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, 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

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.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-3302). MSL serves as the unpaid editorial board member of Annals of Translational Medicine from Nov 2019 to Oct 2021. The other authors have no conflicts of interest to declare.

2020 Annals of Translational Medicine. All rights reserved.

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