Computed tomography features of COVID-19 in children: A systematic review and meta-analysis

Exploring the prevalence and chest CT predictors of Long COVID in children: a comprehensive study from Shanghai and Linyi

Introduction

COVID-19 constitutes a pandemic of significant detriment to human health. This study aimed to investigate the prevalence of Long COVID following SARS-CoV-2 infection, analyze the potential predictors of chest CT for the development of Long COVID in children.

Methods

A cohort of children who visited the respiratory outpatient clinics at Shanghai Children's Medical Center or Linyi Maternal and Child Health Care Hospital from December 2022 to February 2023 and underwent chest CT scans within 1 week was followed up. Data on clinical characteristics, Long COVID symptoms, and chest CT manifestations were collected and analyzed. Multivariate logistic regression models and decision tree models were employed to identify factors associated with Long COVID.

Results

A total of 416 children were included in the study. Among 277 children who completed the follow-up, the prevalence of Long COVID was 23.1%. Chronic cough, fatigue, brain fog, and post-exertional malaise were the most commonly reported symptoms. In the decision tree model for Long COVID, the presence of increased vascular markings, the absence of normal CT findings, and younger age were identified as predictors associated with a higher likelihood of developing Long COVID in children. However, no significant correlation was found between chest CT abnormality and the occurrence of Long COVID.

Discussion

Long COVID in children presents a complex challenge with a significant prevalence rate of 23.1%. Chest CT scans of children post-SARS-CoV-2 infection, identified as abnormal with increased vascular markings, indicate a higher risk of developing Long COVID.

Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review

BACKGROUND

Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus.

METHODS

In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures.

RESULTS

We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression.

CONCLUSIONS

The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.

Respiratory Syncytial Virus: A Systematic Review and Meta-Analysis of Tomographic Findings (2000-2022)

Human respiratory syncytial virus (RSV) is a main cause of medical referrals and hospitalizations in all infants, particularly among newborns. Nevertheless, relatively limited evidence on chest tomography (CT) findings has been collected. According to the PRISMA statement, Pubmed, Embase, and medRxiv were searched for eligible observational studies published up to 31 December 2022. Cases were categorized in children and adolescents (age < 18 years), adults and elderly (age ≥ 18 years), and immunocompromised patients, and then pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 10 studies (217 RSV cases) were retrieved (children, 37.3%; immunocompromised, 41.0%; adults, 21.7%). The most common features were signs of organizing pneumonia (33.65%, 95% confidence interval [95% CI] 22.39-47.27), followed by septal thickening (33.19%, 95% CI 21.76-47.03), ground glass opacities (GGOs; 28.03%, 95% CI 14.69-46.82), and tree-in-bud (TIB, 27.44%, 95% CI 15.04-44.68). Interestingly, up to 16.23% (95% CI 8.17-29.69) showed normal findings, while the large majority (76.06%, 95% CI 64.81-84.56) were characterized by bilateral involvement. Studies were highly heterogeneous without substantial reporting bias. Assuming children and adolescents as reference groups, healthy adults were characterized by a higher risk ratio [RR] for septal thickening (RR 3.878, 95% CI 1.253-12.000), nodular lesions (RR 20.197, 95% CI 1.286-317.082), and GGOs (RR 2.121, 95% CI 1.121-4.013). RSV cases are rarely assessed in terms of CT characteristics. Our study identified some specificities, suggesting that RSV infections evolve heterogeneous CT features in children/adolescents and adults, but the paucity of studies recommends a cautious appraisal.

COVID-19 and pediatric pulmonology: Feedback from an expert center after the first year of the pandemic

The coronavirus disease 2019 (COVID-19) outbreak has evolved with different waves corresponding to subsequent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mutations. While the most severe cases have been observed in the elderly and in individuals with underlying comorbidities, severe pediatric and young adult cases have been observed, as well as post-infectious inflammatory syndromes and persistent symptoms leading to long-COVID. This manuscript describes the experience of a pediatric respiratory unit during the first year of the pandemic and reviews the corresponding literature with a special emphasis on children and young people with underlying conditions, such as immunosuppression, sickle cell disease, and cystic fibrosis.

Lung ultrasound in children and adolescents with long-term effects of COVID-19: Initial results

Introduction

Chronic health effects following acute COVID-19 are increasingly observed as the pandemic continues and are grouped under long COVID. Although the acute course of the COVID disease is often milder, long COVID also affects children and adolescents. As the symptoms present in Long-COVID often seem to be non-specific and not limited to organ systems, clarification of the causes and the creation of a meaningful, efficient and targeted diagnostic algorithm is urgently needed.

Methods

Therefore, in this prospective observational study, we examined 30 children with long COVID using lung ultrasound and compared the results with those of 15 lung-healthy children.

Results

In our study, no significant difference was found between the two groups in the morphological criteria of lung ultrasound of the pleura or pleural lung structures. There was no significant correlation between the lung ultrasound findings and clinical Data.

Discussion

Our findings are congruent with the current, albeit sparse, data. It is possible that the causes of persistent thoracic symptoms in long COVID might be more likely to be present in functional examinations, but not morphologically imageable. Nonspecific symptoms do not appear to be due to changes in the lung parenchyma. In conclusion, lung ultrasound alone and without baseline in acute disease is not suitable as a standard in the follow-up of long COVID patients. Further investigations on the morphological and functional changes in patient with long COVID is needed.

A Comprehensive Comparison of COVID-19 Characteristics (Wuhan‎ Strain) Between Children and Adults During Initial Pandemic Phase: A Meta-Analysis Study

Objectives: This systematic review and meta-analysis aimed to compare coronavirus disease 2019 (COVID-19) (Wuhan strain) features in children and adults during the initial pandemic phase. Methods: Until June 4, 2020, a systematic search was conducted on the EMBASE, PubMed, Web of Science, Google Scholar, and Scopus to find and collect studies based on available data among adults and children. The heterogeneity of the studies was assessed using I2 statistics and chi-square testing. The random-effect model was used to pool the effect sizes due to inter-study heterogeneity (chi-square P-value 0.1 and I2 >50%). Results: Fever (65.73%), cough (53.78%), expectoration (37.9%), gastrointestinal symptoms (37.01%), headache (23.41%), shortness of breath (21.65%), and myalgia (20.79%) were the most common symptoms reported in children, according to the pooled estimation analysis. Arthralgia (Effect estimate (ES): adults = 2.15, children = 17.94) and headache (ES: adults = 9.22, children = 23.41) were significantly observed higher in children (P-value = 0.019). Adult patients had a higher rate of abnormal computer tomography (CT)-scan findings, while most children had a normal study. Adults had significantly higher rates of comorbidities, whereas children had significantly higher rates of asthma (ES: 17.94% vs 8.85%; P-value = 0.026) and malignancy (‎ES: 10.36‎% vs ‎5.47‎‎%; P-value = 0.045‎). During initial pandemic phase, hydroxychloroquine (ES: 66.21% vs ‎‎29.01%; P-value = 0.001) and antibiotics (ES: 77.86% vs 38.01%; P-value = 0.001) ‎were used much more frequently in adult patients. Adults used much more antibiotics than children. Nonetheless, antibiotics were given to around 40% of the children studied. ‎ Conclusions: Although children were afflicted less than adults in the early stages of the pandemic and had lower mortality, clinical and radiological findings, as well as prognostic factors, did not differ significantly between adults and children. However, with the advent of novel variants, clinical signs and symptoms, complications, and outcomes changed in children significantly.

COVID-19 implications for pediatric anesthesia: Lessons learnt and how to prepare for the next pandemic

COVID-19 is mainly considered an "adult pandemic," but it also has strong implications for children and consequently for pediatric anesthesia. Despite the lethality of SARS-CoV-2 infection being directly correlated with age, children have equally experienced the negative impacts of this pandemic. In fact, the spectrum of COVID-19 symptoms among children ranges from very mild to those resembling adults, but may also present as a multisystemic inflammatory syndrome. Moreover, the vast majority of children might be affected by asymptomatic or pauci-symptomatic infection making them the "perfect" carriers for spreading the disease in the community. Beyond the clinical manifestations of SARS-CoV-2 infection, the COVID-19 pandemic may ultimately have catastrophic health and socioeconomic consequences for children and adolescents, which are yet to be defined. The aim of this narrative review is to highlight how COVID-19 pandemic has affected and changed the pediatric anesthesia practice and which lessons are to be learned in case of a future "pandemic." In particular, the rapid evolution and dissemination of research and clinical findings have forced the scientific community to adapt and alter clinical practice on an unseen and pragmatic manner. Equally, implementation of new platforms, techniques, and devices together with artificial intelligence and large-scale collaborative efforts may present a giant step for mankind. The valuable lessons of this pandemic will ultimately translate into new treatments modalities for various diseases but will also have the potential for safety improvement and better quality of care. However, this pandemic has revealed the vulnerability and deficiencies of our health-care system. If not addressed properly, we may end up with a tsunami of burnout and compassionate fatigue among health-care professionals. Pediatric anesthesia and critical care staff are no exceptions.