Diagnostic Imaging in the Newborn, Child and Adolescent Infected with SARS-CoV-2: is there a Realistic Alternative to Lung-HRCT and Chest X-rays ? A Systematic Review of the Literature

Chest computed tomography (CT) has been frequently used to evaluate patients with potential COVID-19 infection. However, this may be particularly risky for pediatric patients due to high doses of ionizing radiation. We sought to evaluate COVID-19 imaging options in pediatric patients based on published literature. We performed an exhaustive literature review focusing on COVID-19 imaing of pediatric patients. Researcher used “COVID-19”, “SARS-CoV2”, “coronavirus”, “2019-nCoV”, “Wuhan virus”, “lung ultrasound (LUS)”, “sonography”, “lung HRCT”, “children”, “childhood” and “newborn” as search terms to query online databases including: US National Library of Medicine (PubMed), Medical Subject Headings (MeSH), Excerpta Medica dataBASE (EMBASE), LitCovid, WHO COVID-19 database and Medical Literature Analysis and Retrieval System Online (Medline Bireme). Articles meeting inclusion criteria were included in the analysis and review. We identified only 7 studies using LUS for diagnosing SARS-CoV2 infection in children. The studies evaluated small numbers of patients and only 6% had severe or critical illness associated with COVID-19. LUS showed the presence of: B-lines in 50% of patients, sub-pleural consolidation in 43.18%, pleural irregularities in 34.09%, coalescent B-lines and white lung in 25%, pleural effusion in 6.82% and thickening of pleural line in 4.55% of newborn/children. Researhers found 117 studies describing CXR or chest CT use in pediatric patients with COVID-19. The proportion of severely or critically ill was similar to the LUS study population. Our review indicates that LUS utilization should be encouraged in pediatric patients, which is at highest risk for complications for medical ionizing radiation. Increased use of LUS may be of particularly high impact in low resourced areas where access to chest CT may be limited.