Clinical Features and Outcome of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-analysis

Abstract

W ith the rapidly evolving severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) pandemic, the knowledge about the disease manifestations and severity has also evolved quickly. Due to its resemblance to SARS, influenza, and other respiratory viruses, children were initially thought to be more susceptible than adults. However, less than 5% of total coronavirus disease (COVID-19) cases belong to the pediatric age group, and the severity has been milder as compared to adults [3,4]. Information regarding clinical manifestations and outcomes of COVID-19 in adults is available due to a huge number of reported cases, but the scenario for the pediatric population is different as our knowledge about clinical and laboratory characteristics as well as prognosis of COVID-19 is very limited. Due to this difference in the manifestations of COVID-19 among pediatric patients from adults, there is a need to clarify the disease manifestations and course among children. We performed this systematic review to synthesize the information on clinical manifestations, laboratory findings, and outcome of COVID-19 among the pediatric population.

Paediatric COVID-19: Milder Presentation—A Silver Lining in Dark Cloud

“…A multicentric study also showed milder form of the disease in children [ 8 ]. A recent meta-analysis has also shown that most of the patients have mild to moderate disease (96%) with only 1% of all the symptomatic paediatric cases being critically sick [ 9 ]. In children who were symptomatic, fever cough and rhinitis were common symptoms; similar findings being reported in a study from China [ 10 ].…”

Virus-Induced Wheezing With COVID-19

“…If small airways are predominantly affected, treatment modalities will include bronchodilators, corticosteroids, oxygen supplementation and respiratory support as required. However, bronchodilators are potentially detrimental in a scenario of alveolar disease due to pro-inflammatory effects on alveoli, worsening of ventilationperfusion mismatch and increased tachycardia [4]. There is no clear-cut separation of these phenotypes and overlap may be expected.…”

“…There is no clear-cut separation of these phenotypes and overlap may be expected. Corticosteroids, typically in courses longer than that used in exacerbations of asthma, are currently in use for treating severe COVID-19 [4,5]. The role of antiviral treatment is not precisely known especially in the pediatric context [4].…”

“…Few autopsy studies have demonstrated the presence of the virus in capillary endothelial cells of the frontal lobe of the brain [3]. The virus can also reach the brain by trojan horse mechanism via infected leukocytes migration across the blood brain barrier [4].…”

“…In addition to primary lung involvement due to COVID-19, this patient developed a hypercoagulable state with consequent DVT and suspected pulmonary thromboembolism, which greatly increased the comorbidity and duration of hospital stay. Although rarely reported in children [3,4], the hypercoagulable state can result in significant clinical sequelae. High altitude is also a predisposing factor for thromboembolic phenomenon [5].…”