Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis

Abstract

ObjectiveCompare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity.DesignSystematic review and meta-analysis.SettingBetween 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0–19 years old) COVID-19 were considered for inclusion.Main outcomes and measuresThe pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity.Results129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample.ConclusionPaediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.

Critical analysis of acute kidney injury in pediatric COVID-19 patients in the intensive care unit

“…Furthermore, there is a significant difference among the outcomes of children with COVID-19 receiving care in high-income countries versus low-and middle-income countries. In comparison to high-income countries, low-and middleincome countries report lower proportions of admissions to the ICU (9.9% vs. 26.0%), yet higher numbers of deaths (relative risk 2.14, 95% CI: 1.43 to 3.20) [9]. This suggests that more large-scale global studies are required to fully assess the extent of AKI in pediatric COVID patients.…”

“…Furthermore, multisystem inflammatory syndrome in children (MIS-C) is a life-threatening complication of the virus specifically among children. MIS-C is associated with SARS-CoV-2 and has been shown to occur within 2-4 weeks, most commonly after an infection [9,10]. Children with MIS-C have been reported to exhibit symptoms similar to those of Kawasaki disease including fever, toxic shock syndrome, macrophage activation syndrome, secondary hemophagocytic lymphohistiocytosis, and multisystem organ involvement, which commonly includes AKI [9,11,12].…”

Risk of infection and transmission of SARS-CoV-2 among children and adolescents in households, communities and educational settings: A systematic review and meta-analysis

“…This is especially true in novel pandemics where pharmaceutical interventions, such as vaccines, are not immediately available and delaying disease spread is a priority [ 3 - 6 ]. However, children and adolescents under 19 years of age comprise a small proportion of total reported COVID-19 cases (1%-10%) [ 7 - 9 ]. This group has been reported to present with a milder clinical course compared to adults infected with SARS-CoV-2, with more favorable outcomes in general [ 7 , 9 - 11 ].…”

“…However, children and adolescents under 19 years of age comprise a small proportion of total reported COVID-19 cases (1%-10%) [ 7 - 9 ]. This group has been reported to present with a milder clinical course compared to adults infected with SARS-CoV-2, with more favorable outcomes in general [ 7 , 9 - 11 ].…”

Legacy of COVID-19 infection in children: long-COVID will have a lifelong health/economic impact

“…Studies have repeatedly shown that children less frequently and less severely manifest acute COVID-19 infection 1 However, as with the whole of the world population, children have been subjected to the direct and indirect effects of lockdowns, restricted education and social interactions, with potential lifelong impacts on mental and physical health. 2…”