A total of 64 pediatric patients were included 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 15 to March 15, 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. Finally, 284 viral pneumonia cases with confirmed virus infection were included in the viral pneumonia cohort. The flow chart of participants’ recruitment is shown in Figure 2.
The epidemiological and baseline characteristics of all 348 participants are 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 differences were found between two cohorts, while the ages of children in the COVID-19 cohort were older (median 6.3 vs 3.2 years) than those in the viral pneumonia cohort. Two of 64 children in the COVID-19 cohort and 19 of 284 children in the viral pneumonia cohort had underlying chronic diseases. No significant differences were found in baseline characteristics between the two cohorts (P=0.279). Contact with confirmed COVID-infected family members (53/64, 82.8%) was the main exposure mode of COVID-19 children. Household exposure was higher in the COVID-19 cohort than in the viral pneumonia cohort (53/64 vs. 23/284, P<0.001). The prevalence of pneumonia in children with COVID-19 was 62.5% (40/64). The ratios of cases progressing 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. No significant differences were found in the ratios between the 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 value
|
Age
|
|
|
|
Median (range)
|
6.3yr (3 mon to 18 yr)
|
3.2yr (1 mon to 13 yr)
|
<0.001
|
<1 yr [no. (%)]
|
6/64 (9.4)
|
44/284 (15.5)
|
<0.001
|
1-5 yr [no. (%)]
|
23/64 (35.9)
|
220/284 (77.5)
|
6-10 yr [no. (%)]
|
20/64 (31.2)
|
19/284 (6.7)
|
11-18 yr [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 comparability between cohorts, COVID-19 cases with pneumonia were filtered out (COVID-19 pneumonia cohort) to compare with the viral pneumonia cohort in terms of clinical manifestations, spectrum of disease severity, and laboratory and imaging findings (Table 2). No significant differences were found in gastrointestinal symptoms (3/40 vs. 17/284) and dry cough (6/40 vs. 35/284) between the 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 than in the viral pneumonia cohort (all P<0.05). In addition, the duration of fever was shorter in the COVID-19 pneumonia cohort than in 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 tests and radiographic findings of COVID-19 pneumonia and other viral pneumonia
Measures
|
COVID-19 pneumonia (N=40)
|
Viral pneumonia (N=284)
|
P value
|
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 critical condition in the COVID-19 pneumonia cohort, with clinical manifestations including shortness of breath, neurological symptoms (drowsiness), three signs of depression, low blood oxygen saturation and increased PCT, CRP, D-dimer and CK-MB on admission, and had received intubation and invasive ventilator-assisted ventilation immediately after admission.
The proportion of children who developed severe conditions was lower in the COVID-19 pneumonia cohort than in the viral pneumonia cohort (1/40 vs. 38/284, P=0.048). However, no significant differences were found in pneumonia subgroups caused by respiratory syncytial virus (RSV) (1/40 vs. 19/133, P=0.041) and human adenovirus (1/40 vs. 7/25, P=0.002)as compared to those with 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 the other four common types of respiratory viruses is shown in 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 yr [no. (%)]
|
4/40 (10.0)
|
25/133 (18.8)
|
6/57 (10.5)
|
5/29 (17.2)
|
1/25 (4.0)
|
1-5 yr [no. (%)]
|
11/40 (27.5)
|
108/133 (81.2)
|
42/57 (73.7)
|
23/29 (79.3)
|
17/25 (68.0)
|
6-10 yr [no. (%)]
|
15/40 (37.5)
|
0/133 (0.0)
|
8/57 (14.0)
|
1/29 (3.4)
|
7/25 (28.0)
|
11-18 yr [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 (2.5-6.0)
|
3 (2-4)
|
5 (2.00-8.25)
|
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 (20.0)
|
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)
|
16/17 (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
|
11/40 (27.5)
|
5/12 (41.7)
|
4/9 (44.4)
|
0/2 (0.0)
|
5/7 (71.4)
|
Light shadow
|
6/40 (15.0)
|
1/12 (8.3)
|
2/9 (22.2)
|
1/2 (50.0)
|
0/7 (0.0)
|
Streak shadow
|
6/40 (15.0)
|
5/12 (41.7)
|
0/9 (0.0)
|
0/2 (0.0)
|
0/7 (0.0)
|
Hydrothorax
|
1/40 (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 cells and lymphocytes of COVID-19 pneumonia children were lower than those of other viral pneumonias (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, ALT, AST, CK, D-dimer, 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 (5/38 vs. 80/281), ESR (5/36 vs. 35/62), IL-6 (5/34 vs. 62/168) 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 significant differences were noted between the two cohorts in 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 the 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, for which no significant differences were found between COVID-19 pneumonia cohort and the viral pneumonia cohort (Table 2).
Treatments and outcomes of children with COVID-19 pneumonia and other viral pneumonia are listed in Table 4. The proportion of children who received lopinavir–ritonavir, ribavirin and interferon alfa was higher in the COVID-19 pneumonia cohort, but the proportion of children who received oseltamivir was lower, as compared to that in the viral pneumonia cohort (all P<0.05). The proportion of children with COVID-19 pneumonia who received 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 who needed oxygen support (P=0.024) were lower than that of those with other viral pneumonias.
Table 4. Treatments and outcome of COVID-19 pneumonia and other viral pneumonia
Measures
|
COVID-19 pneumonia (N=40)
|
Viral pneumonia (N=284)
|
P value
|
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.
Evaluation of the effects of three antiviral drugs through comparisons within the COVID-19 cohort showed that 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, and arbidol (5-8 mg/kg per day, median for 7 days) was used in 6 (9.4%) children with COVID-19. The duration of positive PCR results from pharyngeal swabs was not significantly different between 25 COVID-19 children receiving those antiviral drugs and that of 39 control cases not receiving those antiviral drugs [median (IQR), 10 (5-13.5) vs 9 (7-11) days, P=0.885]. Subgroup analysis performed to evaluate the effectiveness of certain antiviral drugs showed that no significant differences were found in the duration of positive PCR results from pharyngeal swabs in children with COVID-19 who used lopinavir–ritonavir, ribavirin, or arbidol with non-antiviral therapy controls, (all P<0.05, Figure 3).
Up until April 15, 2020, only one patient in the viral pneumonia cohort died and the other 347 patients were discharged, with no significant differences in the mortality rate between the two cohorts. As compared to the viral pneumonia cohorts, the proportion of cases that 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.