Clinical Features of COVID-19 in Newborns, Infants, and Children: A Systematic Review and Meta-analysis

ABSTRACT

Although it was thought that children were not susceptible to 2019-nCoV in the early days of the COVID‐19 infection outbreak, there are currently reports of children and even one-day-old newborns being infected by the virus and hospitalized around the world. Recognizing the symptoms of the infection in children is of great value since a large number of children are asymptomatic or have mild symptoms, which may act as facilitators of the virus transmission. This review aimed to identify and summarize the existing evidence on clinical characteristics of COVID-19 in pediatric patients. A systematic search was conducted in the PubMed, Web of Science, Scopus, Google Scholar, and WHO database for eligible publications. The review proposal was registered with the PROSPERO. The quality assessment was done based on JBI Critical appraisal tools. The random-effects model was used to pool clinical features in the meta-analysis. From the identified 256 potentially relevant studies, 32 articles met the predetermined inclusion and exclusion criteria. Twenty-one studies fulfilled the criteria for this meta-analysis. Fever (58%) and cough (48%) were reported as the most common symptoms of infected children. Disease severity was mild in 51% and moderate in 39% of cases. A total of 63% of cases had respiratory and 25% of children had gastrointestinal symptoms, particularly diarrhea and nausea/vomiting. Approximately 24% of patients were asymptomatic. Results demonstrated that fever and cough were the most common symptoms of COVID-19-infected children and the majority of cases had mild-to-moderate disease severity.

KEYWORDS:

• Clinical features
• COVID-19
• infant
• newborn
• child
• adolescent
• systematic review
• meta-analysis

Acknowledgments

The authors thank Professor Abolfazl Mohammad Beigi, Ph.D. in Epidemiology, Qom University of Medical Sciences, Dr. Habib Shareinia, and Dr. Mohammad Mehdi Mohamadi, Tehran University of Medical Sciences, for providing guidance and comments for this review. We thank all those who contributed to this study.

Authors’ contributions

(1) Main concept, development of the selection, and data extraction criteria: NDn, LT; FGh;

(2) Developing the search strategy and the quality assessment strategy: LT, FGh, MT, NDn;

(3) Collection and assembly of data: LT, FGh, MT, NDn;

(4) Data analysis and interpretation: MhB, LT, FGh;

(5) Manuscript writing and revising: All authors;

(6) Approval of final version of manuscript: All authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Scopus

(TITLE-ABS-KEY (youth*) OR TITLE-ABS-KEY (teen*) OR TITLE-ABS-KEY (adolescent*) OR TITLE-ABS-KEY (child*) OR TITLE-ABS-KEY (infant*) OR TITLE-ABS-KEY (newborn*) OR TITLE-ABS-KEY (neonate*) OR TITLE-ABS-KEY (pediatric*) OR TITLE-ABS-KEY (peadiatric*)) AND (TITLE-ABS-KEY (sars-cov-2*) OR TITLE-ABS-KEY (covs*) OR TITLE-ABS-KEY (2019-ncov*) OR TITLE-ABS-KEY (covid-19*) OR TITLE-ABS-KEY (coronavirus*)) AND (TITLE-ABS-KEY (manifestation*) OR TITLE-ABS-KEY (characteristic*) OR TITLE-ABS-KEY (sign*) OR TITLE-ABS-KEY (symptom*) OR TITLE-ABS-KEY (diagnos*))

Web of science

(TS=(SARS-CoV-2) OR TS=(CoVs) OR TS=(2019-nCoV) OR TS=(COVID-19) OR TS=(coronavirus)) AND(TS=(Youth) OR TS=(Teen) OR TS=(Adolescent) OR TS=(child) OR TS=(infant) OR TS=(newborn) OR TS=(neonate) OR TS=(pediatric) OR TS=(peadiatric)) AND(TS=(Symptom Assessment) OR TS=(clinical manifestation) OR TS=(clinical characteristic) OR TS=(clinical feature) OR TS=(sign) OR TS=(symptom) OR TS=(diagnosis))

Additional information

Funding

This project received no specific grant from any funding source.