Patients.
The Epidemiological Study of Coronavirus in Children (EPICO-AEP) is a
prospective multicenter national study conducted in Spain to assess the
characteristics of children with COVID-19. In the present study, we
included hospitalized children with a primary diagnosis of
SARS-CoV-2-associated pneumonia enrolled in EPICO-AEP. CAP was defined
as fever or respiratory symptoms and an image consistent with pneumonia
in the chest x-ray, according to the criteria applied by the attending
physician. COVID-19 infection was confirmed by RT-PCR testing or by
rapid antigen detection testing on nasopharyngeal swabs. We enrolled
pediatric patients (ages 18 years and younger) from 80 hospitals of the
network, from February 25th, 2020 to April
30th, 2021.
Epidemiological, clinical, laboratory and radiological data were
collected from medical records, including the age at onset of the
infection, sex, clinical signs and symptoms, outcomes, laboratory data,
chest X‐ray findings, comorbidities, treatment, and pediatric intensive
care unit (PICU) admission. Radiographs were obtained following the
institutional protocols of each participating center, and all included
patients underwent at least one chest X-ray. We used a standardized data
collection online platform (Research Electronic Data Capture:
RedCAPTM) to record and collect the clinical data.
The findings were compared with data from children diagnosed with
viral-associated CAP from a different study performed by our
group11. In this study, eligible participants were
children under 18 years of age admitted to any of the participating
hospitals, with radiologically-confirmed CAP, from April 2012 to May
2019. An extensive microbiological workup was performed, including blood
cultures, Streptococcus pneumoniae antigen
(BinaxNowTM) and/or RT-PCR for S.pneumoniae in
pleural fluid if thoracentesis was performed, RT-PCR in blood forS.pneumoniae , multiplex RT-PCR on nasopharyngeal aspirate samples
for pertussis and for the following panel of 16 viruses: RSV, hMPV, PIV
1, 2, 3 and 4, influenza (A and B), human bocavirus (hBoV), ADV,
enterovirus (EV), RhV, and coronavirus (CoV) 229E, OC43, NL63 and HKU12.
Two paired samples for serology (at admission and 2–4 weeks later) forMycoplasma pneumoniae and Chlamydia pneumoniae were
performed using enzyme-linked immunoassays 12.
Viral etiology was assigned to CAP if at least one putative pathogen
respiratory virus (RSV, influenza A or B, PIV, hMPV) was detected in
nasopharyngeal aspirates by PCR, and no bacterial pathogen was detected.
Other respiratory viruses (RhV, ADV, EV, CoV, hBoV) were not included as
likely viral infections due to poor specificity for
CAP13,14.
Both studies were approved by the ethics committee of every center, and
all guardians signed the informed consent to participate in the study.