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Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis.
J Clin Virol. 2021 02; 135:104715.JC

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.

Authors+Show Affiliations

School of Medicine, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN, 55455, USA. Electronic address: badal014@umn.edu.AabKa Research & Consulting, Calgary, Alberta, Canada. Electronic address: k.thapab@aabka.ca.BLH Technologies, INC, Rockville, MD, USA. Electronic address: sbadal@blhtech.com.Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta, T1K 3M4, Canada. Electronic address: rama.thapa@uleth.ca.Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 1N4, Canada. Electronic address: bishnu.bajgain@ucalgary.ca.Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 1N4, Canada. Electronic address: mjsantan@ucalgary.ca.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33348220

Citation

Badal, Sujan, et al. "Prevalence, Clinical Characteristics, and Outcomes of Pediatric COVID-19: a Systematic Review and Meta-analysis." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 135, 2021, p. 104715.
Badal S, Thapa Bajgain K, Badal S, et al. Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis. J Clin Virol. 2021;135:104715.
Badal, S., Thapa Bajgain, K., Badal, S., Thapa, R., Bajgain, B. B., & Santana, M. J. (2021). Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 135, 104715. https://doi.org/10.1016/j.jcv.2020.104715
Badal S, et al. Prevalence, Clinical Characteristics, and Outcomes of Pediatric COVID-19: a Systematic Review and Meta-analysis. J Clin Virol. 2021;135:104715. PubMed PMID: 33348220.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence, clinical characteristics, and outcomes of pediatric COVID-19: A systematic review and meta-analysis. AU - Badal,Sujan, AU - Thapa Bajgain,Kalpana, AU - Badal,Sujeena, AU - Thapa,Rama, AU - Bajgain,Bishnu B, AU - Santana,Maria Jose, Y1 - 2020/12/08/ PY - 2020/08/08/received PY - 2020/11/19/revised PY - 2020/11/29/accepted PY - 2020/12/22/pubmed PY - 2021/2/18/medline PY - 2020/12/21/entrez KW - COVID-19 KW - Clinical characteristics KW - Meta-analysis KW - Outcomes KW - Pediatric KW - Systematic review SP - 104715 EP - 104715 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J Clin Virol VL - 135 N2 - 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. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/33348220/Prevalence_clinical_characteristics_and_outcomes_of_pediatric_COVID_19:_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-6532(20)30457-1 DB - PRIME DP - Unbound Medicine ER -