*Lukasz Szarpak1, Ishag Adam2, Tomasz Dzieciatkowski3, Klaudiusz Nadolny4, 5, Milosz Jaguszewski6, Krzysztof Jerzy Filipiak7, Jerzy Robert Ladny8, 9, Jacek Smereka9, 10
Characteristic of COVID-19 pediatric patients: evidence from systematic review
1Faculty of Medicine, Lazarski University, Warsaw, Poland
2Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
3Chair and Department of Medical Microbiology, Medical University of Warsaw, Poland
4Faculty of Medicine, Katowice School of Technology, Poland
5Department Emergency Medical Service, University of Strategic Planning in Dabrowa Gornicza, Poland
6First Department of Cardiology, Medical University of Gdansk, Poland
7First Chair and Department of Cardiology, Medical University of Warsaw, Poland
8Clinic of Emergency Medicine, Medical University of Bialystok, Poland
9Polish Society of Disaster Medicine, Warsaw, Poland
10Department of Emergency Medical Service, Wroclaw Medical University, Poland
Summary
Introduction. The SARS-CoV-2 infection pandemic has affected virtually the whole world. Since the outbreak in China, countries on all continents have been progressively infected, and COVID-19 represents a major challenge to healthcare systems even in highly developed countries. Children are a very special group, largely due to close family contacts, and may be susceptible to cross-infection. Children, generally, have low immunity and some exhibit a long incubation period after SARS-CoV-2 infection. Therefore, children should try to avoid contact with complex populations to avoid being infected by potential spreaders.
Aim. The aim of the study was to identify the most frequently observed symptoms in pediatric patients with confirmed COVID-19.
Material and methods. We performed a comprehensive systematic literature search of online databases, including PubMed, EMBASE, Web of Science, CENTRAL, from December 2019 to April 10, 2020 to identify all case studies. All the search results were evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The inclusion criterions for the articles were as follows: study population: pediatric patients with diagnosed COVID-19 (excluding newborn patient); study design: case studies; outcomes measure: at least one outcome reported among clinical symptoms.
Results. The analysis of 10 papers reporting 466 pediatric patients with confirmed COVID-19 revealed that the most frequently observed symptoms are fever (56.0%), cough (49.8%), headache (22.9%), sore throat (22.7%) and fatigue/myalgia (20.3%). The remaining symptoms are much less frequent. In 13.6% of cases, the disease was asymptomatic, and in 40.8% it was mild in clinical classification and in 40.2% moderate type. Relatively rarely children with severe and critical presentation of COVID-19 are observed (3.0 and 1.0%, respectively).
Conclusions. The five most frequent symptoms in pediatric patients with confirmed COVID-19 are: fever, cough, headache, sore throat and fatigue/myalgia. In the pediatric population, 81% of patients infected with SARS-CoV-2 have mild or moderate symptoms, and only 4% have severe and critical presentation.
INTRODUCTION
The SARS-CoV-2 infection pandemic has affected virtually the whole world. Since the outbreak in China, countries on all continents have been progressively infected, and COVID-19 represents a major challenge to healthcare systems even in highly developed countries. Social isolation, the use of face masks, the use of personal protective equipment by medical personnel and rapid diagnosis are essential to control the epidemic. It is extremely important to determine the prevalence of individual symptoms of SARS-CoV-2 infection, which may suggest performing appropriate tests to confirm or exclude the infection both in adults and in the pediatric population (1).
It has been observed that COVID-19 is much more severe and with significantly higher mortality in the population of older patients and with coexisting diseases. In the pediatric population a mild course of infection is observed much more often than in adults, although there are also fatalities. From a health safety point of view, it is important that asymptomatic persons, which often occur in the pediatric population, may infect other people who have a severe or even fatal course of infection.
On January 30, 2020 World Health Organization (WHO) said a disease called COVID-19 is a ‘public health emergency of an international range’ (2). The number of infections has increased rapidly in many countries on all continents and resulted on 20/03/2020 announcement by WHO pandemic status. As of April 16, 2020, the reported number of confirmed infection cases equaled 2,167,955. Children are a very special group, largely due to close family contacts, and may be susceptible to cross-infection. Children, generally, have low immunity and some exhibit a long incubation period after SARS-CoV-2 infection. Therefore, children should try to avoid contact with complex populations to avoid being infected by potential spreaders. COVID-19 is an acute, self-limiting disease; nevertheless, patients can die, with a mortality rate over 6.7%, and have also been reported in critically ill children (3).
AIM
The aim of the study was to identify the most frequently observed symptoms in pediatric patients with confirmed COVID-19.
MATERIAL AND METHODS
We conducted a comprehensive systematic literature search of online databases, including PubMed, EMBASE, Web of Science, CENTRAL, from December 2019 to April 10, 2020 to identify all case studies. The search terms and relative variants were as follows: COVID-19; 2019-nCoV; clinical characteristics; pediatric; child. We also reviewed the references of included articles to guarantee the comprehensiveness and accuracy of our research. All the search results were evaluated according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The inclusion criterions for the articles were as follows: study population: pediatric patients with diagnosed COVID-19 (excluding newborn patient); study design: case studies; outcomes measure: at least one outcome reported among clinical symptoms.
RESULTS
The analysis of 10 papers reporting 466 pediatric patients with confirmed COVID-19 revealed that the most frequently observed symptoms are fever (56.0%), cough (49.8%), headache (22.9%), sore throat (22.7%) and fatigue/myalgia (20.3%) (1, 3-11). The remaining symptoms are much less frequent. Detailed characteristics of pediatric patients with COVID-19 are presented in table 1.
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Piśmiennictwo
1. Qiu H, Wu J, Hong L et al.: Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020. doi: 10.1016/S1473-3099(20)30198-5.
2. World Health Organization: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov), 2020 (data dostępu: 13.04.2020).
3. Xia W, Shao J, Guo Y et al.: Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol 2020; 55(5): 1169-1174.
4. Cai J, Xu J, Lin D et al.: A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa198.
5. CDC COVID-19 Response Team: Coronavirus Disease 2019 in Children – United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69(14): 422-426.
6. Sun D, Li H, Lu XX et al.: Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center’s observational study. World J Pediatr 2020. doi: 10.1007/s12519-020-00354-4.
7. Tang A, Xu W, Shen M et al.: A retrospective study of the clinical characteristics of COVID-19 infection in 26 children. medRxiv 2020. https://doi.org/10.1101/2020.03.08.20029710.
8. Wang S, Guo L, Chen L et al.: A case report of neonatal COVID-19 infection in China. Clin Infect Dis 2020. doi: 10.1093/cid/ciaa225.
9. Wei M, Yuan J, Liu Y et al.: Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA 2020. doi: 10.1001/jama.2020.2131.
10. Xu Y, Li X, Zhu B et al.: Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020; 26(4): 502-505.
11. Zheng F, Liao C, Fan QH et al..: Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China. Curr Med Sci 2020. doi: 10.1007/s11596-020-2172-6.
12. Dong Y, Mo X, Hu Y et al.: Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China. Pediatrics 2020. doi: 10.1542/peds.2020-0702.
