Clinical characteristics of COVID‐19 in children: A systematic review

Abstract

Background Limited pediatric cases with coronavirus disease 2019 (COVID‐19) have been reported and the clinical profiles regarding COVID‐19 in children remain obscure. Our aim was to investigate the clinical characteristics of COVID‐19 in children. Methods PUBMED and EMBASE were searched through 20 June 2020, for case reports and case series reporting pediatric COVID‐19 cases. Epidemiological, clinical, laboratory, and radiological data were collected and analyzed to compare by age. Results Our search identified 46 eligible case reports and case series. A total of 114 pediatric cases with COVID‐19 were included. The main clinical features were mild symptoms including fever (64%), cough (35%), and rhinorrhea (16%), or no symptoms (15%). Ground‐like opacities were common radiological findings (54%). The main laboratory findings were lymphopenia (33%) and elevated D‐dimer (52%) and C‐reactive protein (40%) levels. We identified 17 patients (15%) with multisystem inflammatory syndrome in children (MIS‐C) manifesting with symptoms overlapping with, but distinct from, Kawasaki disease, including gastrointestinal symptoms, left ventricular systolic dysfunction, shock, and marked elevated inflammatory biomarkers. Twelve percent of the patients including 65% of the MIS‐C cases required intensive care because of hypotension. No deaths were reported. Conclusion This systematic review found that children with COVID‐19 are generally less severe or asymptomatic. However, infants might be seriously ill and older children might develop MIS‐C with severe illness. Early detection of children with mild symptoms or an asymptomatic state and early diagnosis of MIS‐C are mandatory for the management of COVID‐19 and the prevention of transmission and a severe inflammatory state.

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

“…We included 18 reviews in our analysis. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Characteristics of the included reviews are shown in table 1; all are freely available online (see online supplemental appendix table 2). All reviews were in English.…”

Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic

“…To date, few data on European pediatric COVID-19 have been published, but specific management strategies were recommended (59). Children and adolescents seem to be less often affected and to experience a milder form of illness compared to adults (60)(61)(62)(63). However, uncertainties on treatment options in the pediatric age are still present.…”

COVID-19 in Pediatric Patients: A Focus on CHD Patients

“…Il-6 was found to be inappropriately elevated in two distinct cases of pediatric myocarditis (52,54). Similarly, CRP, pro-calcitonin and ferritin were elevated in most cases of Kawasaki-like disease and myocarditis (54,(56)(57)(58). Kawasaki-like disease may occur following a prior infection of COVID-19 documented by the presence of SARS-CoV-2 IgG antibodies or a known contact with a confirmed case of COVID-19 (58).…”

“…These manifestations are triggered primarily by the massive immune response mounted against the viral infection (50)(51)(52)(53)(54)(55). In fact, elevated levels of inflammatory markers have been noted in patients with COVID-19 associated Kawasaki-like disease or myocarditis (52,54,56). Il-6 was found to be inappropriately elevated in two distinct cases of pediatric myocarditis (52,54).…”

“…Nevertheless, the disease may develop 2-4 weeks after a COVID-19 infection in any patient aged <21 years (60). SARS-CoV-2 infections complicated by MIS-C are often associated with fatal conditions denoted by heart failure, hepatic injury, renal dysfunction and coagulopathies (56).…”