Novel coronavirus infection (COVID‐19) in children younger than one year: A systematic review of symptoms, management and outcomes

Abstract

Aim The aim of this systematic review was to evaluate the clinical characteristics of COVID‐19 in neonates and children under one year of age. Methods A systematic literature review of the MEDLINE, PubMed, CINAHL, Embase and EBSCO databases was carried out for studies from January 1, 2020, to April 7, 2020. We included all papers that addressed clinical manifestations, laboratory results, imaging findings and outcomes in infants and neonates. Results Our search identified 77 peer‐reviewed papers, and 18 papers covering 160 infants were reviewed. One paper was from Vietnam, and the other 17 were from China: eight were cross‐sectional studies, eight were case reports, one was a case series, and one was a prospective cohort study. The most common clinical symptoms were fever (54%) and cough (33%). Most infants were treated symptomatically, with frequent use of various empirical medications. Infants and neonates tended to have more severe COVID‐19 disease than older children: 11 (7%) were admitted to intensive care and one infant died. The mortality rate was 0.006%, with favourable outcomes in most cases. Conclusion Infants and neonates were more vulnerable to more severe COVID‐19 disease than older children, but morbidity and mortality were low.

Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents

“…We included 18 reviews in our analysis. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Characteristics of the included reviews are shown in table 1; all are freely available online (see online supplemental appendix table 2). All reviews were in English.…”

“…No reviews specifically focused on symptoms or signs among community samples of infected children, and none compared symptoms in hospitalised compared with non-hospitalised children. One review included only studies of infants, 16 one included a comparison of symptoms in children with those in adults from China 26 and one examined only gastrointestinal symptoms. 28 One study provided descriptive data from included studies only and did not report pooled estimates of symptom prevalence.…”

Hematological manifestations of SARS‐CoV‐2 in children

“…Infants and neonates appeared to present severe disease more commonly, as 7% were admitted to the intensive care unit (ICU) and one infant died. 38 To summarize, the currently available data showed that the majority of children with COVID-19 had a normal WBC count, and that lymphopenia was rarer in children than in adults. Since lymphopenia appears to be associated with the severity of COVID-19 in adults, the absence of significant lymphopenia in children may be explained by the milder disease in this population.…”

Clinical symptoms of COVID-19 pneumonia in children

“…Coronavirus disease 2019 (COVID-19) is a major problem in public health in the world. [ 1 , 2 ] COVID-19 has spread throughout China and globally, as a pandemic. [ 3 , 4 ] Up to June, 2020, the number of infections arising to 869,0000 and cause 41, 0000 deaths all over the world.…”