Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children

Abstract

s u m m a r yBackground: The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported. Methods: Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared. Findings: Compared with the non-pregnant adults group ( n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed ( n = 16) and clinically-diagnosed ( n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults ( P = 0 ·007, P < 0 ·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults ( P = 0 ·001, P < 0 ·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twentythree patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6-9 days after initial CT scans. Interpretation: Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT.

A single-center, retrospective study of COVID-19 features in children: a descriptive investigation

“…The symptoms in children with COVID-19 infection have been well described in the literature [9][10][11][12][13][14][15][16][17][18]. Our results are consistent with these previous reports.…”

“…The most common pattern of chest CT is groundglass opacities, followed by local patchy shadowing and then local bilateral patchy shadowing, which is consistent with published data [9][10][11][12][13][14][15][16][17][18]. Our study indicates that chest CT manifested with a predominance of lesions in the subpleural area (41 [95%] of 43) and in lower lung lobes (28 [65%] of 43), especially in the posterior segment (22 [78%] of 28), an area with a relatively dense amount of bronchioles, blood vessels, and alveoli.…”

“…Compared to adults [3][4][5][6][7], there are a few studies on the COVID-19 in children. Although mortality in children has been reported [8], studies have demonstrated that COVID-19 is generally less severe compared to adults in terms of both symptoms and computerized tomography (CT) manifestations [9][10][11][12][13][14][15][16][17][18]. The common chest CT patterns are ground-glass opacities (GGO) followed by local bilateral shadowing (LPS), in contrast to a large percentage of bilateral patchy shadowing (BPS) pattern in adults [19,20].…”

Infections in Pregnancy With COVID-19 and Other Respiratory RNA Virus Diseases Are Rarely, If Ever, Transmitted to the Fetus: Experiences With Coronaviruses, Parainfluenza, Metapneumovirus Respiratory Syncytial Virus, and Influenza

“…For those pregnant women who developed respiratory disease it has been typically non-life-threatening, including pneumonia accompanied by radiological findings of patchy pulmonary infiltrates, ground glass opacities and consolidation. 55 However, in a few cases there have been pregnant women with COVID-19 who have developed severe pneumonia and life-threatening disease. In a report from New York City the infection status of 2 pregnant women was unknown until after delivery when they developed medical complications, were admitted for intensive care and found to have COVID-19 -their infants were negative for the virus.…”

COVID-19 and maternal mental health: Are we getting the balance right?

“…There is no evidence that the virus can be transmitted vertically from the mother to the fetus during pregnancy. This is based on; one study of 9 pregnant women with laboratory-confirmed COVID-19 pneumonia [8];a single case report [9]; a study of 41 pregnant women with confirmed COVID-19 [11]; and a study of 15 pregnant women with COVID-19 [10].…”