Clinical manifestations of children with COVID‐19: A systematic review

Abstract

Background: The coronavirus disease 2019 (COVID-19) outbreak is an unprecedented global public health challenge, leading to thousands of deaths every day worldwide. Despite the epidemiological importance, clinical patterns of children with COVID-19 remain unclear. The aim of this study was to describe the clinical, laboratorial, and radiological characteristics of children with COVID-19. Methods: The Medline database was searched between December 1st 2019 and April 6th 2020. No language restrictions were applied. Inclusion criteria were (a) studied patients younger than 18 years old; (b) presented original data from cases of COVID-19 confirmed by reverse-transcription polymerase chain reaction; and (c) contained descriptions of clinical manifestations, laboratory tests, or radiological examinations. Results: A total of 38 studies (1124 cases) were included. From all the cases, 1117 had their severity classified: 14.2% were asymptomatic, 36.3% were mild, 46.0% were moderate, 2.1% were severe, and 1.2% were critical. The most prevalent symptom was fever (47.5%), followed by cough (41.5%), nasal symptoms (11.2%), diarrhea (8.1%), and nausea/vomiting (7.1%). One hundred forty-five (36.9%) children were diagnosed with pneumonia and 43 (10.9%) upper airway infections were reported. Reduced lymphocyte count was reported in 12.9% of cases. Abnormalities in computed tomography were reported in 63.0% of cases. The most prevalent abnormalities reported were ground-glass opacities, patchy shadows, and consolidations. Only one death was reported. Conclusions: Clinical manifestations of children with COVID-19 differ widely from adult cases. Fever and respiratory symptoms should not be considered a hallmark of COVID-19 in children.

Clinical Manifestations of Children and Adolescents With Covid-19: Report of the First 115 Cases From Sabará Hospital Infantil

“…The median age of hospitalized children was significantly lower than that of non-hospitalized children (7)(8)(9)(10)(11)(12) vs. 36 months ; p=0.001). When comparing symptoms and signs between hospitalized and non-hospitalized children, a significantly higher frequency of irritability, dyspnea, drowsiness, respiratory distress, low oxygen saturation, and hepatomegaly was observed among hospitalized patients; and headache was verified among non-hospitalized ones.…”

“…This pattern of symptoms is similar to that described by the pediatric largest case series, mainly from China and Europe, and by systematic reviews. 7,8,[10][11][12] The severity of the clinical condition was clearly higher among younger children, aging up to 3 years, with a frequency of hospitalization four times higher than that of older children, and who required ICU care five times more (Table 2). This finding corroborates the results found in the pediatric largest case series published to date.…”

“…1,6,7 Studies describing the manifestations of COVID-19 in children are still scarce, and the number of reported cases is often small. 7,8 The objectives of this study were to describe the clinical manifestations and severity of children and adolescents affected by COVID-19 treated or hospitalized in a single private hospital in the city of São Paulo and also to compare such manifestations between younger and older children.…”

Características clínicas de los pacientes pediátricos con COVID-19 en un departamento de emergencia

“…Los pacientes pequeños tuvieron más afección respiratoria y los más grandes pudieron referir síntomas más específicos como anosmia y ageusia, así como localizar síntomas inespecíficos como dolor corporal y de garganta. La tos referida como (16), frecuente en algunas series estuvo presente en (17) menos de la mitad de nuestros pacientes . Los síntomas gastrointestinales presentaron la misma frecuencia que otros síntomas respiratorios como la tos y definitivamente más frecuencia que la dificultad respiratoria.…”

Covid-19 em Crianças com Câncer

“…Entre os casos analisados nessa revisão, foram reportadas apenas 11 crianças (0,14%) que se enquadraram no quadro de síndrome inflamatória multissistêmica e sete mortes (0,09%), sendo que 76,6% dos pacientes foram expostos a familiares diagnosticados com Covid-19. Como observado em estudos anteriores, as manifestações clínicas em crianças com Covid-19 foram geralmente brandas, sendo as mais frequentes febre e tosse, havendo muitos casos assintomáticos 11,12,15,16 .…”