Objective@#To explore imaging characteristics of children with 2019 novel coronavirus (2019-nCoV) infection.@*Methods@#A retrospective analysis was performed on clinical data and chest CT images of 15 children diagnosed with 2019-nCoV. They were admitted to the third people’s Hospital of Shenzhen from January 16 to February 6, 2020. The distribution and morphology of pulmonary lesions on chest CT images were analyzed.@*Results@#Among the 15 children, there were 5 males and 10 females, aged from 4 to 14 years old. Five of the 15 children were febrile and 10 were asymptomatic on first visit. The first nasal or pharyngeal swab samples in all the 15 cases were positive for 2019-nCoV nucleic acid. For their first chest CT images, 6 patients had no lesions, while 9 patients had pulmonary inflammation lesions. Seven cases of small nodular ground glass opacities and 2 cases of speckled ground glass opacities were found. After 3 to 5 days of treatment, 2019-nCoV nucleic acid in a second respiratory sample turned negative in 6 cases. Among them, chest CT images showed less lesions in 2 cases, no lesion in 3 cases, and no improvement in 1 case. Other 9 cases were still positive in a second nucleic acid test. Six patients showed similar chest CT inflammation, while 3 patients had new lesions, which were all small nodular ground glass opacities.@*Conclusions@#The early chest CT images of children with 2019-nCoV infection are mostly small nodular ground glass opacities. The clinical symptoms of children with 2019-nCoV infection are nonspecific. Dynamic reexamination of chest CT and nucleic acid are important.

Analysis of CT features of 15 Children with 2019 novel coronavirus infection/ 中华儿科杂志/ Analysis of CT features of 15 Children with 2019 novel coronavirus infection/ 中华儿科杂志

Objective To identify factors that contribute to the increased susceptibility and severity of COVID-19 in obese children and adolescents, and its health consequences. Sources Studies published between 2000 and 2020 in the PubMed, MEDLINE, Scopus, SciELO, and Cochrane databases. Summary of findings Obesity is a highly prevalent comorbidity in severe cases of COVID-19 in children and adolescents; social isolation may lead to increase fat accumulation. Excessive adipose tissue, deficit in lean mass, insulin resistance, dyslipidemia, hypertension, high levels of proinflammatory cytokines, and low intake of essential nutrients are factors that compromise the functioning of organs and systems in obese individuals. These factors are associated with damage to immune, cardiovascular, respiratory, and urinary systems, along with modification of the intestinal microbiota (dysbiosis). In severe acute respiratory syndrome coronavirus 2 infection, these organic changes from obesity may increase the need for ventilatory assistance, risk of thromboembolism, reduced glomerular filtration rate, changes in the innate and adaptive immune response, and perpetuation of the chronic inflammatory response. Conclusions The need for social isolation can have the effect of causing or worsening obesity and its comorbidities, and pediatricians need to be aware of this issue. Facing children with suspected or confirmed COVID-19, health professionals should 1) diagnose excess weight; 2) advise on health care in times of isolation; 3) screen for comorbidities, ensuring that treatment is not interrupted; 4) measure levels of immunonutrients; 5) guide the family in understanding the specifics of the situation; and 6) refer to units qualified to care for obese children and adolescents when necessary.

http://www.scielo.br/pdf/jped/v96n5/0021-7557-jped-96-05-0546.pdf

COVID-19 and obesity in childhood and adolescence: a clinical review.

Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database.

OBJECTIVE: To undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years. DESIGN: Narrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020. SETTING: All settings, including hospitalised and community settings. PATIENTS: Children and young people (CYP) under age 20 years with laboratory-proven COVID-19. STUDY REVIEW, DATA EXTRACTION AND QUALITY: Potentially eligible articles were reviewed on title and abstract by one reviewer. Quality was assessed using the modified AMSTARS criteria and data were extracted from included studies by two reviewers. MAIN OUTCOME MEASURES: Prevalence of symptoms and signs of COVID-19. RESULTS: 1325 studies were identified and 18 reviews were included. Eight were high quality, 7 medium and 3 low quality. All reviews were dominated by studies of hospitalised children. The proportion of asymptomatic CYP ranged from 14.6% to 42%. Fever and cough were the the most common symptoms; proportions with fever ranged from 46% to 64.2% and with cough from 32% to 55.9%. All other symptoms or signs including rhinorrhoea, sore throat, headache, fatigue/myalgia and gastrointestinal symptoms including diarrhoea and vomiting were infrequent, occurring in less than 10%-20%. CONCLUSIONS: Fever and cough are the most common symptoms in CYP with COVID-19, with other symptoms infrequent. Further research on symptoms in community samples are needed to inform pragmatic identification and testing programmes for CYP.

https://adc.bmj.com/content/archdischild/106/8/802.full.pdf

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents.

Objective To undertake a systematic review of reviews of the prevalence of symptoms and signs of COVID-19 in those aged under 20 years? Design Narrative systematic review of reviews. PubMed, medRxiv, Europe PMC and COVID-19 Living Evidence Database were searched on 9 October 2020. Setting All settings, including hospitalised and community settings. Patients CYP under age 20 years with laboratory-proven COVID-19. Study review, data extraction and quality Potentially eligible articles were reviewed on title and abstract by one reviewer. Quality was assessed using the modified AMSTARS criteria and data were extracted from included studies by two reviewers. Main outcome measures Prevalence of symptoms and signs of COVID-19 Results 1325 studies were identified and 18 reviews were included. Eight were high quality, 7 medium and 3 low quality. All reviews were dominated by studies of hospitalised children. The proportion who were asymptomatic ranged from 14.6 to 42%. Fever and cough were the commonest symptoms; proportions with fever ranged from 46 to 64.2% and with cough from 32 to 55.9%. All other symptoms or signs including rhinorrhoea, sore throat, headache, fatigue/myalgia and gastrointestinal symptoms including diarrhoea and vomiting are infrequent, occurring in less than 10-20%. Conclusions Fever and cough are the most common symptoms in CYP with COVID-19, with other symptoms infrequent. Further research on symptoms in community samples are needed to inform pragmatic identification and testing programmes for CYP.

/pdf/systematic-review-of-reviews-of-symptoms-and-signs-of-covid-427wkfap0w.pdf

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

To assess the overall prevalence of clinical signs, symptoms, and radiological findings in children and/or adolescents with COVID-19 We systematically researched in PubMed, Scopus and Web of Science databases observational studies describing COVID-19 in children and/or adolescents until April 11, 2020 Data regarding clinical and radiological features were extracted from eligible studies and meta-analysis was performed using random-effects modeling We examined 19 eligible studies for a total of 2855 children and/or adolescents with COVID-19 Approximately 47% of subjects had fever (95% confidence interval [CI] 22−72%; I2 = 986%), 37% cough (95%CI 15−63%; I2 = 986%), 4% diarrhea (95%CI 0−12%; I2 = 922%), 2% nasal congestion (95%CI 0−7%; I2 = 877%), 1% dyspnea (95%CI 0−7%; I2 = 915%) and 0% abdominal pain (95%CI 0−1%; I2 = 763%) Subjects presented mild symptoms in 79% (95%CI 65−91%; I2 = 935%) of cases, whereas only 4% (95%CI 1−9%; I2 = 764%) were critical Among those with pneumonia on computed tomography, 264% (95%CI 13−41%; I2 = 808%) presented a unilateral involvement, 16% (95%CI 5−29%, I2 = 812%) had bilateral involvement and 9% (95%CI 0−24%; I2 = 887%) had interstitial pneumonia Children and/or adolescents tend to have a mild COVID-19 course with a good prognosis

/pdf/coronavirus-disease-2019-covid-19-in-children-and-or-4fz6c4pfzb.pdf

Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis.

/pdf/covid-19-outbreak-in-children-and-or-adolescents-2i9tryibzz.pdf

Marco Deganello Saccomani

Papers

Coronavirus disease 2019 (COVID-19) in children and/or adolescents: a meta-analysis.

COVID-19 outbreak in children and/or adolescents.