Clinical, laboratory, and imaging features of pediatric COVID-19: A systematic review and meta-analysis.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
16 Apr 2021
16 Apr 2021
Historique:
received:
22
10
2020
accepted:
27
02
2021
entrez:
13
4
2021
pubmed:
14
4
2021
medline:
21
4
2021
Statut:
ppublish
Résumé
Pediatric cases of coronavirus disease 2019 (COVID-19) have been reported. This meta-analysis was aimed at describing the clinical, laboratory, and imaging characteristics of children with COVID-19 based on published data of pediatric COVID-19 cases.Search of PubMed, Embase, Web of Sciences, Science Direct, and Google Scholar for articles published until December 14, 2020, that described the clinical, laboratory, and imaging features of children with COVID-19. Data were extracted independently by 2 authors. Random-effects meta-analysis models were used to report pooled results.Clinical data from 2874 children with COVID-19 from 37 articles were finally included for quantitative analyses. Fever (48.5%, 95% CI: 41.4%-55.6%) and cough (40.6%, 95% CI: 33.9%-47.5%) were the most common symptoms; asymptomatic infection and severe cases, respectively, accounted for 27.7% (95% CI: 19.7%-36.4%) patients and 1.1% of the 1933 patients included. Laboratory tests showed 5.5% (95% CI: 2.8%-8.9%) of the patients had lymphopenia. The pooled prevalence of leukopenia was 7.3% (95% CI: 3.4%-12.2%), and the C-reactive protein level was high in 14.0% (95% CI: 6.8%-22.8%). Chest computed tomography showed unilateral and bilateral lesions, and ground-glass opacity in 29.4% (95% CI: 24.8%-34.3%) and 24.7% (95% CI: 18.2%-31.6%), and 32.9% (95% CI: 25.3%-40.9%), respectively, and normal in approximately 36.0% (95% CI: 27.7%-44.7%).We found that children with COVID-19 had relatively mild disease, with quite a lot of asymptomatic infections and low rate of severe illness. Data from more regions are needed to determine the prevention and treatment strategies for children with COVID-19.
Identifiants
pubmed: 33847620
doi: 10.1097/MD.0000000000025230
pii: 00005792-202104160-00016
pmc: PMC8052054
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25230Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no funding and conflicts of interests to disclose.
Références
World Health Organization. Coronavirus disease (COVID-19) outbreak 2020. 2020; https://www.who.int . [access date 04 October, 2020].
World Health Organization. Critical preparedness, readiness and response actions for COVID-19. 2020; https://www.who.int/publications-detail/critical-preparedness-readiness-and-response-actions-for-covid-19 . [access date 02 October, 2020].
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13.
Pongpirul WA, Pongpirul K, Ratnarathon AC, et al. Journey of a thai taxi driver and novel coronavirus. N Engl J Med 2020;382:1067–8.
Chen T, Dai Z, Mo P, et al. Clinical characteristics and outcomes of older patients with coronavirus disease 2019 (COVID-19) in Wuhan, China: a single-centered, retrospective study. J Gerontol A Biol Sci Med Sci 2020;75:1788–95.
Fu L, Wang B, Yuan T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect 2020;80:656–65.
Alexpandi R, De Mesquita JF, Pandian SK, et al. Quinolines-Based SARS-CoV-2 3CLpro and RdRp Inhibitors and Spike-RBD-ACE2 Inhibitor for Drug-Repurposing Against COVID-19: An in silico Analysis. Front Microbiol 2020;11:1796.
Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020;145:
She J, Liu L, Liu W. COVID-19 epidemic: disease characteristics in children. J Med Virol 2020;92:747–54.
Cardona-Ospina JA, Henao-SanMartin V, Acevedo-Mendoza WF, et al. Fatal Zika virus infection in the Americas: a systematic review. Int J Infect Dis 2019;88:49–59.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–12.
Moher D, Shamseer L, Clarke M, et al. PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:01.
Aromataris E FR, Godfrey C, Holly C, Kahlil H, P T. Methodology for JBI umbrella reviews, In Joanna Briggs Institute reviewer's manual 2014. 2014; http://joannabriggs.org/assets/docs/sumari/ReviewersManual-Methodology-JBI_Umbrella%20Reviews-2014.pdf . [access date Deceber 13, 2020].
Wells G, Shea B, O Connell DL, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. 2014; https://www.semanticscholar.org/paper/The-Newcastle-Ottawa-Scale-(NOS)-for-Assessing-the-Wells-Wells/c293fb316b6176154c3fdbb8340a107d9c8c82bf . [access date December 13, 2020].
CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12–April 2, 2020. MMWR Morb Mortal Wkly Rep 2020;69:422–6.
Wang D, Ju XL, Xie F, et al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi 2020;58:269–74.
Jiehao C, Jin X, Daojiong L, et al. A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020;71:1547–51.
Du W, Yu J, Wang H, et al. Clinical characteristics of COVID-19 in children compared with adults in Shandong Province. China Infection 2020;48:445–52.
Feng K, Yun YX, Wang XF, et al. Analysis of CT features of 15 children with 2019 novel coronavirus infection. Zhonghua Er Ke Za Zhi 2020;58:E007.
Li B, Shen J, Li L, et al. Radiographic and clinical features of children with coronavirus disease (COVID-19) pneumonia. Indian Pediatrics 2020;57:423–6.
Qiu H, Wu J, Hong L, et al. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020;20:689–96.
Xia W, Shao JB, Guo Y, et al. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults. Pediatr Pulmonol 2020;55:1169–74.
Zheng F, Liao C, Fan QH, et al. Clinical characteristics of children with coronavirus disease 2019 in Hubei, China. Curr Med Sci 2020;40:275–80.
Zhu L, Wang J, Huang R, et al. Clinical characteristics of a case series of children with coronavirus disease 2019. Pediatr Pulmonol 2020;55:1430–2.
Chandratre S. Promoting medical students’ interest in pediatric endocrinology during COVID-19. Clin Pediatr (Phila) 2020;59:1219.
Li W, Cui H, Li K, et al. Chest computed tomography in children with COVID-19 respiratory infection. Pediatr Radiol 2020;50:796–9.
Liu H, Liu F, Li J, et al. Clinical and CT imaging features of the COVID-19 pneumonia: focus on pregnant women and children. J Infect 2020;80:e7–13.
Lu XX, Zhang LQ, Du H, et al. SARS-CoV-2 infection in children. N Engl J Med 2020;382:1663–5.
Shen QX, Guo W, Guo T, et al. Novel coronavirus infection in children outside of Wuhan, China. Pediatr Pulmonol 2020;55:1424–9.
Su L, Ma X, Yu H, et al. The different clinical characteristics of corona virus disease cases between children and their families in China-the character of children with COVID-19. Emerging Microbes Infections 2020;9:707–13.
Tan YP, Tan BY, Pan J, et al. Epidemiologic and clinical characteristics of 10 children with coronavirus disease 2019 in Changsha, China. J Clin Virol 2020;127:104353.
Xie M, Tian J, Hun M, et al. Analysis of Epidemiological and Clinical Characteristics of Children with Mild COVID-19 and Discussion on the Clinical Significance of SARS-CoV-2 Antibody. Available at SSRN: https://ssrn.com/abstract=3566189 . [access date Deceber 13, 2020].
Zhou Y, Yang GD, Feng K, et al. Clinical features and chest CT findings of coronavirus disease 2019 in infants and young children. Chin J Contemp Pediatr 2020;22:215–20.
Wu Q, Xing Y, Shi L, et al. Coinfection and other clinical characteristics of COVID-19 in children. Pediatrics 2020;146:
Wu H, Zhu H, Yuan C, et al. Clinical and immune features of hospitalized pediatric patients with coronavirus disease 2019 (COVID-19) in Wuhan, China. JAMA Netw Open 2020;3:
Steinberger S, Lin B, Bernheim A, et al. CT features of coronavirus disease (COVID-19) in 30 pediatric patients. AJR Am J Roentgenol 2020;215:1303–11.
Parri N, Magistà AM, Marchetti F, et al. Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks. Eur J Pediatr 2020;179:1315–23.
Ma HJ, Hu JN, Tian J, et al. A single-center, retrospective study of COVID-19 features in children: a descriptive investigation. BMC Med 2020;18:123.
Korkmaz MF, Türe E, Dorum BA, et al. The epidemiological and clinical characteristics of 81 children with COVID-19 in a pandemic hospital in Turkey: an observational cohort study. J Korean Med Sci 2020;35:
Du H, Dong X, Zhang JJ, et al. Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status. Allergy 2021;76:510–32.
Han MS, Choi EH, Chang SH, et al. Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea. JAMA Pediatr 2021;175:73–80.
Kilani MM, Odeh MM, Shalabi M, et al. Clinical and laboratory characteristics of SARS-CoV2-infected paediatric patients in Jordan: serial RT-PCR testing until discharge. Paediatr Int Child Health 2020;01–10.
Mohammadi A, Mohebbi I, Khademvatani K, et al. Clinical and radiological characteristics of pediatric patients with COVID-19: focus on imaging findings. Jpn J Radiol 2020;38:987–92.
Caro-Dominguez P, Shelmerdine SC, Toso S, et al. Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases. Pediatr Radiol 2020;50:1354–68.
Fakiri KE, Nassih H, Sab IA, et al. Epidemiology and clinical features of coronavirus disease 2019 in moroccan children. Indian Pediatr 2020;57:808–10.
Alsharrah D, Alhaddad F, Alyaseen M, et al. Clinical characteristics of pediatric SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) in Kuwait. J Med Virol 2020;10.1002/jmv.26684.
doi: 10.1002/jmv.26684
Mamishi S, Heydari H, Aziz-Ahari A, et al. Novel coronavirus disease 2019 (COVID-19) outbreak in children in Iran: Atypical CT manifestations and mortality risk of severe COVID-19 infection. J Microbiol Immunol Infect 2020;S1684-1182(20)30177-8.
Ma N, Li P, Wang X, et al. Ocular manifestations and clinical characteristics of children with laboratory-confirmed COVID-19 in Wuhan, China. JAMA Ophthalmol 2020;138:1079–86.
Chen J, Zhang ZZ, Chen YK, et al. The clinical and immunological features of pediatric COVID-19 patients in China. Genes Dis 2020;7:535–41.
Xu Y, Li X, Zhu B, et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020;26:502–5.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020;323:1239–42.
Chen ZM, Fu JF, Shu Q, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr 2020;16:240–6.
Kontopantelis E, Reeves D. Performance of statistical methods for meta-analysis when true study effects are non-normally distributed: a comparison between DerSimonian-Laird and restricted maximum likelihood. Stat Methods Med Res 2012;21:657–9.
Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020;34:101623.
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–20.
Hu Tuo FL, Junling Wang, Jingping Ye. Clinical characteristics of 2019 novel coronavirus (2019-nCoV) infection in children and family prevention and control (in Chinese). Med J Wuhan Univ 2020;41:357–61.
Xu T, Chen C, Zhu Z, et al. Clinical features and dynamics of viral load in imported and non-imported patients with COVID-19. Int J Infect Dis 2020;94:68–71.
Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:145–51.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020;579:270–3.
Liu WJ, Zhao M, Liu K, et al. T-cell immunity of SARS-CoV: implications for vaccine development against MERS-CoV. Antiviral Res 2017;137:82–92.
Cai JH, Wang XS, Ge YL, et al. First case of 2019 novel coronavirus infection in children in Shanghai. Zhonghua Er Ke Za Zhi 2020;58:86–7.
Zhu Y, Xie J, Huang F, et al. Association between short-term exposure to air pollution and COVID-19 infection: Evidence from China. Sci Total Environ 2020;727:138704.
Nickbakhsh S, Mair C, Matthews L, et al. Virus-virus interactions impact the population dynamics of influenza and the common cold. Proc Natl Acad Sci U S A 2019;116:27142–50.
Fang F, Luo XP. Facing the pandemic of 2019 novel coronavirus infections: the pediatric perspectives. Zhonghua Er Ke Za Zhi 2020;58:E001.
Cao Y, Li L, Feng Z, et al. Comparative genetic analysis of the novel coronavirus (2019-nCoV/SARS-CoV-2) receptor ACE2 in different populations. Cell Discov 2020;6:11.
Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565–74.
Brodin P. Why is COVID-19 so mild in children? Acta Paediatr 2020;109:1082–3.
Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proceedings Biological Sci 2015;282:20143085.
Emami A, Javanmardi F, Pirbonyeh N, et al. Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis. Arch Acad Emerg Med 2020;8:e35.
Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA 2020;323:1335.