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

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%, I2 =91.4%) asymptomatic, 33% (95% CI: 23 to 43%, I2 =95.6%) mild and 51% (95% CI: 42 to 61%, I2 =93.4%) moderate. The typical clinical manifestations were fever 51% (95% CI: 45 to 57%, I2 =78.9%) and cough 41% (95% CI: 35 to 47%, I2 =81.0%). The common laboratory findings were normal white blood cell 69% (95% CI: 64 to 75%, I2 =58.5%), lymphopenia 16% (95% CI: 11 to 21%, I2 =76.9%) and elevated creatine-kinase MB (CK-MB) 37% (95% CI: 25 to 48%, I2 =59.0%). The frequent imaging features were normal images 41% (95% CI: 30 to 52%, I2 =93.4%) and ground-glass opacity 36% (95% CI: 25 to 47%, I2 =92.9%). Among children under 1-year old, critical cases account for 14% (95% CI: 13 to 34%, I2 =37.3%) that should be of concern. In addition, vomiting occurred in 33% (95% CI: 18 to 67%, I2 =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.