# Clinical Manifestations Laboratory Tests Abdominal Ultrasonic Findings and In-hospital Prognosis of COVID-19 in 185 Pediatric Cases in a Tertiary Center

## TL;DR

This study examines clinical features, lab results, and outcomes of 185 children with COVID-19, highlighting common symptoms, ultrasound findings, and risk factors for severe illness.

## Contribution

The study provides detailed clinical and ultrasound data on pediatric COVID-19 cases, identifying key predictors of severe disease and ICU admission.

## Key findings

- Mesenteric lymphadenitis was observed in 60% of pediatric COVID-19 cases via ultrasound.
- ARDS, low oxygen saturation, elevated WBC, and CRP were main determinants of in-hospital death.
- Lower age and elevated CRP predicted ICU admission in pediatric patients.

## Abstract

Despite the COVID-19 pandemic, there is little information about the different clinical aspects of COVID-19 in children. In this study, we assessed the clinical manifestations, outcome, ultrasound, and laboratory findings of pediatric COVID-19.

This retrospective study was conducted on 185 children with definitive diagnosis of COVID-19 between 2021 and 2022. The patients’ information was retrieved from hospital records.

The average age of the patients was 5.18 ± 4.55 years, and 61.1% were male. The most frequent clinical manifestation was fever (81.1%) followed by cough (31.9%), vomiting (20.0%), and diarrhea (20.0%). Mesenteric lymphadenitis was common on ultrasound and found in 60% of cases. In-hospital death was identified in 3.8% of cases. The mean length of hospital stay was 8.5 days. Mandating intensive care unit (ICU) stay was found in 19.5% and 5.9% of cases were intubated. Acute respiratory distress syndrome (ARDS), lower arterial oxygen saturation, higher white blood cell (WBC) count, and higher C-reactive protein (CRP) were the main determinants of death. Lower age, respiratory distress, early onset of clinical manifestations, lower arterial oxygen saturation, lower serum hemoglobin (Hb) level, and higher CRP level could predict requiring ICU admission.

We recommend close monitoring on CRP, serum Hb level, WBC count, and arterial level of oxygenation as clinical indicators for potential progression to critical illness and severe disease. Mesenteric lymphadenitis is a common sonographic finding in pediatric COVID-19 which can cause abdominal pain. Ultrasound is helpful to avoid unnecessary surgical interventions in COVID-19.