Abstract
Background
There are sparse patient-level data available for children with novel coronavirus disease (COVID-19). Therefore, there is an urgent need for an updated systematic literature review that analyzes individual children rather than aggregated data in broad age groups.
Methods
Six databases (MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, medRxiv) were searched for studies indexed from January 1 to May 15, 2020, with MeSH terms: children, pediatrics, COVID-19, SARS-CoV-2. 1241 records were identified, of which only unique papers in English with individual patient information and documented COVID-19 testing were included. This review of 22 eligible studies followed Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data guidelines.
Results
A total of 123 patients from five countries were identified. 46% were females. The median age was 5 years (IQR = 8). At presentation, 62% had a fever, 32% had a cough, 58% had a single symptom, and 21% were asymptomatic. Abnormal chest imaging was seen in 62% (65/105) of imaged and 76.9% (20/26) of asymptomatic children. A minority of children had elevated platelets, CRP, lactate dehydrogenase, and d-dimer.
Conclusion
Data from this independent participant data systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom.
Impact
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This systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom.
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By using an independent participant data approach, this analysis underscores the challenge of diagnosing COVID-19 in pediatric patients due to the wide variety of symptoms and seemingly poor correlation of imaging findings with symptomatic disease.
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The data presented from individual patients from case series or cohort studies add more granularity to the current description of pediatric COVID-19.
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Funding
B.C. was supported by a Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM007739 to the Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD–Ph.D. Program. B.G.M. and I.C.M. were supported by the National Institute of Allergies and Infectious Diseases of the National Institutes of Health award number R25AI140490.
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B.C. conceptualized and designed the study, developed the search strategy and conducted the database search, analyzed the data, drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript for submission. B.G.M. and R.O. conducted the database search, analyzed the data, drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript for submission. W.T.P., T.S., and I.C.M. advised, reviewed and revised the manuscript, and approved the final manuscript for submission.
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Patient consent was not required for this study as it analyzed anonymized, publicly available data.
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Christophers, B., Gallo Marin, B., Oliva, R. et al. Trends in clinical presentation of children with COVID-19: a systematic review of individual participant data. Pediatr Res 91, 494–501 (2022). https://doi.org/10.1038/s41390-020-01161-3
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DOI: https://doi.org/10.1038/s41390-020-01161-3
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