Severe Outcomes Associated With SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo estimate the proportion of SARS-CoV-2 infected children experiencing hospitalization, intensive care unit (ICU) admission, severe outcomes, and death.Data SourcesPubMed, Embase, and MedRxiv were searched for studies published between December 1, 2019 and May 28, 2021. References of relevant systematic reviews were also screened.Study SelectionWe included cohort or cross-sectional studies reporting on at least one outcome measure (i.e., hospitalization, ICU admission, severe outcomes, death) for ≥100 children ≤21 years old within 28 days of SARS-CoV-2 positivity; no language restrictions were applied.Data Extraction and SynthesisTwo independent reviewers performed data extraction and risk of bias assessment. Estimates were pooled using random effects models. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.Main Outcomes and MeasuresPercentage of SARS-CoV-2 positive children experiencing hospitalization, ICU admission, severe outcome, and death.Results118 studies representing 3,324,851 SARS-CoV-2 infected children from 68 countries were included. Community-based studies (N = 48) reported that 3.3% (95%CI: 2.7–4.0%) of children were hospitalized, 0.3% (95%CI: 0.2–0.6%) were admitted to the ICU, 0.1% (95%CI: 0.0–2.2%) experienced a “severe” outcome and 0.02% (95%CI: 0.001–0.05%) died. Hospital-based screening studies (N = 39) reported that 23.9% (95%CI: 19.0–29.2%) of children were hospitalized, 2.9% (95%CI: 2.1–3.8%) were admitted to the ICU, 1.3% (95%CI: 0.5–2.3%) experienced a severe outcome, and 0.2% (95%CI: 0.02–0.5%) died. Studies of hospitalized children (N = 31) reported that 10.1% (95%CI: 6.1–14.9%) of children required ICU admission, 4.2% (95%CI: 0.0–13.8%) had a severe outcome and 1.1% (95%CI: 0.2–2.3%) died. Low risk of bias studies, those from high-income countries, and those reporting outcomes later in the pandemic presented lower estimates. However, studies reporting outcomes after May 31, 2020, compared to earlier publications, had higher proportions of hospitalized patients requiring ICU admission and experiencing severe outcomes.Conclusion and RelevanceAmong children tested positive for SARS-CoV-2, 3.3% were hospitalized, with rates being higher early in the pandemic. Severe outcomes, ICU admission and death were uncommon, however estimates vary by study population, pandemic timing, study risk of bias, and economic status of the country.Systematic Review RegistrationPROSPERO, identifier [CRD42021260164].

Early Childhood COVID-19: A Comparative Report of 20,506 Cases

“…1,4 In a meta-analysis of 31 studies in hospitalized children, a cumulative mortality rate of 1.1% was reported. 5 The relatively higher rate of mortality in our study is partly due to the younger population; but other contributing factors, for which our dataset may not account for, need further and thorough investigation.…”

High SARS-CoV-2 incidence and asymptomatic fraction during Delta and Omicron BA.1 waves in The Gambia

“…A striking finding in our cohort was that children <5 years old were relatively protected from SARS-CoV-2 infection, even with the more transmissible Omicron BA.1 variant. Many studies have reported that young children are protected from severe COVID-19 and are more likely to experience mild or asymptomatic infection 26 – 29 . Our data suggest that young children may be relatively protected from SARS-CoV-2 infection and not just severe disease.…”

Arrhythmia and COVID-19 in children

“…Children infected with SARS-CoV-2 generally have mild symptoms, with reported mortality rates of <0.1% [ 6 , 22 - 25 ]. A significant number of children (15%–42%) are asymptomatic, whereas 18%–57% require hospitalization [ 25 - 29 ].…”

“…In a European multicenter study of 582 individuals <18 years of age with polymerase chain reaction (PCR)-confirmed COVID-19, 8% of study participants required ICU admission, 4% required mechanical ventilation, 3% required inotropic support, and 1% required extracorporeal membrane oxygenation (ECMO) support [ 26 ]. A meta-analysis by Sumner et al [ 6 ] demonstrated that, among 973 hospitalized school-aged patients, 10.1% required ICU admission, 4.2% had a severe outcome, and 1.1% (95% confidence interval, 0.2%–2.3%) died.…”

“…Its cardiovascular complications include acute myocarditis, pericarditis, vasculitis, heart failure, venous thromboembolism, and arrhythmia, all of which are associated with increased mortality in adults [ 2 - 5 ]. Children generally have milder symptoms than adults, but severe pediatric cases have been described [ 6 ]. Furthermore, multisystem inflammatory syndrome in children (MIS-C) with the feature of Kawasaki disease and toxic shock syndrome is a severe postinflammatory complication of SARS-CoV-2 infection reported mainly in children and adolescents [ 7 - 9 ].…”