A systematic review and meta‐analysis of children with Coronavirus Disease 2019 (COVID‐19)

Cui, Xiaojian; Zhao, Zhihu; Zhang, Tongqiang; Guo, Wei; Guo, Wenwei; Zheng, Jiafeng; Zhang, Jiayi; Dong, Cuicui; Na, Ren; Zheng, Lisheng; Li, Wenliang; Liu, Zihui; Ma, Jia; Wang, Jinhu; He, Sijia; Xu, Yongsheng; Si, Ping; Shen, Yongming; Cai, Chunquan

OBJECTIVE: To provide a comprehensive and systematic analysis of demographic characteristics, clinical symptoms, laboratory findings and imaging features of coronavirus disease 2019 (COVID‐19) in pediatric patients. METHODS: A meta‐analysis was carried out to identify studies on COVID‐19 from December 25, 2019 to April 30, 2020. RESULTS: A total of 48 studies with 5829 pediatric patients were included. Children at all ages were at risk for COVID‐19. The main illness classification ranged as: 20% (95% CI: 14 to 26%, I(2)=91.4%) asymptomatic, 33% (95% CI: 23 to 43%, I(2)=95.6%) mild and 51% (95% CI: 42 to 61%, I(2)=93.4%) moderate. The typical clinical manifestations were fever 51% (95% CI: 45 to 57%, I(2)=78.9%) and cough 41% (95% CI: 35 to 47%, I(2)=81.0%). The common laboratory findings were normal white blood cell 69% (95% CI: 64 to 75%, I(2)=58.5%), lymphopenia 16% (95% CI: 11 to 21%, I(2)=76.9%) and elevated creatine‐kinase MB (CK‐MB) 37% (95% CI: 25 to 48%, I(2)=59.0%). The frequent imaging features were normal images 41% (95% CI: 30 to 52%, I(2)=93.4%) and ground‐glass opacity 36% (95% CI: 25 to 47%, I(2)=92.9%). Among children under 1‐year old, critical cases account for 14% (95% CI: 13 to 34%, I(2)=37.3%) that should be of concern. In addition, vomiting occurred in 33% (95% CI: 18 to 67%, I(2)=0.0%) cases that may also need attention. CONCLUSIONS: Pediatric patients with COVID‐19 may experience milder illness with atypical clinical manifestations and rare lymphopenia. High incidence of critical illness and vomiting symptoms reward attention in children under 1‐year old. This article is protected by copyright. All rights reserved.