Investigators from the University of Texas Health Sciences Center San Antonio and Texas Children’s Hospital, Houston, conducted a systematic review to characterize the demographics, presenting symptoms, laboratory findings, and outcomes in children diagnosed with COVID-19 and identify specific presenting symptoms and laboratory findings in those who developed multisystem inflammatory syndrome in children (MIS-C). The authors used a systematic process to identify relevant studies for inclusion. Data from studies of children and young adults from 0 to 21 years old with COVID-19, confirmed by PCR testing, were extracted. Patients were classified as developing MIS-C based on the CDC definition. Presenting symptoms and initial laboratory results were compared in children with MIS-C to those in a group of matched controls. Differences between the group with MIS-C and controls were assessed with t-tests, rank sum, or Fisher’s exact tests.
From a total of 1,142 studies reviewed, 319 articles met criteria for inclusion in the systematic review. The included studies were from 26 countries and published between January 24 and May 11, 2020. Data on 7,780 COVID-19–positive children were extracted. The mean age of study participants was 8.9 years, 55.6% were male, and 75.6% had been exposed to a family member with COVID-19. The most common symptoms reported were fever (59.1%), cough (55.9%), nasal congestion or rhinorrhea (20.0%), myalgia and/or fatigue (18.7%), sore throat (18.2%), and dyspnea (11.7%); 19.3% of COVID-19–positive children were asymptomatic. Laboratory findings were generally non-remarkable. Compared to normal ranges used by the authors, slight elevations were noted for D-dimer (mean 0.7 ± 0.1 mg/L) and C-reactive protein (mean 9.4 ± 0.5 mg/L). Patchy lesions were seen on chest x-ray (CXR) in 21.0% of patients, and 23.6% of patients had normal CXRs. Rates of complications were low, including mechanical ventilation (0.54% of patients), shock (0.24%), kidney failure (0.12%), and cardiac injury (0.10%). Seven children (0.09%) died, and 11 (0.14%) developed MIS-C. Compared to 14 control patients, those with MIS-C more often presented with dyspnea (72.7% vs 28.6%, P = 0.04), vomiting (45.5% vs 7.1%, P = 0.02), and diarrhea (45.5% vs 21.4%, P = 0.02). In addition, on complete blood count those with MIS-C had a lower proportion of lymphocytes (mean value 11.1% compared to 41.8% in controls, P < 0.01), higher mean lactate dehydrogenase (459 U/L and 217 U/L, respectively, P < 0.01), and higher D-dimer values (40.3 mg/L and 0.3 mg/L, P < 0.01) than control children.
The authors conclude that children with COVID-19 have an overall excellent prognosis.
Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The current review adds new data on SARS-CoV-2 infection presentation, laboratory findings, and outcomes in children. Similar to the first systemic review (See AAP Grand Rounds...