COVID-19 in 7780 pediatric patients: A systematic review

Abstract

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.

Hospital and Population-Based Evidence for COVID-19 Early Circulation in the East of France

“…Existing COVID-19 epidemiological data show that children are significantly less affected than adults [ 24 , 25 ]. Another study conducted in one of the earliest French COVID-19 clusters in the department of Oise has documented that infection in young children (below 12 years old) was largely mild or asymptomatic, but also that other respiratory viruses were circulating concurrently with COVID-19 in the French population in February 2020 [ 26 ].…”

“…We also estimated the generation interval as the mean difference between the occurrence days of two successive cases in the same family [ 22 , 23 ]. Considering that children were more sensitive to other seasonal respiratory viruses than to COVID-19 [ 24 , 25 ], we compared the seven day moving average of daily incidence among children under 15 years old and among adults and children aged 15 years and older.…”

Targeting Host Defense System and Rescuing Compromised Mitochondria to Increase Tolerance against Pathogens by Melatonin May Impact Outcome of Deadly Virus Infection Pertinent to COVID-19

“…As mentioned in Section 5.1 , children have the highest melatonin levels and this may be related to their less severe symptoms and lowest mortality relative to other age groups in COVID-19 patients [ 229 , 230 ]. Pregnant women with COVID-19 are a special population with a mostly lower grade of severity, less enhanced inflammatory response and more favorable cell immunity than other individuals in a similar age group [ 231 ].…”

Outcome of SARS-CoV-2 and immune thrombocytopenia in a pediatric patient

“…Systematic review of 7,780 pediatric patients with COVID-19 did not find bruises, petechiae, thrombocytopenia or neutropenia as disease manifestations. 5 Therefore, the patient presented a clinical condition different from the usual, reporting skin bleeding as the initial symptom, with thrombocytopenia and neutropenia appearing as laboratory test results. As already described in the literature for most symptomatic pediatric cases with COVID-19, the clinical and laboratory manifestations are mild, 1 , 3 as observed in the reported patient.…”