Background: Coronavirus disease 2019 (COVID-19) continues to be a pandemic to this time, and chest radiography has been used as a first-line triage tool, due to long turnaround times for real-time reverse transcription polymerase chain reaction (RT-PCR), which remains to be the gold standard in COVID-19 diagnosis. Chest x-ray alone has poor sensitivity to diagnosing COVID-19 and pediatric studies on this are scarce.

Objectives: The main objective is to evaluate the usefulness of a routine chest radiograph as an adjunct to diagnosing suspected pediatric COVID-19, along with its sensitivity, specificity, accuracy, and correlation with the most common pediatric signs and symptoms. In line with this, the radiographic characteristics seen in pediatric COVID-19 patients are presented.

Methods: A cross-sectional study involving a retrospective chart review of 259 pediatric patients admitted in a tertiary hospital with COVID-19 signs and symptoms, with baseline chest x-ray and SARS-CoV2 RT-PCR tests. Correlation of signs and symptoms with chest x-ray findings to RT-PCR positivity was determined using univariate and multivariate logistic regression analysis.

Results: The study was composed of 259 pediatric patients (ages 0-18 years old). Of these, 35 had positive findings with RT-PCR (15%). Sensitivity of a chest radiograph with pneumonia is at 62.9%, while specificity is at 39.3%. Overall accuracy of CXR findings leading to RT-PCR positivity is at 42.5%. Ground glass or hazy opacities was the most common radiographic finding (45.5%), followed by reticular opacities (31.8%). Abnormalities were mostly distributed in the inner lung zone distribution with bilateral lung involvement (90%). Those with difficulty of breathing were more likely to have pneumonia on their CXR, though a finding of pneumonia on CXR did not significantly correlate to a positive RT-PCR.

Conclusions & Recommendations: Findings of pneumonia on a pediatric CXR may not necessarily lead to a positive SARS-CoV2 RT-PCR, but correlating this with the patient's clinical course and symptoms may be beneficial in effective triaging of patients. Reassessment by another radiologist may provide additional strength to this study.

Human ; Male ; Female ; Adolescent (a Person 13-18 Years Of Age) ; Pre-adolescent (a Child 6-12 Years Of Age) ; Child ; Mass Screening ; Sensitivity And Specificity

OBJECTIVE

To determine whether neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) within the first three days of dengue illness are independent predictors of dengue severity among pediatric patients.

METHODOLOGY

A cross-sectional analytical retrospective study was conducted among pediatric dengue patients admitted to The Medical City, Pasig from September 2021 to August 2024. Data collection was done through electronic chart review. Baseline characteristics were analyzed using the Kruskal-Wallis test, Chi-Square test, and Fisher’s exact test. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analyses, along with diagnostic performance metrics, were used to evaluate daily ratio cut-offs differentiating dengue classifications. Multivariable logistic regression was performed to assess NLR and PLR as independent predictors of warning signs or severe dengue development.

RESULTS

Among the 316 subjects included in the analysis, 40.5% had dengue fever without warning signs, 57.3% had dengue fever with warning signs, and 2.2% had severe dengue. Differentiating patients without warning signs from those with warning signs, the NLR cut-offs were 4.73, 2.07, and 2.5 on days 1-3, respectively, whereas from those with severe dengue, the cut-offs were 1.27, 0.68, and 0.47 on the same days. For this pairwise analysis, PLR cut-offs were 170, 233.92, and 208.79 for the first comparison; and 209.24, 244.12, and 187.5 for the second, respectively. Statistical analysis showed poor discrimination and diagnostic performance for all cut-offs. Likewise, multivariable linear regression revealed no significant correlation between either ratio and dengue severity.

CONCLUSION

NLR and PLR within the first three days of dengue illness revealed poor performance in predicting the development of warning signs or progression to severe dengue among pediatric patients.

Human ; Dengue Fever ; Dengue

The clinical course of COVID-19 in the pediatric population has been reported to be mild in the majority of affected patients. However, a condition referred to as multisystem inflammatory syndrome in children (MIS-C) can occur with SARS-CoV-2 infection where patients can become critically ill. In this series, we describe five pediatric patients with the spectrum of MIS-C associated with SARS-CoV-2 infection.
COVID-19 ; SARS-CoV-2