COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment, Diagnosis, Prognosis Ludvigsson JF Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020 Jun;109(6):1088-1095. doi: 10.1111/apa.15270. Epub 2020 Apr 14.

AIM: The coronavirus disease 2019 (COVID-19) pandemic has affected hundreds of thousands of people. Data on symptoms and prognosis in children are rare.

METHODS: A systematic literature review was carried out to identify papers on COVID-19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), using the MEDLINE and Embase databases between January 1 and March 18, 2020.

RESULTS: The search identified 45 relevant scientific papers and letters. The review showed that children have so far accounted for 1%-5% of diagnosed COVID-19 cases, they often have milder disease than adults and deaths have been extremely rare. Diagnostic findings have been similar to adults, with fever and respiratory symptoms being prevalent, but fewer children seem to have developed severe pneumonia. Elevated inflammatory markers were less common in children, and lymphocytopenia seemed rare. Newborn infants have developed symptomatic COVID-19, but evidence of vertical intrauterine transmission was scarce. Suggested treatment included providing oxygen, inhalations, nutritional support and maintaining fluids and electrolyte balances.

CONCLUSIONS: The coronavirus disease 2019 has occurred in children, but they seemed to have a milder disease course and better prognosis than adults. Deaths were extremely rare.

Discipline / Specialty Area Score
Infectious Disease
Pediatrics (General)
Pediatric Neonatology
Family Medicine (FM)/General Practice (GP)
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

The review article reports the current data showing that COVID-19 has affected children mildly up to this point. We will continue to monitor the disease process in children as new reports coming from the UK show a disease process similar to toxic shock syndrome and atypical Kawasaki disease.

Infectious Disease rater

There are important data provided by this study despite the documented limitations. Further larger datasets from a wider range of geographical locations are needed to substantiate these findings, and stratification of severity in different pediatric age groups would be helpful in fine-tuning age-related susceptibility.

Pediatric Neonatology rater

Data from China, Italy and US support the wide belief that children with COVID-19 run a milder course with comparatively better prognosis.

Pediatrics (General) rater

Readers should note that this review lacked a pre-specified protocol and probably did not undergo peer review (limitations that are imposed by the gravity of the pandemic and the scarcity on information on the disease in children).