Abstract

The novel coronavirus pandemic is an ongoing challenge faced by the public and health care systems around the globe. Majority of information and evidence gathered so far has been derived from data and studies in adult populations. Crucial information regarding the characterization, clinical symptomatology, sequelae, and overall outcomes in the pediatric population is lacking. As such, we conducted a comprehensive meta-analysis and systematic review to collect and analyze current evidence about COVID-19 in the pediatric population. A systematic search and review of scientific literatures was conducted in various databases following the PRISMA guidelines. All relevant studies until June 16, 2020 were included. Studies were reviewed for methodological quality, and random-effects model was used to conduct the primary meta-analysis. I2 value and Egger’s test was used to estimate heterogeneity and publication bias respectively. We reviewed 20 eligible studies that included 1810 pediatric patient population (<21 yo) with PCR tested COVID-19 positivity. In pooled data, majority (25 % [CI 18-32], I2 59 %) of overall COVID-19 positive patients fell in the 6-10 yr age group. 13 % ([CI 11-14], I2 78 %) of the patients were asymptomatic, with headache (67 % [CI 60-74], I2 46 %), fever (55 % [CI 52-58], I2 61 %), and cough (45 % [CI 42-49], I2 79 %) accounting for the most prevalent physical signs seen in symptomatic patients. Leukopenia (12 % [CI 9-15], I250 %) and lymphopenia (15 % [CI 13-19], I2 85 %) was common. Elevated Ferritin (26 % [CI 16-40], I2 73 %), Procal (25 % [CI 21-29 %], I2 83 %), and CRP (19 % [CI 16-22 %], I2 74 %) were other laboratory abnormalities commonly observed. Common radiological features were ground-glass opacities (36 % [CI 32-39 %], I2 92 %), normal finding (33 % [CI 30-36 %], I2 81 %), and consolidation. 29 % ([CI 26-33], I2 85 %) of the patient cases was non-severe, whereas only 5 % ([CI 1-8], I2 87 %) was severe. Mortality was observed in 0.3 % ([CI 0.1-0.4], I2 0%) of the overall cases. Results showed that COVID-19 is prevalent across all pediatric age-groups and presents with varying degree of symptomology. However, children have a milder course of the disease with extremely favorable prognosis. Laboratory and radiological features are inconsistent and require further investigations. Additional studies are needed on this topic to corroborate findings and establish evidence-based and consistent characterization of COVID-19 in the pediatric population. Biography

Sujeena Badal, M.P.H., currently works as a research associate/ analyst at BLH Technologies, Inc. in Rockville, Maryland, USA. Ms. Badal is skilled with expert knowledge of public health polices and issues including behavioral health in vulnerable populations, youth mental health, and health disparities in minority populations. Experienced in project management, literature reviews, and data analysis using quantitative and qualitative tools, with extensive experience developing inter-agency relations. Ms. Badal also hosts on-site conferences, as well as virtual meetings and webinars using online virtual platforms which includes facilitation and providing logistic and technical support. Ms. Badal earned an M.P.H. in Epidemiology from University of Oklahoma Health Sciences Center in Oklahoma and a B.A. in Biology from The College of Saint Scholastica in Minnesota. Before joining BLH Technologies, she had opportunity to intern at Oklahoma State Department of Health, where she worked on Oklahoma State Health Report and conducted extensive statistical analyses on data obtained from Weight Management Clinic Program. She also completed one- year internship at Substance Abuse and Mental Health Services Administration, where she conducted literature reviews on various evidence-based programs, including quantitative and qualitative research, and policy analysis to improve behavioral health services.

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