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Flow diagram of the literature search. 11,512 records from databases (Cochrane library, MEDLINE, WHO COVID-19, Web of Science, China Biology Medicine, Wanfang Data, China National Knowledge Infrastructure) and additional sources were included in the initial search and 56 studies were finally included after full-text screen.
Source publication
Background
This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents.
Methods
We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used ra...
Context in source publication
Context 1
... identified 9937 potentially relevant records from the literature databases and registers, and 1575 records from the additional searches. After screening the titles, abstracts and full texts, 56 studies (22 cohort studies, 9 case-control studies, and 25 case series) with a total of 79,104 patients were included [10][11] (Fig. 1). Table 1 shows the characteristics of the studies and their participants. The number of subjects examined in the individual studies ranged from 19 to 29,886. The highest number of studies were conducted in the USA (n = 21, 37.5%), and more than half of the studies did not report the follow-up time (n = 29, 51.8%). Among those that ...
Citations
... At the same time, fever was also associated with a higher mortality risk (OR 1.96) among children and adolescents in Rio de Janeiro state. Shi et al. [49] showed that dyspnea was associated with poor prognosis in children and adolescents with COVID-19. The presence of lower respiratory tract infection signs or symptoms (dyspnea and/or decreased oxygen saturation) at COVID-19 presentation was associated with ICU admission according to Götzinger et al.'s multicenter study [6]; in this study, fever was the most common presenting sign, observed in 65% of individuals. ...
Background Children and adolescents with COVID-19 typically present milder symptoms of the infection, with fatal outcomes being rare. This study aimed to analyze the main risk factors for mortality in this population group. Methods A cross-sectional study was performed to analyze reported COVID-19 cases among individuals under 18 years old in Rio de Janeiro state, Brazil, from March 2021 to September 2023. Pearson's chi-square test was used for categorical variables, and the Wilcoxon test for numerical variables. The significance level was set at 5%. Logistic regression analysis was performed to identify factors associated with COVID-19 mortality in individuals under 18. Results Infants under 1 year old had a higher mortality risk (OR = 4.70; 95% CI: 2.45–9.60) compared to adolescents aged 15–17 years. Non-white individuals had a lower mortality risk compared to white individuals (OR = 0.64; 95% CI: 0.41–0.99). The presence of fever (OR = 1.83; 95% CI: 1.17–2.89), dyspnea (OR = 11.83; 95% CI: 7.50-18.74), and oxygen saturation below 95% (OR = 11.97; 95% CI: 3.78–33.19) was associated with a higher mortality risk. Patients with heart disease (OR = 7.74; 95% CI: 3.89–14.58) and immunodeficiency/immunosuppression (OR = 17.16; 95% CI: 8.58–32.14) had a higher mortality risk. Infection during the predominance of variants B1_wild (OR = 3.44; CI 1.75–6.81), Gamma (OR = 3.93; CI 2.13–7.44), and Delta (OR = 2.27; CI 1.02–4.84) was associated with a higher mortality risk compared to the Omicron variant. Conclusions The main risk factors for death were fever, dyspnea, oxygen saturation below 95% on room air, age under one year, cardiac disease comorbidity, immunodeficiency, and infection during the predominance of B1_wild, Gamma, and Delta variants. Understanding the epidemiological profile and risk factors for mortality in this population is essential to inform effective prevention and control measures and guide optimal clinical management.
... COVID-19 in children is usually less severe and associated with a lower mortality than in adults [2]. However, severe disease and COVIDrelated mortality have been observed in neonates and infants, children with comorbidities and those living in low-or middle-income countries (LMICs) [3][4][5]. Furthermore, there is concern regarding long-term health consequences following acute COVID-19 infection in children and adolescents based on observational evidence in adults with COVID-19 as well as previous experience of severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) [6,7]. ...
The long-term health consequences following COVID-19 have largely been reported in adult populations living in high-income countries. We therefore did a systematic review of post COVID-19 condition symptoms reported in children and adolescents (<18 years), aiming to identify and include publications from low- or middle-income countries (LMICs). From EMBASE, Medline, and Pubmed until the 30th of October 2023, we searched all studies reporting original and complete data of long-term outcomes of at least 20 children or adolescents under 18 years of age with a history of confirmed acute COVID-19 infection. We excluded non-English publications, pre-prints, unreviewed articles, grey literature, studies with inaccessible full text, and those limited to a specific population. Risk of Bias was assessed using STROBE guidelines for observational studies. We used descriptive narrative analysis to summarize the findings. Forty studies reporting 825,849 children and adolescents; the median age of those with persistent symptoms was consistently in the adolescent age range but not all studies included young children (<5 years). Only one study, with 58 participants aged 6-17 years, population was from a LMIC. Studies relied on symptom reporting rather than objective measures of organ dysfunction. The definition of post COVID-19 condition varied; most studies used persistent symptom duration of two or three months or more. However, since the symptom onset was not specified, it was difficult to identify which study is truly consistent with WHO’s definition of post COVID-19 condition. Prevalence of post COVID-19 condition ranged from 1.8% to 70% but with marked heterogeneity between study populations and reporting criteria including the severity of acute COVID presentation. Most studies were undertaken when the Alpha variant was the predominant strain. The prevalence of post COVID-19 condition ranged from 6.7% to 70% in the Alpha variant-, 23% to 61.9% in the Delta-, 17% to 34.6% in the Omicron-, and 3.7% to 34% in the Other-variant predominated studies. The most reported symptoms were fatigue (70%), headache (37.5%) and respiratory symptoms (35%); fatigue was most reported in all variant subgroups. Only half of the studies included a control group. The variations in study population, reporting methods, reliance on symptom reporting alone and lack of control groups make it challenging to determine the impact of COVID-19 on post COVID health in children and adolescents. The lack of data from LMIC populations especially infants and young children is a major gap.
... However, a distinct and concerning entity known as Multisystem Inflammatory Syndrome in Children (MIS-C) emerged as a complication associated with COVID-19 infection in pediatric populations [6,7]. While children generally experience milder cases of COVID-19 compared to adults, there are instances where they require hospitalization, intensive care unit (ICU) admission, or mechanical ventilation to manage severe respiratory distress [3,[8][9][10]. ...
... Among these cases, 171 (36.5%) had underlying diseases. Within the severe/critical group, which comprised 67 cases (14.3%), the median hospitalization stay was 12 days (IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Furthermore, among the deceased group, which consisted of 23 cases (4.9%), the median hospital stay was 15 days (IQR, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], with 19 of them (82.6%) ...
... Identifying potential predictors that can aid in improving the clinical management of children with COVID-19 is indeed an urgent task that requires immediate attention. By understanding factors that influence disease progression and severity in pediatric cases, healthcare providers can better tailor treatment strategies, allocate resources effectively, and improve outcomes for children affected by the virus [9,15,16]. ...
Background
Understanding the factors influencing disease progression and severity in pediatric COVID-19 cases is essential for effective management and intervention strategies. This study aimed to evaluate the discriminative ability of clinical and laboratory parameters to identify predictors of COVID-19 severity and mortality in hospitalized children.
Methods
In this multicenter retrospective cohort study, we included 468 pediatric patients with COVID-19. We developed a predictive model using their demographic, clinical, and laboratory data. The performance of the model was assessed using various metrics including sensitivity, specificity, positive predictive value rates, and receiver operating characteristics (ROC).
Results
Our findings demonstrated strong discriminatory power, with an area under the curve (AUC) of 0.818 for severity and 0.873 for mortality prediction. Key risk factors for severe COVID-19 in children include low albumin levels, elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), and underlying medical conditions. Furthermore, ROC curve analysis highlights the predictive value of CRP, LDH, and albumin, with AUC values of 0.789, 0.752, and 0.758, respectively.
Conclusion
Our study indicates that laboratory values are valuable in predicting COVID-19 severity in children. Various factors, including CRP, LDH, and albumin levels, demonstrated statistically significant differences between patient groups, suggesting their potential as predictive markers for disease severity. Implementing predictive analyses based on these markers could aid clinicians in making informed decisions regarding patient management.
... Furthermore, a retrospective review found that pediatric patients with CHD and COVID-19 had signifcantly longer hospital stays, complication rate, and mortality rate compared to pediatric COVID-19 patients with no CHD [71]. Several other studies echo these fndings [72][73][74], with one demonstrating that the more severe the heart disease, the worse the outcomes with COVID-19 [75]. ...
Due to the deleterious global impact of the COVID-19 pandemic, tremendous effort has been invested in the development of vaccines against the virus. Vaccine candidates are first tested in adult populations, a number of which have been approved for EUL by the WHO, and are in use across the USA and MENA region. The question remains whether these (or other) vaccines should be recommended to a neonatal, pediatric, and/or adolescent cohort. Incidence and severity of COVID-19 infection are low in pediatric, neonatal, and adolescent patients. Since both overall incidence and severity are lower in children than in adults, safety is an important consideration in vaccine approval for these age groups, in addition to efficacy and a decreased risk of transmission. The following review discusses vaccine immunology in children aged 0–18 years, with emphasis on the negative impact of the COVID-19 pandemic on the lives of children, considerations for pediatric vaccine approval, and available vaccines for pediatric cohorts along with a breakdown of the efficacy, advantages, and disadvantages for each. This review also contains current and future perspectives, as well as a section on the cardiovascular implications and related dynamics of pediatric COVID-19 vaccination.
... Severe cases were also found among those with elevated serum C-reactive protein, D-dimer, and in those who develop Multisystem Inflammatory Syndrome in Children (MIS-C). 6,7 Although mortality was highest among children less than 5 years old, age-segregated data on disease severity, hospitalization rates, and risk factors are needed and information on clinical and laboratory profile, management and outcomes, and risk factors of hospitalized COVID-19 cases is important to continue to guide clinicians and policymakers. Locally published reports of COVID-19 cases in the pediatric population are limited. ...
Background. The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deathsduring the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance. Objectives. This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children. Methods. This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designatedCOVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. Results. There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases. Antibiotics were given to 71.7% of patients at the outset.As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at2.2%. Conclusion. Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illnessor comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.
... Similarly, there are evidently increased incidences of pulmonary emboli [166,167], thrombosis, and angiopathy of the microvasculature that may contribute to multi-organ failure [168,169], and extrapulmonary arterial and venous thromboembolic phenomena in adults [170,171], and to a lesser degree, in children and adolescents with COVID-19, where nine (2.1%) of the 426 hospitalized pediatric patients with symptoms developed thrombotic events across seven children's hospitals in the US [172]. Therefore, thrombo-inflammatory markers such as D-dimer are the most common abnormal laboratory findings in adult and pediatric COVID-19 [173], and may be predictive of disease course [174,175]. ...
Background
Coronavirus disease 2019 (COVID-19) tends to have mild presentations in children. However, severe and critical cases do arise in the pediatric population with debilitating systemic impacts and can be fatal at times, meriting further attention from clinicians. Meanwhile, the intricate interactions between the pathogen virulence factors and host defense mechanisms are believed to play indispensable roles in severe COVID-19 pathophysiology but remain incompletely understood.
Data sources
A comprehensive literature review was conducted for pertinent publications by reviewers independently using the PubMed, Embase, and Wanfang databases. Searched keywords included “COVID-19 in children”, “severe pediatric COVID-19”, and “critical illness in children with COVID-19”.
Results
Risks of developing severe COVID-19 in children escalate with increasing numbers of co-morbidities and an unvaccinated status. Acute respiratory distress stress and necrotizing pneumonia are prominent pulmonary manifestations, while various forms of cardiovascular and neurological involvement may also be seen. Multiple immunological processes are implicated in the host response to COVID-19 including the type I interferon and inflammasome pathways, whose dysregulation in severe and critical diseases translates into adverse clinical manifestations. Multisystem inflammatory syndrome in children (MIS-C), a potentially life-threatening immune-mediated condition chronologically associated with COVID-19 exposure, denotes another scientific and clinical conundrum that exemplifies the complexity of pediatric immunity. Despite the considerable dissimilarities between the pediatric and adult immune systems, clinical trials dedicated to children are lacking and current management recommendations are largely adapted from adult guidelines.
Conclusions
Severe pediatric COVID-19 can affect multiple organ systems. The dysregulated immune pathways in severe COVID-19 shape the disease course, epitomize the vast functional diversity of the pediatric immune system and highlight the immunophenotypical differences between children and adults. Consequently, further research may be warranted to adequately address them in pediatric-specific clinical practice guidelines.
... Hasil yang serupa ditemukan pada penelitian di Cina yang tidak menemukan perbedaan yang bermakna antara jenis kelamin dengan usia onset DA (p>0.005). (Shi et al., 2021) Hal ini dapat karena persebaran data yang cukup bervariasi di beberapa penelitian. (Kanwar, 2011) Kejadian DA tertinggi pada penelitian ini yakni fase anak sebanyak 42 pasien (53,3%). ...
The prevalence of atopic dermatitis is starting to grow rapidly not only in the population of industrialized countries but also in developing countries. Data on the prevalence of AD at RSUDP NTB was last reported in the 2013-2014 period, so data updates are needed to determine the characteristics of AD at Dermatology and Venereology Outpatient Clinic at RSUDP NTB. This is a descriptive retrospective study by taking secondary data from medical records on AD patients for the period January 2017-December 2021 who came for treatment.The total number of new visits to DV outpatient clinic RSUDP NTB was 3120 patients. There were 78 new AD diagnosed patients, dominated by women (51,2%). The prevalence of AD between 2017-2021 is 2.5%. Most of patients is in pediatric age group (53,3%) and mostly live at rural area (56,4%) the most frequent comorbidity was scabies, namely 10 patients (12,8%). There was a decrease in the prevalence of AD compared to previous data. It is necessary to optimize medical records to determine trends in AD cases in patients visiting the DV Outpatient Clinic RSUDP NTB.
... Hasil yang serupa ditemukan pada penelitian di Cina yang tidak menemukan perbedaan yang bermakna antara jenis kelamin dengan usia onset DA (p>0.005). (Shi et al., 2021) Hal ini dapat karena persebaran data yang cukup bervariasi di beberapa penelitian. (Kanwar, 2011) Kejadian DA tertinggi pada penelitian ini yakni fase anak sebanyak 42 pasien (53,3%). ...
Abstrak Latar Belakang : Prevalensi keseluruhan dermatitis atopik (DA) telah meningkat menjadi 3 kali lipat selama dekade terakhir di negara-negara industri. Data prevalensi pasien DA di RSUDP NTB terakhir dilaporkan pada pada periode 2013-2014 dimana terdapat 85 (8,5%) pasien baru bayi dan anak DA, sehingga diperlukan pembaruan data untuk mengetahui karakteristik pasien DA di Poliklinik Rawat Jalan Kulit dan Kelamin RSUDP NTB. Metode : Ini merupakan penelitian retrospektif deskriptif dengan cara mengambil data sekunder dari rekam medis pada pasien DA periode Januari 2017-Desember 2021 yang datang berobat. Hasil : Total kunjungan pasien baru di poliklinik rawat jalan Kulit dan Kelamin RSUDP NTB adalah sebanyak 3.120 pasien. Pada penelitian ini terdapat 78 pasien baru dengan diagnosis DA, didominasi oleh perempuan (51,2%). Prevalensi DA antara tahun 2017-2021 sebesar 2,5%. Kelompok usia terbanyak pada fase anak yaitu sebanyak 42 pasien (53,3%). Pasien lebih banyak tinggal di daerah rural dibandingkan urban yaitu sebanyak 44 (56,4%). Pasien yang memiliki riwayat atopi pada diri sendiri sebanyak 4 (5,1%), riwayat atopi pada keluarga sebanyak 2 (2,5%), dan riwayat atopi pada diri sendiri dan keluarga sebanyak 3 (3,8%). Penyakit penyerta yang paling sering terjadi adalah skabies yaitu sebanyak 10 (12,8%). Kesimpulan : Selama kurun waktu lima tahun terjadi penurunan prevalensi kejadian DA dibandingkan data penelitian sebelumnya. Perlu optimalisasi rekam medis untuk mengetahui trend kasus DA pada pasien yang berkunjung ke Poliklinik RSUDP NTB.
... Fortunately, the impact of this infection on children has been lower than what has been seen in adults, particularly in older individuals [1,2]. However, multiple risk factors have been associated with greater morbidity and mortality in children [3][4][5][6][7][8], including cardiac disease, neurologic disorders, prematurity, diabetes, obesity (particularly severe obesity), chronic lung disease, feeding tube dependence, and immunocompromised status. Age (<1 year and 10-14 years) and being from a racial and ethnic minority group have also been associated with severe disease. ...
The impact of SARS-CoV-2 infections in children has fortunately been lower than what has been seen in adults. However, even previously healthy children have developed severe disease, sometimes with subsequent mortality, and those who are infants or adolescents, are from racial and ethnic minority groups, or have certain chronic conditions are at higher risk of these outcomes. During the pandemic, extensive studies of therapeutic agents, including antivirals and immunomodulators, were conducted in adults. Few trials included children, and most were in older children and adolescents. Thus, the potential benefits of therapies in children must be extrapolated from adult evidence. Despite these limitations, advisory committees of the National Institute of Health (NIH), the Infectious Disease Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) were constituted, and expert consensus guidelines were developed. This review provides a synthesis of those comprehensive recommendations for therapy in children. These address treatment during the early infectious period with antiviral agents, including remdesivir and nirmatrelvir/ritonavir, as well as treatment in the later period of immune dysregulation with corticosteroids and immunomodulators. In addition, the therapeutic approach for multisystem inflammatory syndrome in children (MIS-C), also referred to as Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is also provided.
... These comorbidities were asthma/chronic pulmonary disease, hypertension, diabetes mellitus, HIV and previous tuberculosis (TB) [4]. A systematic review exploring poor prognostic factors for COVID-19 in children and adolescent found that congenital heart disease, chronic pulmonary disease, neurological diseases, and obesity were associated with unfavourable outcomes [5]. ...
A rapid systematic review, based on Cochrane rapid review methodology was conducted to assess the effectiveness of two 10μg doses of BNT162b2 vaccine in preventing morbidity and mortality associated with COVID-19 in children aged 5 to 11 years. We searched the Cochrane Library COVID-19 study register, the COVID-NMA living review database and the McMaster University Living Evidence Synthesis for pre-appraised trials and observational studies up to 7 December 2022. Records were screened independently in duplicate. Where appraisal was not available, these were done in duplicate. Meta-analysis was conducted using RevMan 5.3 presenting risk ratios/odds ratios/inverse vaccine efficacy with 95% confidence intervals (CI). GRADE for assessing the overall certainty of the evidence was done in Gradepro. We screened 403 records and assessed 52 full-text articles for eligibility. One randomised controlled trial (RCT) and 24 observational studies were included. The RCT reported that BNT162b2 was likely safe and 91% efficacious, RR 0.09 (95% CI 0.03 to 0.32) against incident COVID-19 infection (moderate certainty evidence). In absolute terms, this is 19 fewer cases per 1,000 vaccines delivered (ranging from 15 to 21 fewer cases). Observational studies reported vaccine effectiveness (VE) against incident COVID-19 infection of 65% (OR 0.35, 95% CI 0.26 to 0.47) and 76% against hospitalisation (OR 0.24, 95% CI 0.13 to 0.42) (moderate certainty evidence). The absolute effect is 167 fewer cases per 1,000 vaccines given (ranging from 130 fewer to 196 fewer cases) and 4 fewer hospitalisations per 10,000 children (from 3 fewer to 5 fewer hospitalisations). Adverse events following vaccination with BNT162b2 were mild or moderate and transient. The evidence demonstrated a reduction in incident COVID-19 cases and small absolute reduction in hospitalisation if a two-dose BNT162b2 vaccine regimen is offered to children aged 5 to 11 years, compared to placebo. PROSPERO registration: CRD42021286710.
