Clinical characteristics, treatment and outcomes of paediatric COVID-19: A systematic review and meta-analysis

Omar Irfan, Fiona Muttalib, Kun Tang, Li Jiang, Zohra S. Lassi, Zulfiqar Bhutta

Research output: Contribution to journalReview articlepeer-review

147 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)440-448
Number of pages9
JournalArchives of Disease in Childhood
Issue number5
Publication statusPublished - 1 May 2021


  • COVID-19
  • adolescent health
  • epidemiology


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