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Meta-Analysis
. 2021 Feb;93(2):1057-1069.
doi: 10.1002/jmv.26398. Epub 2020 Sep 28.

A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19)

Xiaojian Cui  1 , Zhihu Zhao  2 , Tongqiang Zhang  3   4 , Wei Guo  3 , Wenwei Guo  1 , Jiafeng Zheng  3 , Jiayi Zhang  1 , Cuicui Dong  1 , Ren Na  1 , Lisheng Zheng  1 , Wenliang Li  1 , Zihui Liu  1 , Jia Ma  1 , Jinhu Wang  5 , Sijia He  6 , Yongsheng Xu  3 , Ping Si  1 , Yongming Shen  1 , Chunquan Cai  7   8   9
Affiliations
Meta-Analysis

A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19)

Xiaojian Cui et al. J Med Virol. 2021 Feb.

Abstract

To provide a comprehensive and systematic analysis of demographic characteristics, clinical symptoms, laboratory findings, and imaging features of coronavirus disease 2019 (COVID-19) in pediatric patients. A meta-analysis was carried out to identify studies on COVID-19 from 25 December 2019 to 30 April 2020. A total of 48 studies with 5829 pediatric patients were included. Children of all ages were at risk for COVID-19. The main illness classification ranged as: 20% (95% confidence interval [CI]: 14%-26%; I2 = 91.4%) asymptomatic, 33% (95% CI: 23%-43%; I2 = 95.6%) mild and 51% (95% CI: 42%-61%; I2 = 93.4%) moderate. The typical clinical manifestations were fever 51% (95% CI: 45%-57%; I2 = 78.9%) and cough 41% (95% CI: 35%-47%, I2 = 81.0%). The common laboratory findings were normal white blood cell 69% (95% CI: 64%-75%; I2 = 58.5%), lymphopenia 16% (95% CI: 11%-21%; I2 = 76.9%) and elevated creatine-kinase MB 37% (95% CI: 25%-48%; I2 = 59.0%). The frequent imaging features were normal images 41% (95% CI: 30%-52%; I2 = 93.4%) and ground-glass opacity 36% (95% CI: 25%-47%; I2 = 92.9%). Among children under 1 year old, critical cases account for 14% (95% CI: 13%-34%; I2 = 37.3%) that should be of concern. In addition, vomiting occurred in 33% (95% CI: 18%-67%; I2 = 0.0%) cases that may also need attention. Pediatric patients with COVID-19 may experience milder illness with atypical clinical manifestations and rare lymphopenia. High incidence of critical illness and vomiting symptoms reward attention in children under 1 year old.

Keywords: 2019-nCoV; COVID-19; SARS-CoV-2; children; coronavirus; meta-analysis.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Flow diagram for the included studies
Figure 2
Figure 2
Summary results of the age distribution of all participants
Figure 3
Figure 3
Summary results of illness severity in children with COVID‐19. The definition of illness severity was mentioned as follows: (A) without any clinical symptoms and signs. Chest imaging examination was normal, while the 2019‐nCoV nucleic acid test is positive. B, The main manifestations were acute upper respiratory tract infection and some children may have only digestive symptoms. Physical examination shows no auscultatory abnormalities. C, With pneumonia, some cases may have no clinical symptoms and signs, but chest CT shows lung lesions, which are subclinical. D, The disease usually progresses in about 1 week, and dyspnea occurs, oxygen saturation is less than 92%. E, Children can quickly progress to acute respiratory distress syndrome (ARDS) or respiratory failure, multiple organ dysfunction can be life‐threatening. COVID‐19, coronavirus disease 2019; CT, computed tomography
Figure 4
Figure 4
Aggregated results of clinical presentation in children with COVID‐19. COVID‐19, coronavirus disease 2019
Figure 5
Figure 5
Summary results of laboratory examination in children with COVID‐19. COVID‐19, coronavirus disease 2019
Figure 6
Figure 6
Pooled results of imaging features in children with COVID‐19. COVID‐19, coronavirus disease 2019
See this image and copyright information in PMC

References

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