Department of Public Health, Indian Institute of Public Health Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada Bus Stop, Gandhinagar-Chiloda Road, Gandhinagar, Gujarat 382042, India.
Department of Public Health, 9138 Harbor Hills Drive, Houston, TX 77054, USA.
QJM. 2021 Nov 5;114(7):476-495. doi: 10.1093/qjmed/hcab206.
Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population.
For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis.
Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818-24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356-0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48-64%) and cough (35-55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4-61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2-50% and 0.3-67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality.
Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population.
鉴于与儿科 COVID-19 相关的已发表文献数量有限且种类繁多，提供基于证据的疾病特征总结以指导决策至关重要。我们旨在全面概述儿科人群 COVID-19 感染的流行病学、临床和生物标志物特征。
对于本次伞式综述，从 PubMed 和预印本数据库中筛选已发表的系统评价。文献检索时间为 2019 年 12 月至 2021 年 4 月。从每项综述中收集临床、影像学和实验室特征的详细信息。采用荟萃分析评估死亡率和无症状病例的综合患病率。
对 38 项系统评价的证据进行综合分析，共纳入 1145 项研究和 334398 名儿童和青少年。综述结果表明，COVID-19 在儿科相对较轻，预后较好。然而，合并症患者风险更高。对综述的荟萃分析显示，21.17%（95%CI：17.818-24.729）的患者无症状，死亡率为 0.12%（95%CI：0.0356-0.246）。虽然没有发表偏倚，但观察到显著的异质性。发热（48-64%）和咳嗽（35-55.9%）是常见症状，几乎影响每两个患者中的一个。磨玻璃影（患病率范围：27.4-61.5%）是最常见的影像学观察结果。C 反应蛋白、乳酸脱氢酶和 D-二聚体升高范围分别为 14%-54%、12.2%-50%和 0.3%-67%。部分纳入的综述（44.7%-AMSTAR；13.2%-GRADE）质量较低。
本次伞式综述提供了最新的关于儿科 COVID-19 感染特征的信息，可以用于指导疫苗接种优先级、早期筛查和识别高危人群的决策。
