儿童 COVID-19 的临床特征、治疗和结局：系统评价和荟萃分析。
Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis.
机构信息
Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Vanke School of Public Health, Tsinghua University, Beijing, China.
出版信息
Arch Dis Child. 2021 Apr 21;106(5):440-448. doi: 10.1136/archdischild-2020-321385.
OBJECTIVE
Compare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity.
DESIGN
Systematic review and meta-analysis.
SETTING
Between 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0-19 years old) COVID-19 were considered for inclusion.
MAIN OUTCOMES AND MEASURES
The pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity.
RESULTS
129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample.
CONCLUSION
Paediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.
目的
根据世界银行的国家收入水平和疾病严重程度，比较儿童 COVID-19 疾病特征、管理和结局。
设计
系统评价和荟萃分析。
设置
2019 年 12 月 1 日至 2021 年 1 月 8 日，共确定了 3350 篇文章。两名审查员独立并重复进行研究筛选、数据提取和质量评估。纳入描述实验室确诊的儿科（0-19 岁）COVID-19 的观察性研究。
主要结果和措施
根据世界银行的国家收入水平和报告的疾病严重程度，比较了临床发现、治疗和结局的合并比例。
结果
从 31 个国家的 129 项研究中纳入了 10251 名儿童，其中 57.4%住院。平均年龄为 7.0 岁（标准差 3.6），27.1%有合并症。发热（63.3%）和咳嗽（33.7%）常见。在 3670 例病例中，44.1%有放射影像学异常。大多数患者康复（88.9%）；然而，96 名住院儿童死亡。与高收入国家相比，在低收入和中等收入国家，入住重症监护病房（ICU）的病例比例较低（9.9%比 26.0%），但住院儿童的死亡比例较高（相对风险 2.14，95%置信区间 1.43 至 3.20）。患有严重疾病的儿童比非严重疾病的儿童更频繁地接受抗生素、正性肌力药和抗炎药治疗。亚组分析表明，患有多系统炎症综合征（MIS-C）的儿童入住 ICU 的比例较高（47.1%比 22.9%），且住院的 MIS-C 患儿死亡比例较高（4.8%比 3.6%）。
结论
儿科 COVID-19 的预后良好。全球范围内需要进一步对儿童的严重疾病特征进行描述。
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