Clinical characteristics of children with COVID-19: a rapid review and meta-analysis

Zijun Wang; Qi Zhou; Chenglin Wang; Qianling Shi; Shuya Lu; Yanfang Ma; Xufei Luo; Yangqin Xun; Weiguo Li; Muna Baskota; Yinmei Yang; Hui Zhai; Toshio Fukuoka; Hyeong Sik Ahn; Myeong Soo Lee; Zhengxiu Luo; Enmei Liu; Yaolong Chen; COVID-19 Evidence and Recommendations Working Group

doi:10.21037/atm-20-3302

Clinical characteristics of children with COVID-19: a rapid review and meta-analysis

Ann Transl Med. 2020 May;8(10):620. doi: 10.21037/atm-20-3302.

Authors

Zijun Wang¹, Qi Zhou², Chenglin Wang^{3

4

5}, Qianling Shi², Shuya Lu^{6

7}, Yanfang Ma¹, Xufei Luo⁸, Yangqin Xun¹, Weiguo Li^{3

4

5}, Muna Baskota^{3

4

5}, Yinmei Yang^{3

4

5}, Hui Zhai^{3

4

5}, Toshio Fukuoka^{9

10}, Hyeong Sik Ahn^{11

12}, Myeong Soo Lee^{13

14}, Zhengxiu Luo^{3

4

5}, Enmei Liu^{3

4

5}, Yaolong Chen^{1

15

16

17}; COVID-19 Evidence and Recommendations Working Group

Affiliations

¹ Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China.
² The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.
³ Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
⁴ National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
⁵ Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
⁶ Department of Pediatric, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China.
⁷ Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu 610072, China.
⁸ School of Public Health, Lanzhou University, Lanzhou 730000, China.
⁹ Emergency and Critical Care Center, Department of General Medicine, Department of Research and Medical Education, Kurashiki Central Hospital, Kurashiki, Japan.
¹⁰ Advisory Committee in Cochrane Japan, Tokyo, Japan.
¹¹ Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
¹² Korea Cochrane Center, Seoul, Korea.
¹³ Korea Institute of Oriental Medicine, Daejeon, Korea.
¹⁴ University of Science and Technology, Daejeon, Korea.
¹⁵ Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou 730000, China.
¹⁶ Chinese GRADE Center, Lanzhou 730000, China.
¹⁷ Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China.

Abstract

Background: Most guidelines on COVID-19 published so far include recommendations for patients regardless of age. Clinicians need a more accurate understanding of the clinical characteristics of children with COVID-19.

Methods: We searched studies reporting clinical characteristics in children with COVID-19 published until March 31, 2020. We screened the literature, extracted the data and evaluated the risk of bias and quality of evidence of the included studies. We combined some of the outcomes (symptoms) in a single-arm meta-analysis using a random-effects model.

Results: Our search retrieved 49 studies, including 25 case reports, 23 case series and one cohort study, with a total of 1,667 patients. Our meta-analysis showed that most children with COVID-19 have mild symptoms. Eighty-three percent of the children were within family clusters of cases, and 19% had no symptoms. At least 7% with digestive symptoms. The main symptoms of children were fever [48%, 95% confidence interval (CI): 39%, 56%] and cough (39%, 95% CI: 30%, 48%). The lymphocyte count was below normal level in only 15% (95% CI: 8%, 22%) of children which is different from adult patients. 66% (95% CI: 55%, 77%) of children had abnormal findings in CT imaging.

Conclusions: Most children with COVID-19 have only mild symptoms, and many children are asymptomatic. Fever and cough are the most common symptoms in children. Vomiting and diarrhea were not common in children. The lymphocyte count is usually within the normal range in children.

Keywords: COVID-19; Children; clinical characteristics; meta-analysis; rapid review.