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

• Published in: International journal of infectious diseases Vol. 103; pp. 246 - 256
• Main Authors: Tsankov, Boyan K., Allaire, Joannie M., Irvine, Michael A., Lopez, Alison A., Sauvé, Laura J., Vallance, Bruce A., Jacobson, Kevan
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.02.2021; The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases; Elsevier
• Subjects: Child; Comorbidity; Coronavirus; COVID-19; COVID-19 - etiology; Humans; Meta-Analysis; Pediatrics; Risk; SARS-CoV-2; COVID-19; Pediatrics; Meta-Analysis; Coronavirus; Comorbidity
• ISSN: 1201-9712; 1878-3511; 1878-3511
• DOI: 10.1016/j.ijid.2020.11.163

What is known •Adults with comorbidities are more likely to suffer from severe manifestations of COVID-19•Children with COVID-19 have less severe disease manifestations than adults•Children may experience multisystem inflammatory syndrome due to COVID-19 What is new •Children with comorbidities may be at an increased risk for PICU admission and/or severe COVID-19•Children with comorbidities may be at an increased risk of mortality during COVID-19 infection•Childhood obesity likely contributes to more serious manifestations of COVID-19 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. 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. 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%). 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.