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A Multicenter Cross-Sectional Study ORIGINAL RESEARCH published: 01 July 2021 doi: 10.3389/fcimb.2021.663884 Comparison of Clinical Characteristics Among COVID-19 Edited by: Danilo Buonsenso, and Non-COVID-19 Pediatric Catholic University of the Sacred Heart, Italy Pneumonias: A Multicenter Reviewed by: Luca Pierantoni, Cross-Sectional Study Policlinico S.Orsola-Malpighi, Italy Adriana Yock-Corrales, 1,2,3† 1,2,3† 4,5† 6† 7† Dr. Carlos Sa´ enz Herrera National Zhongwei Jia , Xiangyu Yan , Liwei Gao , Shenggang Ding , Yan Bai , † † † † † † Children’s Hospital, Costa Rica Yuejie Zheng 8 , Yuxia Cui 9 , Xianfeng Wang 10 , Jingfeng Li 11 , Gen Lu 12 ,YiXu12 , † Gabriela Naranjo-Zuñiga, Xiangyu Zhang 1,2,3 , Junhua Li 13, Ning Chen 14, Yunxiao Shang 14, Mingfeng Han 15, Dr. Carlos Sa´ enz Herrera National Jun Liu 16, Hourong Zhou 17,18,CenLi9,WanqiuLu19, Jun Liu 4,5,LinaWang4,5,QihongFan20, ’ Children s Hospital, Costa Rica Jiang Wu 21, Hanling Shen 22,RongJiao23, Chunxi Chen 24, Xiaoling Gao 25,MaoqiangTian26, *Correspondence: Wei Lu 27, Yonghong Yang 28,29, Gary Wing-Kin Wong 30,TianyouWang31*, Runming Jin 7*, Kunling Shen Adong Shen 32*,BaopingXu4,5* and Kunling Shen 4* [email protected] Baoping Xu 1 School of Public Health, Peking University, Beijing, China, 2 Center for Intelligent Public Health, Institute for Artificial [email protected] Intelligence, Peking University, Beijing, China, 3 Center for Drug Abuse Control and Prevention, National Institute of Health Adong Shen Data Science, Peking University, Beijing, China, 4 China National Clinical Research Center for Respiratory Diseases, [email protected] Department of Respiratory Medicine, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical Runming Jin University, Beijing, China, 5 Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing, [email protected] China, 6 Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China, 7 Pediatric Tianyou Wang Department, Union Hospital, Tongji Medical College, Huazhong University of Science And Technology, Hubei, China, [email protected] 8 Department of Respiratory Medicine, Shenzhen Children’s Hospital, Shenzhen, China, 9 Department of Pediatrics, Guizhou ’ 10 ’ †These authors have contributed Provincial People s Hospital, Guizhou, China, Department of Pediatrics, Shenzhen Third People s Hospital, Second fi 11 equally to this work Af liated Hospital of Southern University of Science and Technology, Shenzhen, China, Department of Pediatrics, Taihe Hospital, Shiyan, China, 12 Department of Pediatric, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China, 13 Department of Pediatrics, Xiangyang Central Hospital, Xiangyang, China, 14 Department of Specialty section: Pediatric, Shengjing Hospital of China Medical University, Liaoning, China, 15 Department of Respiratory Medicine, The This article was submitted to Second People’s Hospital of Fuyang, Anhui, China, 16 Department of Pediatrics, The People Hospital of Bozhou, Anhui, Clinical Microbiology, China, 17 Department of General Practice, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China, 18 Office of a section of the journal Academic Research, Jiangjunshan Hospital, Guizhou, China, 19 Department of Pediatrics, The Affiliated Hospital of Guizhou Frontiers in Cellular and Infection University, Guizhou, China, 20 Department of Pediatrics, Jingzhou First People’s Hospital, Jingzhou, China, 21 Department of Microbiology Pediatrics, Huangshi Maternity and Child Health Care Hospital, Huangshi, China, 22 Department of Pediatrics, Suizhou Received: 03 February 2021 Maternity and Child Health Care Hospital, Suizhou, China, 23 Department of Pediatrics, Xiangyang First People’s Hospital, Accepted: 05 May 2021 Xiangyang, China, 24 Department of Pediatrics, Xishui People’s Hospital, Huanggang, China, 25 Department of Pediatrics, Published: 01 July 2021 People’s Hospital of Tuanfeng County, Huanggang, China, 26 Department of Pediatrics, Tongren People’s Hospital of 27 ’ 28 Citation: Guizhou Province, Guizhou, China, Department of Pediatrics, Yichang Central People s Hospital, Yichang, China, Beijing Pediatric Research Institute, Beijing, China, 29 Beijing Children's Hospital, National Center for Children’s Health, Capital Jia Z, Yan X, Gao L, Ding S, Bai Y, Medical University, Beijing, China, 30 Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Zheng Y, Cui Y, Wang X, Li J, Lu G, Hong Kong Special Administrative Region, China, 31 Center of Hematologic Oncology, Beijing Children’s Hospital, National Xu Y, Zhang X, Li J, Chen N, Shang Y, Center for Children’s Health, Capital Medical University, Beijing, China, 32 Beijing Key Laboratory of Pediatric Respiratory Han M, Liu J, Zhou H, Li C, Lu W, Infection Diseases, Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Liu J, Wang L, Fan Q, Wu J, Shen H, Capital Medical University, Beijing, China Jiao R, Chen C, Gao X, Tian M, Lu W, Yang Y, Wong GW-K, Wang T, Jin R, Shen A, Xu B and Shen K (2021) Background: The pandemic of Coronavirus Disease 2019 (COVID-19) brings new Comparison of Clinical Characteristics Among COVID-19 and Non- challenges for pediatricians, especially in the differentiation with non-COVID-19 COVID-19 Pediatric Pneumonias: A pneumonia in the peak season of pneumonia. We aimed to compare the clinical Multicenter Cross-Sectional Study. characteristics of pediatric patients with COVID-19 and other respiratory pathogens Front. Cell. Infect. Microbiol. 11:663884. doi: 10.3389/fcimb.2021.663884 infected pneumonias. Frontiers in Cellular and Infection Microbiology | www.frontiersin.org1 July 2021 | Volume 11 | Article 663884 Jia et al. COVID-19 and Other Pediatric Pneumonia Methods: We conducted a multi-center, cross-sectional study of pediatric inpatients in China. Based on pathogenic test results, pediatric patients were divided into three groups, including COVID-19 pneumonia group, Non-COVID-19 viral (NCV) pneumonia group and Non-viral (NV) pneumonia group. Their clinical characteristics were compared by Kruskal- Wallis H test or chi-square test. Results: A total of 636 pediatric pneumonia inpatients, among which 87 in COVID-19 group, 194 in NCV group, and 355 in NV group, were included in analysis. Compared with NCV and NV patients, COVID-19 patients were older (median age 6.33, IQR 2.00-12.00 years), and relatively fewer COVID-19 patients presented fever (63.2%), cough (60.9%), shortness of breath (1.1%), and abnormal pulmonary auscultation (18.4%). The results were verified by the comparison of COVID-19, respiratory syncytial virus (RSV) and influenza A (IFA) pneumonia patients. Approximately 42.5%, 44.8%, and 12.6% of the COVID-19 patients presented simply ground-glass opacity (GGO), simply consolidation, and the both changes on computed tomography (CT) scans, respectively; the proportions were similar as those in NCV and NV group (p>0.05). Only 47.1% of COVID-19 patients had both lungs pneumonia, which was significantly lower than that proportion of nearly 80% in the other two groups. COVID-19 patients presented lower proportions of increased white blood cell count (16.5%) and abnormal procalcitonin (PCT) (10.7%), and a higher proportion of decreased lymphocyte count (44.0%) compared with the other two groups. Conclusion: Majority clinical characteristics of pediatric COVID-19 pneumonia patients were milder than non-COVID-19 patients. However, lymphocytopenia remained a prominent feature of COVID-19 pediatric pneumonia. Keywords: COVID-19 pneumonia, viral pneumonia, non-viral pneumonia, pediatric patients, clinical characteristics INTRODUCTION milder symptoms and better prognosis (CDC COVID-19 Response Team, 2020; National Health Commission of the Since December 2019, cases of pneumonia with no clear etiology People’s Republic of China, 2020). Although most pediatric were reported in Wuhan, Hubei, China, which was known as the patients with COVID-19 had a good prognosis, severe or Coronavirus Disease 2019 (COVID-19) and the virus was named critical cases or even death cases were reported (Lu et al., as severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2020). Additionally, with the pandemic of COVID-19 in the 2) by the World Health Organization (WHO). It subsequently world, more and more pediatric cases were reported and it brings has spread rapidly to the whole world (Huang et al., 2020; Lu a new challenge for pediatricians. et al., 2020; Zhu et al., 2020 ). People of all ages are susceptible to Pneumonias are the major cause of death among infectious COVID-19. Children are paid more attention as a vulnerable diseases in children less than five years old in the world, killing group. Fortunately, compared with the adult patients, the approximately 800,000 children a year (Liu et al., 2016). In number of pediatric patients were lower and mostly with clinical, pediatricians usually diagnosed pneumonia according to clinical manifestations and (or) chest imaging exam. Yet, fever, cough with or without sputum, wheeze are common Abbreviations: COVID-19, Coronavirus Disease 2019; SARS-CoV-2, severe acute symptoms in most cases with pneumonia even if they had respiratory syndrome coronavirus 2; NCV, Non-COVID-19 viral; NV, Non-viral; different pathogens. Previous study of COVID-19 pneumonia GGO, ground-glass opacity; CT, computed tomography; WHO, World Health also reported that the common symptoms were fever, cough
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