Pediatric COVID-19: Systematic review of the literature

Abstract

Objectives There is limited data regarding the demographics and clinical features of SARS-CoV-2 infection in children. This information is especially important as pneumonia is the single leading cause of death in children worldwide. This Systematic Review aims to elucidate a better understanding of the global impact of COVID-19 on the pediatric population. Methods A systematic review of the literature was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to gain insight into pediatric COVID-19 epidemiology. Specifically, Pubmed and Google Scholar databases were searched to identify any relevant article with a focus on Pediatric Covid 19, Pediatric Covid-19, Pediatric SARS-COV-2 , and Pediatric Coronavirus 19 . References within the included articles were reviewed. All articles that met criteria where analyzed for demographics, clinical, laboratory, radiographic, treatment and outcomes data. Results Ten studies including two case series and 8 retrospective chart reviews, altogether describing a total of 2914 pediatric patients with COVID-19 were included in this systematic review. Of the patients whose data was available, 56% were male, the age range was 1 day to 17 years, 79% were reported to have no comorbidities, and of the 21% with comorbidities, the most common were asthma, immunosupression, and cardiovascular disease. Of pediatric patients that were tested and positive for an infection with SARS-CoV-2, patients were asymptomatic, 14.9% of the time. Patients presented with cough (48%), fever (47%) and sore throat/pharyngitis (28.6%), more commonly than with upper respiratory symptoms/rhinorrhea/sneezing/nasal congestion (13.7%), vomiting/nausea (7.8%) and diarrhea (10.1%). Median lab values including those for WBC, lymphocyte count and CRP, were within the reference ranges with the exception of procalcitonin levels, which were slightly elevated in children with COVID-19 (median procalcitonin levels ranged from 0.07 to 0.5 ng/mL. Computed tomography (CT) results suggest that unilateral CT imaging findings are present 36% of cases while 64% of pediatric patients with COVID-19 had bilateral findings. Of the studies with age specific hospitalization data available, 27.0% of patients hospitalized were infants under 1 year of age. Various treatment regimens including interferon, antivirals, and hydroxychloroquine therapies have been trialed on the pediatric population but there are currently no studies showing efficacy of one regimen over the other. The mortality rate of children that were hospitalized with COVID-19 was 0.18%. Conclusion In contrast to adults, most infected children appear to have a milder course and have better outcomes overall. Additional care may be needed for children with comorbidities and younger children. This review also suggests that unilateral CT chest imaging finding...

A Multi-Center Retrospective Study of Clinical features, Laboratory Characteristics, and Outcomes of 325  Hospitalized Children with Coronavirus Disease 2019 (COVID-19); A Preliminary Report from Iranian Network for Research in Viral Diseases (INRVD)

“…The present study showed that ground-glass opacity and lung consolidation showed signi cant correlations with disease severity. Similar ndings were observed by others [8,19,21,27]. Two studies compared the radiological features between severe versus non-severe cases [19,20].…”

“…Nevertheless, in other publications from China and the USA, GI manifestations were reported at 8-29% [8,[22][23][24]. Patel et al reported a prevalence of 128 (20%) GI symptoms among 633 patients from 10 studies [21]. Cough and GI symptoms were common among severe cases in a systematic review and meta-analysis [8].…”

“…Similarly, fever, cough, shortness of breath, and dyspnea have been reported as the most common symptoms among admitted children to the hospitals in the USA [19] and China [20], respectively. Overall, in a systematic review published by Patel et al of 633 patients from 10 studies, 296 (46.7%) had a fever [21]. Other publications emphasized the presence of fever as well as respiratory symptoms among children with different proportions, especially in severe cases [19,20,22].…”

Hematological manifestations of SARS‐CoV‐2 in children

“…26 Two more recent systematic reviews and meta-analyses confirmed the findings that most children with COVID-19 had a normal WBC count, and that the most common abnormality was leukopenia. 35,36 These reviews, however, provided no information on the association of the various WBC abnormalities (leukopenia, lymphopenia) with the disease severity or clinical course.…”

Effect of COVID-19 in Paediatric Population: Review of Recent Studies

“…Although different treatments have been tried to fight COVID-19, none of them has proven to be more efficient than other. 3 There are three factors which can help to estimate the number of children who might be severely ill due to COVID-19. First among them is the number of children at risk in population.…”