Clinical Characteristics of Asymptomatic and Symptomatic Pediatric Coronavirus Disease 2019 (COVID-19): A Systematic Review

Abstract

Background and objectives: Characterization of pediatric coronavirus disease 2019 (COVID-19) is necessary to control the pandemic, as asymptomatic or mildly infected children may act as carriers. To date, there are limited reports describing differences in clinical, laboratory, and radiological characteristics between asymptomatic and symptomatic infection, and between younger and older pediatric patients. The objective of this study is to compare characteristics among: (1) asymptomatic versus symptomatic and (2) less than 10 versus greater or equal to 10 years old pediatric COVID-19 patients. Materials and Methods: We searched for all terms related to pediatric COVID-19 in electronic databases (Embase, Medline, PubMed, and Web of Science) for articles from January 2020. This protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: Eligible study designs included case reports and series, while we excluded comments/letters, reviews, and literature not written in English. Initially, 817 articles were identified. Forty-three articles encompassing 158 confirmed pediatric COVID-19 cases were included in the final analyses. Lymphocytosis and high CRP were associated with symptomatic infection. Abnormal chest CT more accurately detected asymptomatic COVID-19 in older patients than in younger ones, but clinical characteristics were similar between older and younger patients. Conclusions: Chest CT scan findings are untrustworthy in younger children with COVID-19 as compared with clinical findings, or significant differences in findings between asymptomatic to symptomatic children. Further studies evaluating pediatric COVID-19 could contribute to potential therapeutic interventions and preventive strategies to limit spreading.

Open Schools, Covid-19, and Child and Teacher Morbidity in Sweden

“…The results of an overview study published in May have been confirmed by several recent systematic reviews from several countries (11,12,17). The surveys show that a high proportion of children who became seriously ill and were on a ventilator had other underlying diseases (18), most commonly heart disease.…”

“…Children experience milder symptoms of COVID-19 than adults (11). Fever and a cough are the most commonly reported symptoms, like in adults, while some children also experience diarrhoea, vomiting, fatigue and a runny nose (11)(12)(13).…”

Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020

“…Several systematic reviews have synthetised the clinical features and outcomes of paediatric cases with a confirmed SARS-CoV-2 infection [ 11 - 17 ] but as yet, few studies have explored the risk factors associated with a positive SARS-CoV-2-positive diagnostic swab test. It is currently not known whether factors indicating increased risk of SARS-CoV-2 infection in adults [ 18 - 21 ], such as exposure history, obesity, lymphocytopenia or ground glass opacity at lung X-ray [ 19 ], apply to children.…”

Cigarette Smoke Exposure, Pediatric Lung Disease, and COVID-19

“…Presenting symptoms are mostly non-specific and self-limiting, which makes it difficult to distinguish COVID-19 from other common viral illnesses, possibly driving a lower testing rate in this population. Children may or may not have fever, and usually present either with cough or gastrointestinal symptoms in addition to more general symptoms such as rhinorrhea, sore throat, headache, and myalgia ( Verma and Amin, 2020 ; Yoon et al, 2020 ; Fernandes et al, 2021 ). Of note, 40–50% of COVID-19 pediatric cases have a documented coinfection with other respiratory pathogens ( Wu et al, 2020 ).…”