Pulmonary imaging in coronavirus disease 2019 (COVID-19): a series of 140 Latin American children.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which resulted in the worldwide coronavirus disease 2019 (COVID-19) pandemic of 2020, has particularly affected Latin America. OBJECTIVE: The purpose of the study was to analyze the imaging findings of pulmonary COVID-19 in a large pediatric series. MATERIALS AND METHODS: Children with SARS-CoV-2 infection confirmed by either quantitative reverse transcription-polymerase chain reaction from nasopharyngeal swabs or presence of circulating immunoglobulin M (IgM) antibodies and who underwent chest radiograph or CT or both were included in this retrospective multicenter study. Three pediatric radiologists independently reviewed radiographs and CTs to identify the presence, localization, distribution and extension of pulmonary lesions. RESULTS: We included 140 children (71 female; median age 6.3 years, interquartile range 1.6-12.1 years) in the study. Peribronchial thickening (93%), ground-glass opacities (79%) and vascular engorgement (63%) were the most frequent findings on 131 radiographs. Ground-glass opacities (91%), vascular engorgement (84%) and peribronchial thickening (72%) were the most frequent findings on 32 CTs. Peribronchial thickening (100%), ground-glass opacities (83%) and pulmonary vascular engorgement (79%) were common radiograph findings in asymptomatic children (n=25). Ground-glass opacity and consolidation were significantly higher in children who needed intensive care admission or died (92% and 48%), in contrast with children with a favorable outcome (71% and 24%, respectively; P<0.05). CONCLUSION: Asymptomatic children and those with mild symptoms of COVID-19 showed mainly peribronchial thickening, ground-glass opacities and pulmonary vascular engorgement on radiographs. Ground-glass opacity and consolidation were more common in children who required intensive care admission or died.

Pediatric hospital demand in the COVID-19 pandemic

RESUMEN La pandemia del COVID-19 en el Perú está causando una presión inusual a nuestros recursos hospitalarios y de cuidados críticos. A medida que la infección progresa en la población, esperamos ver un alza en los casos severos y en la demanda de unidad de cuidados intensivos (UCI) donde la capacidad de camas puede ser excedida. A pesar de que usualmente el COVID-19 causa una enfermedad poco grave en los niños, debemos estar preparados para que el numero de casos pediátricos ocasionen una sobrecarga en la capacidad de recursos hospitalarios. En un escenario de un 25% de proporción de infección acumulada en la población, podremos ver aproximadamente 891 niños críticamente enfermos que requieren hospitalización en UCI. Proponemos algunas estrategias para enfrentar la escasez de recursos de cuidados intensivos que permitan asegurar la atención de niños vulnerables con condiciones agudas y condiciones complejas que siguen incidiendo en los tiempos de pandemia. ABSTRACT The COVID-19 pandemic in Perú is causing an unusual pressure in our sanitarian and critic care resources. As the pandemics have progressed in the population, an increasing of several cases and intensive care units (ICU) demand will be expected, because of that, the hospitals capacities would be exceeded in a short place. Despite the low severity of COVID-19 cases in children, we expect that the projected number of pediatric cases could overwhelm the available pediatric capacity. Under a 25% cumulative infection rate scenario, there would be approximately 891 critically ill children requiring ICU admission. We propose several strategies to handle the concerns about shortfalls in our ability to provide pediatric ventilation and critical care support during the epidemic in Perú.