Children and Coronavirus Disease 2019 (COVID-19)

Abstract

Source: Castagnoli R, Votto M, Licari A, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review. JAMA Pediatr. 2020 22 April [published online ahead of print]; doi: 10.1001/jamapediatrics.2020.1467Investigators from multiple institutions in Italy conducted a systematic review to describe the clinical features of children ≤19 years old diagnosed with coronavirus 2 (SARS-CoV-2) infection. Articles eligible for inclusion in the review were published from December 1, 2019 to March 3, 2020. A systematic process was conducted to identify the articles and determine eligibility for inclusion. Only articles that included clinical data on patients 0–19 years old were analyzed. Review of the included articles focused on age, diagnostic tests, clinical features, therapeutic management, and prognosis.A total of 776 articles were reviewed, and 18 were included in the analysis. Included articles were published in February and March 2020. Seventeen articles were from China and included children with travel to Wuhan, China, or contact with affected family members; one study was from Singapore.The 18 articles included data on 1,065 children with SARS-CoV-2 infection; 444 cases were in children <10 years old, and 553 were in youths 10–19 years old. There were 2 reported cases in neonates, including a newborn with symptoms at 30 hours of life. All diagnoses were confirmed by a nasopharyngeal swab that tested positive for SARS-CoV-2. At least 3 children among the 1,065 cases were asymptomatic. When symptoms did occur, they typically were mild and most commonly included fever and cough, although a wide array of symptoms were reported. One 13-month-old child required aggressive treatment in an ICU, including mechanical ventilation, but recovered. Except for this case, no patient required supplemental oxygen or ventilation. Information on chest imaging (radiographs and/or CT) was included in 12 articles. Common findings were bronchial thickening and ground-glass opacities. There was one death reported in a child who was in the 10- to 19-year age range. Otherwise, all patients reportedly had a good prognosis.The authors conclude that this is only the first systematic review of pediatric cases of SARS-CoV-2 infection. Further epidemiologic and clinical studies are needed.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.Analysis of the first 2,572 US pediatric patients with SARS-CoV-2 infection revealed a median age of 11 years; 1,495 (58%) were 10–17 years; 398 were infants <1 year old. Among 184 cases with exposure information, 91% had exposure to a COVID-19 patient in the household or community.1Data on signs and symptoms were available for 291 (11%) of the pediatric cases. Among those with information, 56% of pediatric patients reported fever, 54% reported cough, and 13% reported shortness of breath. These findings were consistent with a report of pediatric COVID-19 cases in China.2Information on hospitalization was available for 745 (29%) of the pediatric cases; 147 (20%) were hospitalized (15 admitted to the ICU). Among 95 children <1 year old whose hospitalization status was known, 59 (62%) were hospitalized, including 5 admitted to an ICU. This suggestion of more severe disease in infants also was noted in a study of 2,143 pediatric COVID-19 cases in China.3Much is still unknown about the risks of COVID-19 during pregnancy and to the newborn infant. However, current evidence suggests low rates of peripartum transmission.4,5 An analysis of 38 pregnant women with COVID-19 infection in China showed no maternal deaths.4 Preterm births have been reported in women who tested positive for COVID-19 late in pregnancy.5A small number of children have developed a multisystem inflammatory syndrome temporally associated with COVID-19.6,7 These children fulfill full or partial criteria for Kawasaki disease and often require ICU care. Their SARS-CoV-2 PCR testing may be negative, and hence, serology may be useful to establish this association.The major symptoms of pandemic SARS-CoV-2 are fever, cough, and shortness of breath. For the latest updates, consult the CDC website.8New data on SARS-CoV-2 disease presentation and complications in infants and children are so rapidly accruing, journal articles undoubtedly will be superseded by newer reports—including case series and studies. All we can advise is: stay tuned.