The aim of this work is to identify the clinical features of pediatric COVID-19 and to relate them with laboratory findings on potential markers of poorer outcomes, such as evidence of organ dysfunction and of superimposed bacterial infection. We performed a systematic literature review with meta-analysis using the data bases Pubmed, Scopus, SciELO, Cochrane Library, Web of Science, EMBASE and Google Scholar. Only pediatric cases with COVID-19 confirmed by rRT-PCR were selected. Demographical and clinical characteristics, laboratory and imaging features, complications, exposure setting, and outcomes were evaluated. After screening, 90 articles were selected for full-text assessment, 42 being included for qualitative and quantitative analyses. Additionally, 31 case reports were included and analyzed separately. For 4210 patients, fever (48.6%, 95% CI: 43.5-53.7%) and cough (44.2%, 95% CI: 39.1-49.3%) were the most prevalent clinical features. 29.7% (95% CI: 23.3-35.5%) of the children did not report any symptom. 66.4% (95% CI: 60.2-72.1%) of children had abnormal radiologic findings. Among the patients, 5.1% (95% CI: 2.7-9.3%) required intensive care unit and 27.5% (95% CI: 19.0-38.1%) presented secondary infections. The pediatric cases of COVID-19 are generally asymptomatic, with fever and cough, however, being the most frequently observed symptoms. The radiologic images often show ground glass opacities. The overall laboratory biomarkers show a scenario of inflammation. Children presented high co-infection rate, particularly with Mycoplasma.
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