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COVID-19 in 7780 pediatric patients: A systematic review
Ansel Hoang1, Kevin Chorath1, Axel Moreira2
1Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
Insights
This review found that most children with COVID-19 (coronavirus disease 2019) have an excellent prognosis, with a low mortality rate. Further research is needed to identify children at risk for severe outcomes.
Area of Science:
- Pediatric infectious diseases
- Respiratory viral infections
- Global health
Background:
- Limited data exists on the clinical presentation of COVID-19 in pediatric populations.
- Characterizing symptoms, laboratory findings, and imaging in children is crucial for effective management.
Purpose of the Study:
- To systematically review and synthesize the clinical characteristics, diagnostic findings, and outcomes of COVID-19 in children.
- To provide a comprehensive overview of the pediatric COVID-19 landscape.
Main Methods:
- A systematic literature search was conducted across major medical databases following PRISMA guidelines.
- Included were peer-reviewed studies reporting clinical, imaging, and laboratory data for confirmed pediatric COVID-19 cases.
- Risk of bias was assessed using the National Institutes of Health quality assessment tool.
Main Results:
- 131 studies from 26 countries included 7780 pediatric patients; 19.3% were asymptomatic.
- Fever and cough were common symptoms; chest imaging revealed patchy lesions and ground-glass opacities.
- Underlying conditions were noted in a subset of patients; coinfections and abnormal lab markers were observed. Mortality was low (0.09%), with 11 cases of multisystem inflammatory syndrome.
Conclusions:
- Children with COVID-19 generally exhibit an excellent prognosis.
- Longitudinal studies are necessary to identify risk factors for severe disease, inflammation, and multiorgan failure in pediatric patients.
Background:
Studies summarizing the clinical picture of COVID-19 in children are lacking. This review characterizes clinical symptoms, laboratory, and imaging findings, as well as therapies provided to confirmed pediatric cases of COVID-19.
Methods:
Adhering to PRISMA guidelines, we searched four medical databases (PubMed, LitCovid, Scopus, WHO COVID-19 database) between December 1, 2019 to May 14, 2020 using the keywords "novel coronavirus", "COVID-19" or "SARS-CoV-2". We included published or in press peer-reviewed cross-sectional, case series, and case reports providing clinical signs, imaging findings, and/or laboratory results of pediatric patients who were positive for COVID-19. Risk of bias was appraised through the quality assessment tool published by the National Institutes of Health. PROSPERO registration # CRD42020182261.
Findings:
We identified 131 studies across 26 countries comprising 7780 pediatric patients. Although fever (59·1%) and cough (55·9%) were the most frequent symptoms 19·3% of children were asymptomatic. Patchy lesions (21·0%) and ground-glass opacities (32·9%) depicted lung radiograph and computed tomography findings, respectively. Immunocompromised children or those with respiratory/cardiac disease comprised the largest subset of COVID-19 children with underlying medical conditions (152 of 233 individuals). Coinfections were observed in 5.6% of children and abnormal laboratory markers included serum D-dimer, procalcitonin, creatine kinase, and interleukin-6. Seven deaths were reported (0·09%) and 11 children (0·14%) met inclusion for multisystem inflammatory syndrome in children.
Interpretation:
This review provides evidence that children diagnosed with COVID-19 have an overall excellent prognosis. Future longitudinal studies are needed to confirm our findings and better understand which patients are at increased risk for developing severe inflammation and multiorgan failure.
Funding:
Parker B. Francis and pilot grant from 2R25-HL126140. Funding agencies had no involvement in the study.
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