illustration of lungs surrounded by virus

COVID-19: First comprehensive review of pediatric lung imaging features

illustration of lungs surrounded by virus

A systematic review and meta-analysis by Children’s National Hospital researchers, published in Pediatric Pulmonology, provides the first comprehensive review of the findings of published studies describing COVID-19 lung imaging data in children.

The number COVID-19 studies focused on children have been small and with limited data. This has prevented the identification of specific pediatric lung disease patterns in COVID-19. Although children make up around 9.5% of COVID-19 infections, less than 2% of the literature on the virus, its symptoms and effects, have focused on kids.

A systematic review and meta-analysis by Children’s National Hospital researchers, published in Pediatric Pulmonology, provides the first comprehensive review of the findings of published studies describing COVID-19 lung imaging data in children. The analysis concludes that chest CT manifestations in children with COVID‐19 could potentially prompt intervention in the pediatric population.

Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National, discusses the importance of this work.

Q: What findings stand out to you?

A: We found that more than a third of children with COVID-19 had normal imaging. The lung imaging findings in these children were overall less frequent and less severe than in adult patients, but they were also more heterogeneous than in adults. Importantly, children with COVID-19 were three times more likely to have a normal exam than adults.

Several common lung imaging findings reported in adults were extremely rare or not found in the pediatric studies. These discoveries, and other recent reports in this space, support the fact that children’s symptoms may be less obvious than adults or even absent, but they still carry the virus and may be at risk for serious and life-threatening illness.

Marius George Linguraru

Marius George Linguraru, D.Phil., M.A., M.Sc., principal investigator in the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National.

Q: How will the findings of this study benefit pediatric care?

A: In our study, we showed how the health of the lungs of these children is impacted. Our results from data from 1,026 children (from newborns to 18 year old) with COVID-19 present chest manifestations that could potentially prompt informed intervention and better recovery.

Another conclusion of our study is that the abnormalities reported on the chest scans of children infected with COVID-19 are distinct from the typical lung images seen during other viral respiratory infections in the pediatric population. This is important for preparing for the cold and flu season.

Q: Why was this review important to our understanding of how COVID-19 impacts children?

A: This is the first systematic review and meta-analysis focused on the manifestation of the COVID-19 infection in the lungs of children. Our study, and others from colleagues at Children’s National, helps lead the efforts on elucidating how the pandemic affects the health of children.

Though children were initially thought to be less susceptible to infection, the data has made it clear that many children are at high risk for hospitalization and severe health complications. Although there are similarities between how children and adults are affected by the pandemic, there are also critical differences.

Given the limited knowledge in the manifestation of COVID-19 in children, with children susceptible to infection and hospitalization, and with children returning to school, continued efforts to understand the impact of COVID-19 on young patients is critically important. Understanding how children fare through the pandemic is the foundation of discovering better ways to take care of young patients and their health.

You can find the full study published in Pediatric Pulmonology. Learn more about the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children’s National.

The science-policy interface

We can do better: Lessons learned on COVID-19 data sharing can inform future outbreak preparedness

Since COVID-19 emerged late last year, there’s been an enormous amount of research produced on this novel coronavirus disease. But the content publicly available for this data and the format in which it’s presented lack consistency across different countries’ national public health institutes, greatly limiting its usefulness, Children’s National Hospital scientists report in a new study. Their findings and suggestions, published online August 19 in Science & Diplomacy, could eventually help countries optimize their COVID-19-related data — and data for future outbreaks of other diseases — to help further new research, clinical decisions and policy-making around the world.

Recently, explains study senior author Emmanuèle Délot, Ph.D., research faculty at Children’s National Research Institute, she and her colleagues sought data on sex differences between COVID-19 patients around the world for a new study. However, she says, when they checked the information available about different countries, they found a startling lack of consistency, not only for sex-disaggregated data, but also for any type of clinical or demographic information.

“The prospects of finding the same types of formats that would allow us to aggregate information, or even the same types of information across different sites, was pretty dismal,” says Dr. Délot.

To determine how deep this problem ran, she and colleagues at Children’s National, including Eric Vilain, M.D., Ph.D., the James A. Clark Distinguished Professor of Molecular Genetics and the director of the Center for Genetic Medicine Research at Children’s National, and Jonathan LoTempio, a doctoral candidate in a joint program with Children’s National and George Washington University, surveyed and analyzed the data on COVID-19.

The research spanned data reported by public health agencies from highly COVID-19 burdened countries, viral genome sequence data sharing efforts, and data presented in publications and preprints.

PubMed entries with coronavirus

Publications with the term “coronavirus” archived in PubMed over time.

At the time of study, the 15 countries with the highest COVID-19 burden at the time included the US, Spain, Italy, France, Germany, the United Kingdom, Turkey, Iran, China, Russia, Brazil, Belgium, Canada, the Netherlands and Switzerland. Together, these countries represented more than 75% of the reported global cases. The research team combed through COVID-19 data presented on each country’s public health institute website, looking first at the dashboards many provided for a quick glimpse into key data, then did a deeper dive into other data on this disease presented in other ways.

The data content they found, says LoTempio, was extremely heterogeneous. For example, while most countries kept running totals on confirmed cases and deaths, the availability of other types of data — such as the number of tests run, clinical aspects of the disease such as comorbidities, symptoms, or admission to intensive care, or demographic information on patients, such as age or sex — differed widely among countries.

Similarly, the format in which data was presented lacked any consistency among these institutes. Among the 15 countries, data was presented in plain text, HTML or PDF. Eleven offered an interactive web-based data dashboard, and seven had comma-separated data available for download. These formats aren’t compatible with each other, LoTempio explains, and there was little to no documentation about where the data that supplies some formats — such as continually updated web-based dashboards — was archived.

The science-policy interface

Graphic representation of the science-policy interface.

Dr. Vilain says that a robust system is already in place to allow uniform sharing of data on flu genomes — the World Health Organization’s (WHO) Global Initiative on Sharing All Influenza Data (GISAID) — which has been readily adapted for the virus that causes COVID-19 and has already helped advance some types of research. However, he says, countries need to work together to develop a similar system for harmonized sharing other types of data for COVID-19. The study authors recommend that COVID-19 data should be shared among countries using a standardized format and standardized content, informed by the success of GISAID and under the backing of the WHO.

In addition, the authors say, the explosion of research on COVID-19 should be curated by experts who can wade through the thousands of papers published on this disease since the pandemic began to identify research of merit and help merge clinical and basic science.

“Identifying the most useful science and sharing it in a way that’s usable to most researchers, clinicians and policymakers, will not only help us emerge from COVID-19 but could help us prepare for the next pandemic,” Dr. Vilain says.

Other researchers who contributed to this study include D’Andre Spencer, MPH, Rebecca Yarvitz, BA, and Arthur Delot-Vilain.

Drs. Tarini, Steinhorn, and Beers

Children’s National Hospital: Starting the new year with strong leadership

Drs. Tarini, Steinhorn, and Beers

Drs. Tarini, Steinhorn and Beers are also in leadership roles within professional societies, elected by their peers, further highlighting the strength of the leadership at Children’s National and professional respect within the health care community.

Three Children’s National Hospital executives are also in leadership roles within professional societies, elected by their peers, further highlighting the strength of the leadership at Children’s National and professional respect within the health care community.

Lee Savio Beers, M.D., FAAP, medical director of Community Health and Advocacy at the Child Health Advocacy Institute (CHAI) at Children’s National, was elected by her peers to become president-elect of the American Academy of Pediatrics (AAP) beginning Jan. 1, 2020. Dr. Beers will then serve as AAP president in 2021 for a one-year term.

“I am humbled and honored to have the support of my peers in taking on this newest leadership role,” says Dr. Beers. “AAP has been a part of my life since I first became a pediatrician, and my many leadership roles in the DC chapter and national AAP have given me a glimpse of the collective good we pediatricians can accomplish by working together toward common strategic goals.”

Dr. Beers is looking forward to continuing her work bringing together the diverse voices of pediatricians, children and families as well as other organizations to support improving the health of all children.

Robin Steinhorn, M.D., senior vice president of the Center for Hospital-Based Specialties at Children’s National was elected by her peers to become Vice President and President-elect of the American Pediatric Society (APS) in May 2018 and she is currently serving her role as the Society’s president, which began in May 2019.

“This is a tremendous honor. I look forward to leveraging the collective leadership and research accomplishments by our members to improve the health of infants and children throughout the U.S.,” said Dr. Steinhorn.

Dr. Steinhorn is particularly passionate about mentoring faculty and supporting the growth and career development of young neonatologists and scientists, with several having developed their own research laboratories and assumed division and department leadership positions. She was selected as a ‘Top Doctor’ by Northern Virginia Magazine in 2019.

Beth A. Tarini, M.D., MS, associate director, Center for Translational Research at The Children’s Research Institute, became vice president of the Society for Pediatric Research (SPR) in May 2019. Dr. Tarini will transition to President-Elect in May 2020 and become President in May 2021.

Dr. Tarini’s personal mission during this tenure will be to ensure that more pediatric researchers get to know SPR and are so excited about the organization that they become active members.

Dr. Tarini says she looks forward to working with other SPR leaders to find ways to build more productive, collaborative professional networks among faculty, especially emerging junior faculty. “Facilitating ways to network for research and professional reasons across pediatric research is vital – albeit easier said than done. I have been told I’m a connector, so I hope to leverage that skill in this new role,” says Dr. Tarini.

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Dr. Laura Olivieri holding a 3D printed heart

Cardiology and radiology experts to participate in CMR 2018

Later this month, the international cardiovascular magnetic resonance (CMR) community will gather in Barcelona, Spain, for CMR 2018, a joint meeting organized by the European Association of Cardiovascular Imaging (EACVI) and the Society for Cardiovascular Magnetic Resonance (SCMR). Among the many attendees will be several cardiology and radiology experts from Children’s National Heart Institute:

  • Pediatric cardiology fellow Ashish Doshi, M.D., will be giving a talk titled, “Subendocardial resting perfusion defect in a case of acute fulminant myocarditis,” and will also present a poster titled, “Native T1 measurements in pediatric heart transplant patients correlate with history of prior rejection episodes.”
  • Pediatric cardiology fellow Rohan Kumthekar, M.D., will present a poster titled, “Native T1 values can identify pediatric patients with myocarditis.”
  • Cardiologist Laura Olivieri, M.D., will present two posters: “Native T1 measurements from CMR identify severity of myocardial disease over time in patients with Duchenne muscular dystrophy on therapy,” and “Feasibility of noncontrast T1 and T2 parametric mapping in assessment of acute ventricular ablation lesions in children.”
  • Pediatric cardiology fellow Neeta Sethi, M.D., will present a poster titled, “Cardiac magnetic resonance T2 mapping in the surveillance of acute allograft rejection in pediatric cardiac transplant patients.”

Additionally, Drs. Doshi and Sethi and Ileen Cronin, FNP-BC, a nurse practitioner in the Cardiac Catheterization Laboratory/Interventional Cardiac Magnetic Resonance (ICMR) Program, received travel awards to attend the conference.

CMR 2018 will be held January 31-February 3, 2018 and will focus on the theme of “Improving Clinical Value by Technical Advances.” The meeting’s emphasis will be on the common goal of improving clinical outcomes in cardiovascular disease through innovation in basic MR development and medical engineering.

William Gaillard

William D. Gaillard, M.D., elected Second Vice President of the American Epilepsy Society

William Gaillard

William Davis Gaillard, M.D., has been elected second vice president of the American Epilepsy Society (AES), a medical and scientific society with 4,000 members. Dr. Gaillard’s term started at the end of the society’s annual meeting, December 1-5, in Washington, D.C.

“The AES is the largest multidisciplinary professional and scientific society dedicated to the understanding, treatment and eradication of epilepsy and associated disorders, and I am honored to serve as the new Second Vice President.” Dr. Gaillard said.

Dr. Gaillard, an internationally recognized expert in pediatric epilepsy and imaging, is chief of Neurology, Epilepsy and Neurophysiology at Children’s National. He is also the associate director of the DC-IDDC and director of the of the Intellectual and Developmental Disabilities Research Center (DC-IDDRC) imaging core and associate director of the Center for Neuroscience Research, Children’s Research Institute. His academic appointments include professor of Pediatrics and Neurology at George Washington University and professor of Neurology at Georgetown University.

As division chief of Child Neurology, Epilepsy and Neurophysiology, Dr. Gaillard directs a team of pediatric specialists who see thousands of patients each year. Dr. Gaillard has worked throughout his career to care for children and young adults with epilepsy from the onset of seizures through novel therapeutic interventions, medication trials and, when appropriate, surgery. Treatment at Children’s National addresses the full range of the condition, including problems of difficult-to-control epilepsy. Additionally, treatment includes the concurrent social, educational and emotional issues faced by children with the condition and their families.

An active participant in AES activities, Dr. Gaillard has served as treasurer and as chair of the Clinical Investigator Workshop and Pediatric Content Committees. He also serves as an associate editor for the journal Epilepsy Research, and as a regular reviewer on AES and Epilepsy Foundation study sections. Dr. Gaillard will service as first vice president in 2019 and accede to the presidency of AES in 2020.

Dorothy Bulas

Congratulations to Dorothy Bulas, M.D. – 2017 RSNA Outstanding Educator recipient

Dorothy Bulas

Dorothy Bulas, M.D., section head of ultrasound and fetal imaging at Children’s National Health System, was honored with the RSNA 2017 Outstanding Educator award at the Radiological Society of North America’s (RSNA) Annual Meeting, held November 26 – December 1 in Chicago, Illinois.

The winner of the award is selected annually by the RSNA Board of Directors based on the awardee’s significant contributions and long-term commitment – 15 years or more – to radiologic education.

“In addition to being a talented clinician and an accomplished researcher, Dr. Bulas is an extraordinary teacher who has made tireless contributions to the educational programs of RSNA,” said RSNA President Richard L. Ehman, M.D. “For more than three decades, she has been a passionate and effective advocate for improving pediatric radiology worldwide – especially in poorly served countries – by participating in educational outreach.”