Brief CommunicationBrief Communication
Open Access

Clinical, laboratory, and chest radiographic characteristics of COVID-19 associated severe pediatric pneumonia. A retrospective study

Ali A. Asseri, Saleh M. Al-Qahtani, Mohammed A. Algathradi, Ibrahim A. Alzaydani, Ahmed A. Al-Jarie, Ibrahim A. Al-Benhassan, Ibrahim A. AlHelali, Mona S. Alassiri, Ali A. Alrmelawi and Abdelwahid S. Ali
Saudi Medical Journal December 2022, 43 (12) 1390-1396; DOI: https://doi.org/10.15537/smj.2022.43.12.20220420

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    - Progression of chest radiography (CXR) and computed tomography (CT) findings in a pediatric COVID-19 patient. A) CXR of the patient on admission showed bilateral mid-lung zone opacifications. B&C) During admission to the pediatric intensive care unit, coronal CT images of the same patient showed multiple right sided pneumatoceles, bilateral ground-glass opacification, and left lower lobe consolidation. D) CXR of the patient at the 3-month post-discharge follow-up showed recovering bilateral ground-glass opacifications.

  • Figure 2
    Figure 2

    - Chest radiographs of 4 pediatric patients with positive COVID-19 results. A) A 3-year-old male patient with COVID-19; initial chest radiography after intubation shows bilateral central ground-glass opacities with left lower lobe consolidation. B) An 8-year-old male patient with underlying severe bronchopulmonary dysplasia was admitted with COVID-19; chest radiography showed bilateral ground-glass opacities (more on the left). C) Chest radiography of a 4-year-old patient showing bilateral ground-glass opacity. D) Chest radiography of a 5-year-old showing bilateral consolidation with right lower lobe localization. This patient eventually died.

Tables

  • Table 1

    - Baseline characteristics of the patients with severe COVID-19 pneumonia (N=34).

    Variablesn (%)
    Age in months, median (IQR)24 (12-72)
    Age categories
    Infants11 (32.4)
    Preschool age15 (44.0)
    School age8 (23.5)
    Gender (male)16 (47.0)
    Symptoms and signs
    GI symptoms (vomiting/diarrhea)20 (59.0)
    SpO2 on room air, median (IQR)75 (70-82)
    Respiratory failure requiring mechanical ventilation12 (35.0)
    Signs of shock or multi-organ failure2 (5.9)
    Comorbidities31 (91.2)
    Vital signs at admission, median (IQR)
    Heart rate147.5 (120-181)
    FiO2100 (80-100)

    Values are presented as a number and percentage (%) or as median and interquartile range (IQR). GI: gastrointestinal, SpO2: peripheral oxygen saturation, FiO2: the fraction of inspired oxygen

    • Table 2

      - Baseline laboratory findings of the pediatric patients.

      Blood and biochemical testsnChildren’s reference rangeValues
      White blood cells (×109/L)344500-110009.21 (6-12.9)
      Absolute lymphocyte count (per mm3)311000-48002340 (1540-4610)
      Absolute neutrophil count (per mm3)311800-77004740 (2470-10300)
      Hemoglobin (g/dL)3412.0-16.012 (10.5-13)
      Platelets (×109/L)34150,000-450,000281 (186-334)
      CRP (mg/dL)22<0.305 (0.5-14.5)
      ESR (mm/hr)290-1332 (15-55)
      Ferritin, µg/l830-300351 (144-1293)
      Procalcitonin, µg/l130.00-0.080.34 (0.04-5.5)
      Troponin, ng/ml12<2.03.8 (1.5-46)
      D-dimer (µg/L)14<500970 (725-3003)
      BUN (mg/dL)318.0-2513 (8-19)
      Creatinine (mg/dL)310.30-1.000.4 (0.3-0.5)
      Sodium (mEq/L)31135-145137 (134-139)
      ALT (IU/L)2910-5529 (18-43.5)
      AST (IU/L)299.0-3229 (22-53.5)
      Albumin (g/dL)263.4-5.43.1 (2.8-3.7)
      Total bilirubin (mg/dL)190.0-1.00.5 (0.3-1)
      LDH (IU/L)1713-60472 (310.5-716)

      Values are presented as median and interquartile range (IQR). CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, BUN: blood urea nitrogen, ALT: alanine transaminase, AST: aspartate transaminase, LDH: lactate dehydrogenase

      • Table 3

        - Interventions and therapeutics options.

        VariablesValues
        Medical treatment
        Inotropes7 (20.6)
        Systemic steroid20 (58.8)
        IVIG12 (35.3)
        Aspirin3 (8.8)
        Azithromycin34 (100)
        ≥2 antibiotics34 (100)
        Favipiravin32 (94.1)
        Hydroxychloroquine9 (26.5)
        Respiratory support
        HFNC31 (91.2)
        MV11 (32.4)
        Days on HFNC3 (1-20)
        Days on MV10 (1-60)
        Days on PICU7 (1-91)
        Total oxygen days during the hospitalization7 (3-80)
        The total days of hospital stay10 (3-105)

        Values are presented as a number and precentage (%) or as median and interquartile range (IQR). IVIG: intravenous immunoglobulin, HFNC: high-flow nasal cannula therapy, MV: mechanical ventilation, PICU: pediatric intensive care unit

        • Table 4

          - Complications and the outcomes.

          VariablesValues
          Complications
          Multiorgan failure4 (11.8)
          Seizures5 (14.8)
          ARDS13 (38.2)
          Air leak4 (11.8)
          Outcomes at the time of discharge
          Tracheostomized3 (8.8)
          Oxygen dependent6 (17.6)
          Discharged alive32 (94.0)
          A 3-months follow-up26 (76.5)

          Values are presented as a number and precentage (%).

          ARDS: acute respiratory distress syndrome

          Back to top

          In this issue

          Print
          Download PDF
          Email Article
          Citation Tools
          Bookmark this article

          Jump to section

          Keywords