Clinical characteristics of COVID‐19 in children: A systematic review

• Published in: Pediatric pulmonology Vol. 55; no. 10; pp. 2565 - 2575
• Main Authors: Yasuhara, Jun, Kuno, Toshiki, Takagi, Hisato, Sumitomo, Naokata
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.10.2020
• Subjects: Asymptomatic; Child; clinical features; COVID-19; Humans; Kawasaki disease; Laboratories; Multisystem inflammatory syndrome in children; multisystem inflammatory syndrome in children (MIS‐C); Pediatrics; SARS-CoV-2; Systematic review; COVID-19; SARS-CoV-2; Kawasaki disease; multisystem inflammatory syndrome in children (MIS-C); clinical features
• ISSN: 8755-6863; 1099-0496; 1099-0496
• DOI: 10.1002/ppul.24991

Background Limited pediatric cases with coronavirus disease 2019 (COVID‐19) have been reported and the clinical profiles regarding COVID‐19 in children remain obscure. Our aim was to investigate the clinical characteristics of COVID‐19 in children. Methods PUBMED and EMBASE were searched through 20 June 2020, for case reports and case series reporting pediatric COVID‐19 cases. Epidemiological, clinical, laboratory, and radiological data were collected and analyzed to compare by age. Results Our search identified 46 eligible case reports and case series. A total of 114 pediatric cases with COVID‐19 were included. The main clinical features were mild symptoms including fever (64%), cough (35%), and rhinorrhea (16%), or no symptoms (15%). Ground‐like opacities were common radiological findings (54%). The main laboratory findings were lymphopenia (33%) and elevated D‐dimer (52%) and C‐reactive protein (40%) levels. We identified 17 patients (15%) with multisystem inflammatory syndrome in children (MIS‐C) manifesting with symptoms overlapping with, but distinct from, Kawasaki disease, including gastrointestinal symptoms, left ventricular systolic dysfunction, shock, and marked elevated inflammatory biomarkers. Twelve percent of the patients including 65% of the MIS‐C cases required intensive care because of hypotension. No deaths were reported. Conclusion This systematic review found that children with COVID‐19 are generally less severe or asymptomatic. However, infants might be seriously ill and older children might develop MIS‐C with severe illness. Early detection of children with mild symptoms or an asymptomatic state and early diagnosis of MIS‐C are mandatory for the management of COVID‐19 and the prevention of transmission and a severe inflammatory state.