRP (> 10 mg/L) | 5/38 (13.2) | 25/131 (19.1) | 24/57 (42.1) | 4/28 (14.3) | 16/25 (64.0) |
ESR (> 20 seconds) | 5/36 (13.9) | 12/22 (54.5) | 10/18 (55.6) | 1/5 (20%) | 9/12 (7.5) |
IL-6 (> 20.9 ng/L) | 5/34 (14.7) | 25/80 (31.2) | 9/31 (29.0) | 6/17 (35.3) | 15/23 (65.2) |
Blood biochemistry | | | | | |
LDH [U/L; median (IQR)] | 210.0 (187.0-482.4) | 361.0 (303.5-418.5) | 363.5 (269.5-489.8) | 310.5 (288.0-361.8) | 342.0 (286.0-405.0) |
> 300 U/L [no. (%)] | 13/36 (36.1) | 97/125 (77.6) | 33/50 (66.0) | 18/28 (64.3) | 17/25 (68.0) |
ALT [U/L; median (IQR)] | 12.5 (9.25-24.0) | 18.0 (14.0–24.0) | 15.0 (12.3–20.8) | 16.5 (13.0–19.0) | 15.5 (9.3–19.3) |
> 45 U/L [no. (%)] | 4/40 (10.0) | 7/130 (5.4) | 3/56 (5.4) | 0/28 (0.0) | 5/24 (20.8) |
AST [U/L; median (IQR)] | 33.9 (19.8–41.3) | 38.5 (33.0–46.0) | 39.0 (28.5–46.8) | 36.5 (32.3–42.3) | 29.0 (23.0-37.5) |
> 50 U/L [no. (%)] | 4/40 (10.0) | 19/130 (14.6) | 8/56 (14.3) | 2/28 (7.1) | 1/25 (4.0) |
CK [U/L; median (IQR)] | 70.0 (57.0-91.8) | 113.0 (82.0-154.3) | 122.5 (88.0-179.0) | 110.5 (84.3–181.0) | 86.0 (49.0-154.5) |
> 185 U/L [no. (%)] | 2/35 (5.7) | 23/130 (17.7) | 12/56 (21.4) | 7/28 (25.0) | 4/25 (16.0) |
CK-MB (> 27 U/L) [no. (%)] | 5/35 (14.3) | 87/126 (69.0) | 21/56 (37.5) | 22/29 (75.9) | 15/24 (62.5) |
Humoral immunity [g/L; median (IQR) ] | | | | | |
Ig G | 8.1 (4.8–10.6) | 8.4 (6.4–10.2) | 8.4 (6.9–10.6) | 8.5 (6.5–10.6) | 8.9 (7.2–9.9) |
Ig M | 1.3 (1.0-1.6) | 1.3 (0.8–1.8) | 1.2 (1.1–1.5) | 1.3 (1.0-1.8) | 1.3 (0.9–1.5) |
Ig A | 1.0 (0.5–1.3) | 0.8 (0.5 − 0.1.3) | 0.9 (0.5–1.4) | 0.9 (0.6–1.4) | 1.0 (0.7–1.2) |
Co-infection [no. (%)] | | | | | |
Virus* | 3/40 (7.5) | | | | |
Mycoplasma pneumoniae | 9/40 (22.5) | 21/133 (15.8) | 16/57 (28.1) | 2/29 (6.9) | 9/25 (36.0) |
Secondary-infection with Bacteria [no. (%)] | 0/40 (0.0) | 25/133 (18.8) | 6/57 (10.5) | 6/29 (20.7) | 5/25 (20.0) |
Affected area on radiography [no. (%)] — no. (%) | | | | | |
Left lung lobe | 5/40 (12.5) | 2/81 (2.5) | 9/52 (17.3) | 2/23 (8.7) | 0/17 (0.0) |
Right lung lobe | 14/40 (35.0) | 16/81 (19.7) | 17/52 (32.7) | 3/23 (13.0) | 1/17 (5.9) |
Bilateral lung lobe | 21/40 (52.5) | 63/81 (77.8) | 26/52 (50.0) | 18/23 (78.3) | 16 (94.1) |
CT images of the chest [no. (%)] | | | | | |
GGO | 18/40 (45.0) | 0/12 (0.0) | 0/9 (0.0) | 0/2 (0.0) | 0/7 (0.0) |
Tiny nodules | 6/40 (15.0) | 0/12 (0.0) | 1/9 (11.1) | 0/2 (0.0) | 0/7 (0.0) |
Consolidation | 5/40 (12.5) | 2/12 (16.7) | 8/9 (88.9) | 1/2 (50.0) | 4/7 (57.1) |
Consolidation combined with GGO | 4/40 (10.0) | 1/12 (8.3) | 0/9 (0.0) | 0/2 (0.0) | 0/7 (0.0) |
Cable shadow | 11 (27.5) | 5/12 (41.7) | 4/9 (44.4) | 0/2 (0.0) | 5/7 (71.4) |
Light shadow | 6 (15.0) | 1/12 (8.3) | 2/9 (22.2) | 1/2 (50.0) | 0/7 (0.0) |
Streak shadow | 6 (15.0) | 5/12 (41.7) | 0/9 (0.0) | 0/2 (0.0) | 0/7 (0.0) |
Hydrothorax | 1 (2.5) | 0/12 (0.0) | 0/9 (0.0) | 0/2 (0.0) | 1/7 (14.3) |
WBC: White blood cell; PCT: Procalcitonin; CRP: C-reactive protein; ESR: Erythrocyte sedimentation rate; IL-6: Interleukin-6; LDH: Lactate dehydrogenase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CK: Creatine kinase; CK-MB: Creatine kinase – MB; RSV: respiratory syncytial virus; GGO: Ground-glass opacity. |
*The blank in the column of co-infection was because viral pneumonia caused by multiple viruses was not included in this comparison. Of the 284 cases of viral pneumonia, 133 were caused by RSV, 57 were caused by influenza A or influenza B, 29 were caused by parainfluenza virus, 25 were caused by human adenovirus, 22 were caused by multiple viruses, six were caused by human rhinovirus, six were caused by human Boca virus and six cases were caused by other viruses. The comparison was made between pneumonia caused by SARS-COV-2 and other four common kinds of respiratory viruses. |
On admission, counts of white blood cell and lymphocyte of COVID-19 pneumonia children were lower than those of other viral pneumonia (all P༜0.05). The proportion of cases with leucopenia (white blood cell counts༜5.5 × 10⁹/L) was higher in the COVID-19 cohort (19/40 vs 53/284). Levels of LDH (median 210.0 vs 349.0 U/L), ALT (median 12.5 vs 17.0 U/L), AST (median 33.9 vs 37.0 U/L), CK (median 70.0 vs 110.5 U/L), D-dimer (median 0.32 vs 0.53 mg/L), and the proportion of cases with elevated LDH (13/36 vs 131/265), CK-MB (5/35 vs 165/270), PCT (2/34 vs 78/209), CRP (5/38vs80/281), ESR (5/36 vs 35/62), IL-6 (5/34 vs62/168) and D-dimer (༞0.5 mg/L, 7/35 vs 18/29) were lower in the COVID-19 pneumonia cohort as compared to the viral pneumonia cohort (all P༜0.05). No statistic difference was noted between the two cohorts in terms of co-infection with other viruses (3/40 vs 22/284, P = 0.956) or co-infection with MP (9/40 vs 61/284, P = 0.883). However, secondary-infection with bacteria was less frequently detected in the COVID-19 pneumonia cohort (0/40 vs 52/284, P = 0.003).
Ground-glass opacity (GGO) was the most common radiographic presentation of children with COVID-19 pneumonia. The proportion of cases with GGO was significantly higher (18/40 vs 0/38, P༜0.001), while the proportion of cases with consolidation (5/40 vs 21/38, P༜0.001) was lower in COVID-19 pneumonia cohort as compared to the viral pneumonia cohort. Other radiographic presentations of COVID-19 pneumonia included tiny nodules, consolidation combined with GGO, cable shadow, light shadow, streak shadow and hydrothorax, had no statistical difference as compared to the viral pneumonia cohort (Table 2).
Treatments and outcome of children with COVID-19 pneumonia and other viral pneumonia were listed on Table 4. The proportion of received were higher in the COVID-19 pneumonia cohort, but the proportion of received oseltamivir was lower, as compared to the viral pneumonia cohort (all P༜0.05). The proportion of children with COVID-19 pneumonia received oseltamivir (1/40 vs 65/284, P = 0.003), antibiotics (8/40 vs 261/284, P༜0.001), corticosteroids (1/40 vs 50/284, P = 0.014), immunoglobulin (1/40 vs 39/284, P = 0.043) and needs for oxygen support (P = 0.024) were lower, but the proportion of cases received interferon alfa (2–4 ug/kg per day, 38/40 vs 15/284, P༜0.001), lopinavir–ritonavir (9/40 vs 0/284, P༜0.001) and ribavirin (4/40 vs 2/284, P༜0.001) was higher than that of other viral pneumonia.
Table 4
Treatments and outcome of COVID-19 pneumonia and other viral pneumonia
Measures | COVID-19 pneumonia (N = 40) | Viral pneumonia (N = 284) | P |
Antiviral therapy [Yes, no. (%)] | 14/40 (35.0) | 71/284 (25.0) | 0.178 |
Lopinavir–ritonavir | 9/40 (22.5) | 0/284 (0.0) | ༜0.001 |
Ribavirin | 4/40 (10.0) | 2/284 (0.7) | ༜0.001 |
Arbidol | 1/40 (2.5) | 0/284 (0.0) | 0.252 |
Oseltamivir | 1/40 (2.5) | 65/284 (22.9) | 0.003 |
Paramive | 0/40 (0.0) | 4/284 (1.4) | 1.000 |
Others | 0/40 (0.0) | 3/284 (1.1) | 1.000 |
Interferon alfa [no. (%)] | 38/40 (95.0) | 15/284 (5.3) | ༜0.001 |
Antibiotic therapy [Yes, no. (%)] | 8/40 (20.0) | 261/284 (91.9) | ༜0.001 |
None | 32/40 (80.0) | 23/284 (8.1) | ༜0.001 |
One kind | 4/40 (10.0) | 151/284 (53.2) |
Two kinds | 3/40 (4.7) | 99/284 (34.9) |
Three or more kinds | 1/40 (2.5) | 11/284 (3.9) |
Corticosteroids [no. (%)] | 1/40 (2.5) | 50/284 (17.6) | 0.014 |
Immunoglobulin [no. (%)] | 1/40 (2.5) | 39/284 (13.7) | 0.043 |
Blood transfusion [no. (%)] | 1/40 (2.5) | 4/284 (1.4) | 1.000 |
Oxygen support [no. (%)] | | | |
None | 39/40 (97.5) | 238/284 (83.8) | 0.024 |
Nasal catheter, mask or other | 0/40 (0.0) | 22/284 (7.7) |
Non-invasive ventilation | 0/40 (0.0) | 8/284 (2.8) |
Invasive mechanical ventilation | 1/40 (2.5) | 16/284 (5.6) |
Mortality [no. (%)] | 0/40 (0.0) | 1/284 (0.4) | 1.000 |
Required ICU support [no. (%)] | 1/40 (2.5) | 32/284 (11.3) | 0.047 |
Symptomatic duration [Days; median (IQR)] | 5 (0–8) | 8 (4–12) | ༜0.001 |
Hospital stay [Days; median (IQR)]* | 15 (10–23) | 6 (5–8) | ༜0.001 |
*The duration of hospital stay was not used as a prognostic indicator in this study, because many children with COVID-19 were observed in the hospital after the symptoms completely disappeared for the possibility of infectivity. |
We evaluated the effects of three antiviral drugs by making comparison within COVID-19 cohort. Lopinavir–ritonavir (lopinavir 6–10 mg/kg and ritonavir 1.5–2.5 mg/kg per day, median for 9 days) was used in 12 (18.8%) cases, ribavirin (10–15 mg/kg per day, median for 8 days) was used in 8 (12.5%) cases, arbidol (5–8 mg/kg per day, median for 7 days) was used in 6 (9.4%) of children with COVID-19, respectively. The duration of positive PCR results from pharyngeal swabs was not significant different between 25 COVID-19 children used those antiviral drugs and that of 39 control cases without those antiviral drugs [median (IQR), 10 (5-13.5) vs 9 (7–11) days, P = 0.885]. Subgroup analysis was performed to evaluate the effectiveness of certain antiviral drug. Comparing children with COVID-19 who used lopinavir–ritonavir, ribavirin, or arbidol with non-antiviral therapy controls, no statistic difference was found in the duration of positive PCR results from pharyngeal swabs (all P < 0.05, Fig. 3).
Up until April 15, 2020, one patient in the viral pneumonia cohort was died and the other 347 patients were discharged, no statistical difference of mortality rate between two cohorts. As compared to the viral pneumonia cohorts, the proportion of cases required intensive care was lower (1/40 vs 32/284, P = 0.047) and the symptomatic duration was shorter [median (IQR), 5 (0–8) vs 8 (4–12) days, P༜0.001] in the COVID-19 pneumonia cohort.