Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis

Abstract

Introduction: The novel coronavirus pandemic is an ongoing challenge faced by the public and health care systems around the globe. Majority of information and evidence gathered so far regarding COVID-19 has been derived from data and studies in adult populations. Crucial information regarding the characterization, clinical symptomatology, sequelae, and overall outcomes in the pediatric population is lacking. As such, we aimed to conduct a comprehensive meta-analysis and systematic review to collect and analyze current evidence about COVID-19 in the pediatric population.

Method: A systematic search and review of scientific literatures was conducted following the PRISMA guidelines using PubMed, Embase, Scopus, Medline, and Google Scholar databases. All relevant studies until June 16, 2020 were included. Studies were reviewed for methodological quality, and random-effects model was used to conduct the primary meta-analysis. I² value and Egger's test was used to estimate heterogeneity and publication bias respectively.

Results: We reviewed 20 eligible studies that included 1810 pediatric patient population (<21 yo) with PCR tested COVID-19 positivity. In pooled data, majority (25 % [CI 18-32], I² 59 %) of overall COVID-19 positive patients fell in the 6-10 yr age group. 13 % ([CI 11-14], I² 78 %) of the patients were asymptomatic, with headache (67 % [CI 60-74], I² 46 %), fever (55 % [CI 52-58], I² 61 %), and cough (45 % [CI 42-49], I² 79 %) accounting for the most prevalent physical signs seen in symptomatic patients. Leukopenia (12 % [CI 9-15], I²50 %) and lymphopenia (15 % [CI 13-19], I² 85 %) was common. Elevated Ferritin (26 % [CI 16-40], I² 73 %), Procal (25 % [CI 21-29 %], I² 83 %), and CRP (19 % [CI 16-22 %], I² 74 %) were other laboratory abnormalities commonly observed. Common radiological features were ground-glass opacities (36 % [CI 32-39 %], I² 92 %), normal finding (33 % [CI 30-36 %], I² 81 %), and consolidation. 29 % ([CI 26-33], I² 85 %) of the patient cases was non-severe, whereas only 5 % ([CI 1-8], I² 87 %) was severe. Mortality was observed in 0.3 % ([CI 0.1-0.4], I² 0%) of the overall cases.

Conclusion: COVID-19 is prevalent across all pediatric age-groups and presents with varying degree of symptomology. However, children have a milder course of the disease with extremely favorable prognosis. Laboratory and radiological features are inconsistent and require further investigations. Additional studies are needed on this topic to corroborate findings and establish evidence-based and consistent characterization of COVID-19 in the pediatric population.

Keywords: COVID-19; Clinical characteristics; Meta-analysis; Outcomes; Pediatric; Systematic review.

Fig. 1

PRISMA flow chart of the systematic literature review and article identification process.

Fig. 2

Prevalence (%) of COVID-19 across various pediatric age groups. Pooled studies (N = 11) included data from China, Europe and US with varying total number of cases (n) for each age group as demonstrated. (Estimated p-values <0.05 for each age group).

Fig. 3

Meta-analysis of the prevalence of clinical symptoms, laboratory findings and radiological features in pediatric COVID-19 patients. ^┼ Includes Unilateral and/or bilateral findings; ^⏆ Includes other Neurological, Hematological, and Musculoskeletal symptoms. Abbreviations: GI: Gastrointestinal; GGO: Ground Glass Opacity; LDH: Lactate Dehydrogenase; AST: Aspartate transaminase; ALT: Alanine transaminase; ESR: Erythrocyte Sedimentation Rate; Procal: Procalcitonin.