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Meta-Analysis
. 2021 Feb:103:246-256.
doi: 10.1016/j.ijid.2020.11.163. Epub 2020 Nov 20.

Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis

Boyan K Tsankov  1 , Joannie M Allaire  2 , Michael A Irvine  3 , Alison A Lopez  4 , Laura J Sauvé  5 , Bruce A Vallance  6 , Kevan Jacobson  7
Affiliations
Meta-Analysis

Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis

Boyan K Tsankov et al. Int J Infect Dis. 2021 Feb.

Abstract

Objective: There is limited information on the severity of COVID-19 infection in children with comorbidities. We investigated the effects of pediatric comorbidities on COVID-19 severity by means of a systematic review and meta-analysis of published literature.

Methods: PubMed, Embase, and Medline databases were searched for publications on pediatric COVID-19 infections published January 1st to October 5th, 2020. Articles describing at least one child with and without comorbidities, COVID-19 infection, and reported outcomes were included.

Results: 42 studies containing 275,661 children without comorbidities and 9,353 children with comorbidities were included. Severe COVID-19 was present in 5.1% of children with comorbidities, and in 0.2% without comorbidities. Random-effects analysis revealed a higher risk of severe COVID-19 among children with comorbidities than for healthy children; relative risk ratio 1.79 (95% CI 1.27 - 2.51; I2 = 94%). Children with underlying conditions also had a higher risk of COVID-19-associated mortality; relative risk ratio 2.81 (95% CI 1.31 - 6.02; I2 = 82%). Children with obesity had a relative risk ratio of 2.87 (95% CI 1.16 - 7.07; I2 = 36%).

Conclusions: Children with comorbidities have a higher risk of severe COVID-19 and associated mortality than children without underlying disease. Additional studies are required to further evaluate this relationship.

Keywords: COVID-19; Comorbidity; Coronavirus; Meta-Analysis; Pediatrics.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram for the identification of studies pertaining to COVID-19 and children with comorbidities published between January 1 st, 2020 and October 5th, 2020.
Fig. 2
Fig. 2
Pooled estimate of the relative risk of severe COVID-19 among pediatric patients with comorbidities.
Fig. 3
Fig. 3
Sensitivity analysis of the influence of each included study on the overall relative risk of severe COVID-19 among children with comorbidities.
Fig. 4
Fig. 4
Pooled estimate of the relative risk of COVID-19-associated mortality among pediatric patients with comorbidities.
Fig. 5
Fig. 5
Sensitivity analysis of the relative contributions of each study toward the relative risk of mortality during COVID-19 infection in pediatric patients with comorbidities.
Fig. 6
Fig. 6
Relative risk of childhood obesity on severe manifestations of COVID-19
See this image and copyright information in PMC

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