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A systematic review and meta-analysis of otorhinolaryngological manifestations of coronavirus disease 2019 in paediatric patients

Part of: JLO Coronavirus Collection

Published online by Cambridge University Press:  17 February 2022

M Yadav ,
A Singh Open the ORCID record for A Singh [Opens in a new window] ,
J Meena  and
J M Sankar
M Yadav
Affiliation:
Department of Paediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India
A Singh*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, New Delhi, India
J Meena
Affiliation:
Department of Paediatric Nephrology Unit, Advanced Paediatrics Centre, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
J M Sankar
Affiliation:
Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
*
Author for correspondence: Dr Anup Singh, room no. 4057, ENT Office, 4th floor, Teaching Block, All India Institute of Medical Sciences, Ansari Nagar, New Delhi110029, India E-mail: anoop.aiims1@gmail.com
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Abstract

Background

This meta-analysis provides a quantitative measure of the otorhinolaryngological manifestations of coronavirus disease 2019 in children.

Methods

A structured literature review was carried out using PubMed, Embase and Cochrane Central, employing pertinent search terms. The statistical analysis was performed using Stata version 14.2 software, and the analysed data were expressed as the pooled prevalence of the symptoms with 95 per cent confidence intervals.

Results

The commonest symptoms noted were cough (38 per cent (95 per cent confidence interval = 33–42; I2 = 97.5 per cent)), sore throat (12 per cent (95 per cent confidence interval =10–14; I2 = 93.7 per cent)), and nasal discharge (15 per cent (95 per cent confidence interval = 12–19; I2 = 96.9 per cent)). Anosmia and taste disturbances showed a pooled prevalence of 8 per cent each. Hearing loss, vertigo and hoarseness were rarely reported.

Conclusion

Cough, sore throat and nasal discharge were the commonest otorhinolaryngological symptoms in paediatric patients with coronavirus disease 2019. Compared with adults, anosmia and taste disturbances were infrequently reported in children.

Keywords

COVID-19ChildPrevalenceRespiratory SystemCoughOlfaction Disorders
Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 7 , July 2022 , pp. 588 - 603
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

Introduction

The coronavirus disease 2019 (Covid-19) pandemic, which started in Wuhan, China, has affected 242 348 657 people worldwide to date and has claimed 4 927 723 lives as of 22 October 2021.1 The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus classically homes to the upper respiratory system, which acts as a gateway to the lower respiratory system, and spreads predominantly by aerosol transmission. Though the lower respiratory system involvement is associated with much of the morbidity and mortality, the upper respiratory symptoms are often present in isolation or precede the onset of lower respiratory system symptoms. Therefore, quantitative documentation of upper respiratory tract manifestations is vital to help identify the disease symptoms early within the community, and possibly undertake testing and containment steps at an early stage in order to curb the community transmission.

There are well-documented differences in the disease characteristics and disease course between paediatric and adult patients. The disease in children usually behaves mildly with lower mortality (0.17 out of 100 000) compared with adult patients.Reference Bhopal, Bagaria, Olabi and Bhopal2 Severe illness has been reported to occur in almost 7 per cent of children compared with 26 per cent of adults.Reference Fu, Wang, Yuan, Chen, Ao and Fitzpatrick3 Nevertheless, this lower disease severity may still be associated with sustained transmission to those susceptible to more severe disease.

Because the upper aerodigestive tract serves as the sentinel to the entry of SARS-CoV-2, Covid-19 symptoms often begin with or are concomitantly present in the upper respiratory tract. The information on clinical aspects of the disease in children is still evolving and is quite limited compared with that in adults. The lower respiratory manifestations and systemic symptoms are well documented in the literature, but focused quantitative documentation regarding upper respiratory symptomatology is still lacking. Though ENT symptoms encountered in Covid-19 patients are unlikely to be life-threatening (as opposed to, for example, shortness of breath, pneumonia and acute respiratory distress syndrome), a close familiarity with the symptoms is vital to identify and isolate the affected individuals in a timely fashion. We conducted this meta-analysis to summarise the upper respiratory tract and otorhinolaryngological manifestations of Covid-19 in children.

Methods

We aimed to evaluate the pooled prevalence of 10 otorhinolaryngological symptoms: loss of smell, loss or alteration of taste, cough, nasal discharge, nasal blockage, hearing loss, vertigo, sore throat, throat pain and hoarseness.

Two authors (AS and MY) independently searched three databases (PubMed, Embase and Cochrane Central Register of Controlled Trials) for the relevant information published between December 2019 and June 2021. The search was conducted using three basic groups of terminologies or key words; the search terms related to: the infection being studied (Covid-19), the patient population (child*/pediatr*) and the otorhinolaryngological manifestations (ear/ oto* /cough/ hearing/ vertigo/ dizziness/ pharynx/ pharyng*/ throat/ larynx/ laryng*/ hoarse*/ taste/ smell/ olfact*/ nasal/ nose/ naso*/ rhino*/ sinus/ ageusia/ dysgeusia). The bibliographic information obtained from selected articles was also searched manually to include further relevant articles. The protocol was registered in the ‘Prospero’ International Prospective Register of Systematic Reviews (code: CRD42021230455), and we followed the Meta-analyses of Observational Studies in Epidemiology (‘MOOSE’) guidelines when reporting the findings.Reference Stroup, Berlin, Morton, Olkin, Williamson and Rennie4

Study selection

The complete search strategy (including Medical Subject Headings (MeSH) terms) can be found in Supplementary Table 1.

The inclusion criteria were: prospective or retrospective studies, or clinical trials, reporting otorhinolaryngological symptoms in the paediatric population (aged 18 years or younger). We excluded: (1) case reports or series reporting fewer than 20 patients; (2) review articles; (3) editorials, opinions, technical reports, and conference abstracts with insufficient information; and (4) studies involving all age groups where no separate paediatric data were available. Non-English-language articles and studies reporting solely on multisystem inflammatory syndrome in children were also excluded. Any discrepancies relating to study inclusion were resolved through discussion with a third reviewer (JMS). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (‘PRISMA’) flowchart (Figure 1) depicts the process of study selection and inclusion.

Fig. 1. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (‘PRISMA’) flowchart.

Data extraction and quality or bias assessment

Data were extracted using a well-structured, standardised proforma. Specifically, we documented the following: first author's name; year of publication; journal title; study setting and design; methods; study population; baseline demographic characteristics; details of intervention and control groups (in the case of clinical trials); case definition of Covid-19; prevalence of smell loss, taste loss or alteration, cough, nasal discharge, nasal blockage, hearing loss, vertigo, sore throat, throat pain, and hoarseness; and information for assessment of risk of bias. The risk of bias was evaluated using the scale by Hoy et al.Reference Hoy, Brooks, Woolf, Blyth, March and Bain5 Two investigators performed the risk of bias assessment independently (AS, MY), and any discrepancies encountered were resolved by discussion with a third reviewer (JMS). Wherever provided, the data on asymptomatic patients were also recorded.

Data synthesis and statistical analysis

We undertook a quantitative synthesis of the prevalence of various otolaryngological symptoms of Covid-19 in children from the included studies. The categorical data were expressed in percentages, while the continuous data were expressed as means and standard deviations. The statistical analysis was performed using Stata® version 14.2 software, and the analysed data were expressed as the numerical value of the pooled prevalence of the symptoms with 95 per cent confidence intervals (CIs).

The studies that did not report an outcome were excluded from the denominator for the pooled prevalence. Wherever explicitly stated as absent from the cohort, we considered zero prevalence towards the final pooled estimate.

Heterogeneity between studies was explored using I2 statistics, and the data were pooled using a random-effects model. A subgroup analysis was performed to explain any heterogeneity detected in the most prevalent symptoms (i.e. those with a pooled prevalence of more than 10 per cent).

A sensitivity analysis was performed to assess the effect of studies with a high risk of bias on final prevalence estimates. The funnel plot asymmetry and Egger's test were used to determine the publication bias.

Results

Study selection and characteristics

The search strategy produced 5271 results; 2299 duplicates were manually removed and 1692 were deemed ineligible by automation tools. The title and abstracts of 1280 records were screened manually and using Rayyan® software; the latter is an application designed to expedite the initial screening of abstracts and titles.Reference Ouzzani, Hammady, Fedorowicz and Elmagarmid6 Of the subsequent 170 retrieved reports, 68 were excluded after full-text review (Figure 1). Eventually, 102 publications, comprising 24 335 children with Covid-19, were included in the meta-analysis.Reference Prata-Barbosa, Lima-Setta, Santos, Lanziotti, Castro and Souza7–Reference Zheng, Wang, Zhang, Xie, Zhang and Wen108 The number of children enrolled in the individual studies ranged from 21 to 3213.

Table 1 provides the key characteristics of the included studies.Reference Prata-Barbosa, Lima-Setta, Santos, Lanziotti, Castro and Souza7–Reference Zheng, Wang, Zhang, Xie, Zhang and Wen108 Of the included studies, 22 (21.6 per cent) were from China, while 12 were from Turkey and 11 were from the USA. Most studies (n = 96) had provided clinical information for children only; the remaining six studies investigated both adult and paediatric populations but had provided the paediatric data separately.

Table 1. Characteristics of included studies

y = years; CDC = Centers for Disease Control and Prevention; UAE = United Arab Emirates; PCR = polymerase chain reaction; RT-PCR = reverse transcriptase transcription polymerase chain reaction; Covid-19 = coronavirus disease 2019; SARS = severe acute respiratory syndrome or median with interquartile range

Retrospective reports (n = 76, 74.5 per cent) constituted the majority of studies, and nearly half (n = 48, 47 per cent) were multicentric studies. The diagnosis of Covid-19 was based on: reverse transcription polymerase chain reaction (n = 76, 74.5 per cent), a combination of clinical and laboratory parameters (n = 16, 15.7 per cent), or serology alone (n = 2). Eight studies lacked clear information on the method employed to confirm the Covid-19 diagnosis. The median age of participants was 7.8 years (interquartile range = 6, 10), and they ranged from newborns to 15.2 years. Both sexes were equally represented across the studies.

The risk of bias was moderate (n = 35) to high (n = 65) in almost all the eligible studies; only two studies were considered to have a low risk of bias. The lack of random selection of the sample and data collection from hospital records (not directly from study subjects) were the most commonly observed biases noted in the eligible studies.

Clinical symptoms

The commonest symptoms were cough, nasal discharge and sore throat (Figures 2–4, and Supplementary Figure 1). The pooled prevalence of cough was 38 per cent (95 per cent CI = 33–42; I2 = 97.5 per cent), while that of sore throat was 12 per cent (95 per cent CI = 10–14; I2 = 93.7 per cent). The prevalence of nasal discharge was 15 per cent (95 per cent CI = 12–19; I2 = 96.9 per cent; Table 2). The least commonly reported symptoms were hearing loss, throat pain and hoarseness, with fewer than five contributory studies for each symptom. Loss of taste or smell was less commonly reported, with an expectedly similar pooled prevalence of 8 per cent (95 per cent CI = 6–10 for smell and 5–10 for taste). Vertigo and hoarseness of voice had a much lower pooled prevalence of 1 per cent each. Table 2 shows the pooled prevalence of these 10 symptoms and the proportion of asymptomatic patients in the eligible studies.

Fig. 2. Forest plot showing the pooled prevalence of cough. ES = effect size; CI = confidence interval; CDC = Centers for Disease Control and Prevention; Covid-19 = coronavirus disease 2019

Fig. 3. Forest plot showing the pooled prevalence of nasal discharge. ES = effect size; CI = confidence interval; CDC = Centers for Disease Control and Prevention; Covid-19 = coronavirus disease 2019

Fig. 4. Forest plot showing the pooled prevalence of sore throat. ES = effect size; CI = confidence interval; CDC = Centers for Disease Control and Prevention; Covid-19 = coronavirus disease 2019

Table 2. Pooled prevalence of various otorhinolaryngological manifestations

*P for heterogeneity. CI = confidence interval

Only 66 studies had information regarding the proportion of asymptomatic children, and the resultant estimate of 27 per cent (95 per cent CI = 23–32) was derived from information across 12 687 children.

Publication bias

The funnel plot suggested a reporting bias for anosmia but appeared symmetrical for cough (Figure 5). We also used Egger's test to assess the publication bias. While Egger's test for anosmia showed significant small study effects (p < 0.001), this was not the case for studies reporting cough (p = 0.14).

Fig. 5. Funnel plot for studies reporting (a) anosmia and (b) cough.

Subgroup and sensitivity analysis

We performed subgroup analyses based on study design, case definition, and risk of bias for the three most prevalent symptoms: sore throat, cough and nasal discharge (Supplementary Figures 2–4 and Table 3). Only two studies had a low risk of bias, and pooled prevalence of cough and nasal discharge was 37 per cent (95 per cent CI = 32–42) and 13 per cent (95 per cent CI = 9–16), respectively, in these two studies.Reference Prata-Barbosa, Lima-Setta, Santos, Lanziotti, Castro and Souza7,Reference Hurst, Heston, Chambers, Cunningham, Price and Suarez8 Data on sore throat were limited to studies with moderate to high risk of bias. Sensitivity analysis, after the exclusion of studies with a high risk of bias, did not show a significant change in the pooled prevalence of sore throat (10 per cent (95 per cent CI = 7–14)) or nasal discharge (12 per cent (95 per cent CI = 8–17)). However, heterogeneity was significant for the pooled prevalence of cough, and the pooled prevalence was 30 per cent (95 per cent CI = 24–36) after the exclusion of studies with a high risk of bias.

Table 3. Subgroup and sensitivity analysis for cough, sore throat and nasal discharge

CI = confidence interval; RT-PCR = reverse transcription polymerase chain reaction

The subgroup analyses based on study design and case definition also demonstrated significant heterogeneity (Table 3). The studies with mixed definitions of Covid-19, rather than based on reverse transcription polymerase chain reaction or serology alone, demonstrated more homogeneous results for the prevalence of sore throat (15 per cent (95 per cent CI = 14–17); I2 = 0 per cent, p = 0.01).

We also performed meta-regression analyses to assess the effect of the four different covariates (multicentric, sample size, risk of bias and study design) on the pooled estimates for cough, sore throat and nasal discharge. We did not observe any significant effect on the pooled estimates of these symptoms with meta-regression analyses (Supplementary Tables 2–4).

Discussion

The current meta-analysis summarises the pooled Covid-19 symptoms frequency and distribution values related to the otorhinolaryngological domain in 24 000 paediatric patients. The commonest otorhinolaryngological symptom was cough, followed by sore throat and nasal discharge. Previous reviewsReference Cui, Zhao, Zhang, Guo, Guo and Zheng109 have revealed the commonest presenting symptoms in children to be fever (pooled prevalence of 51 per cent; 95 per cent CI = 45–57) and cough (pooled prevalence of 41 per cent; 95 per cent CI = 35–47). By comparison, the commonest otorhinolaryngological symptoms noted in adult patients, by Qiu et al.,Reference Qiu, Yang, Liu, Wu, Cui and Mou110 were olfactory dysfunction (47 per cent), sneezing (27 per cent) and nasal congestion (19 per cent). These findings highlight the differences between the otolaryngological symptom profiles of children and adults.

Cough is a common symptom of Covid-19 infection that may arise with both upper and lower respiratory involvement. We found cough to be the commonest symptom, with a pooled prevalence of 38 per cent, as reported from 94 studies. This is similar to the findings of previous reports. Though severe lower respiratory involvement often manifests with accompanying symptoms, it may be difficult to localise the focus to the upper versus the lower respiratory tract in milder cases presenting with cough. Regardless, given the potential for significant aerosol generation, cough remains an important symptom for disease transmission. In addition, the high prevalence of cough in children suggests the potential for transmissibility to other vulnerable age groups and caregivers.

Given the frequent occurrence of common cold symptoms in children irrespective of Covid-19 infection, it is possible to mistake Covid-19 infection for common cold symptoms in this age group, leading to a higher propensity of community transmission. Compared with the common cold and allergic rhinitis, nasal symptoms are less frequent in Covid-19 patients.Reference Bruno, Locatello, Cilona, Fancello, Vultaggio and Maltagliati111 Rhinorrhoea and nasal congestion are reported in fewer than one-fifth of Covid-19 cases.Reference Cui, Zhao, Zhang, Guo, Guo and Zheng109 The present analysis showed the pooled prevalence of rhinorrhoea and congestion to be 15 per cent and 8 per cent, respectively.

Olfactory and taste dysfunction is one of the most familiar manifestations of Covid-19 encountered in adults. The high rate of olfactory symptoms correlates with the neurotropism exhibited by SARS-CoV-2 towards the neuroepithelium present in the olfactory cleft. These symptoms can occur in isolation without other nasal symptoms, they typically signal a milder disease course, and they are reversible in the majority of patients.Reference Nguyen, Hoang, Lagier, Raoult and Gautret112,Reference Moein, Hashemian, Tabarsi and Doty113 The meta-analysis by Qiu et al.,Reference Qiu, Yang, Liu, Wu, Cui and Mou110 involving 54 studies and 16 478 adult patients, revealed the pooled prevalence of olfactory symptoms to be 47 per cent (95 per cent CI = 29–65). However, in the paediatric age group, the olfactory and taste symptoms are relatively infrequent. A higher prevalence is noted in older children.Reference Hijazi, Alaraifi and Alsaab9 This may be attributed to an age-related biological difference, or may be secondary to the inability of the children to identify or communicate these symptoms effectively. Regarding the pooled incidence, these symptoms affected less than a tenth of infected children. A recent meta-analysis by Yan et al.Reference Yan, Qiu, Liu, Guo and Hu114 showed the prevalence of smell and taste disturbances in children to be 15 per cent and 9 per cent, respectively. Older age and female gender were associated with a higher prevalence of smell disturbances.

Laryngeal and otological symptoms have been infrequent in adult and paediatric populations, and were described as case reports or case series. The current report showed fewer than 10 per cent of the studies reporting on the presence or absence of these symptoms.Reference Kilic, Kalcioglu, Cag, Tuysuz, Pektas and Caskurlu115–Reference Azzam, Samy, Sefein and ElRouby119

The current analysis showed asymptomatic infections in almost a fourth of affected children. Previous reviews reported the proportion of asymptomatic infections as 40–45 per cent,Reference Oran and Topol120 while the pooled prevalence of asymptomatic cases was calculated to be 48 per cent by Syangtan et al. using a random effect model.Reference Syangtan, Bista, Dawadi, Rayamajhee, Shrestha and Tuladhar121 The same meta-analysis revealed the largest proportion of asymptomatic cases in children (49.6 per cent), followed by the adult (30.3 per cent) and elderly (16.9 per cent) populations. The prevalence of asymptomatic infections apparent from our data is lower (27 per cent). However, given that many asymptomatic infected individuals possibly never visited the hospital, we assume this percentage is larger than that reflected in the current data. Asymptomatic, equally infectious individuals are likely to continue spreading the infection in the community if not detected and isolated. The lower exposure rate for children compared with adults, secondary to the lack of workplace and travel-related exposures, may contribute to the lower predisposition of children to the viral infection. Once exposed, the children are equally likely as adults to acquire the infection.Reference Bi, Wu, Mei, Ye, Zou and Zhang122 However, the more favourable immunity profile, a different pattern of de novo angiotensin-converting enzyme 2 (ACE-2) receptor expression in the airway, or a different pattern of induction of the lower airway ACE-2 receptor after homing of the virus to the upper airways in children may underlie the higher rate of ‘asymptomatic’ infections.Reference Bunyavanich, Do and Vicencio123,Reference Fialkowski, Gernez, Arya, Weinacht, Kinane and Yonker124 The usual lack of associated co-morbidities in children is also protective.

Strength and limitations

This meta-analysis has certain limitations. The inclusion of English-only articles limited the results obtained. The prognostic importance of otorhinolaryngological manifestations could not be assessed because of the paucity of such studies in children. In addition, heterogeneity was significant, limiting the interpretation of pooled estimates. Despite these limitations, the current meta-analysis may serve as a helpful reference database for the pooled prevalence of otorhinolaryngological symptoms, with data obtained from over 100 studies enrolling over 24 000 children with Covid-19.

Conclusion

The commonest otorhinolaryngological manifestation of Covid-19 in paediatric patients was cough, followed by sore throat and nasal discharge. Anosmia and taste disturbances were less prevalent in children compared with adults based on the data available in the literature. Hearing loss, vertigo, throat pain and hoarseness were infrequently reported. Almost a fourth of the paediatric patients infected with Covid-19 were found to be asymptomatic.

Supplementary material

The supplementary material for this article can be found at https://doi.org/10.1017/S0022215122000536

Competing interests

None declared

Footnotes

Dr A Singh takes responsibility for the integrity of the content of the paper

References

WHO Coronavirus (COVID-19) Dashboard. In: https://covid19.who.int [23 October 2021]Google Scholar
Bhopal, SS, Bagaria, J, Olabi, B, Bhopal, R. Children and young people remain at low risk of COVID-19 mortality. Lancet Child Adolesc Health 2021;5:e12–13CrossRefGoogle Scholar
Fu, L, Wang, B, Yuan, T, Chen, X, Ao, Y, Fitzpatrick, T et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect 2020;80:656–65CrossRefGoogle ScholarPubMed
Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–12Google Scholar
Hoy, D, Brooks, P, Woolf, A, Blyth, F, March, L, Bain, C et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 2012;65:934–9CrossRefGoogle ScholarPubMed
Ouzzani, M, Hammady, H, Fedorowicz, Z, Elmagarmid, A. Rayyan--a web and mobile app for systematic reviews. Syst Rev 2016;5:210CrossRefGoogle ScholarPubMed
Prata-Barbosa, A, Lima-Setta, F, Santos, GRD, Lanziotti, VS, de Castro, REV, de Souza, DC et al. Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (Rio J) 2020;96:582–92CrossRefGoogle ScholarPubMed
Hurst, JH, Heston, SM, Chambers, HN, Cunningham, HM, Price, MJ, Suarez, L et al. SARS-CoV-2 infections among children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) study. Clin Infect Dis 2021;73:e2875–82CrossRefGoogle ScholarPubMed
Hijazi, LO, Alaraifi, AK, Alsaab, F. Otolaryngology manifestations of COVID-19 in pediatric patients. Int J Pediatr Otorhinolaryngol 2021;144:110701CrossRefGoogle ScholarPubMed
Bernaola Abraira, M, Bartha De Las Peñas, I, López-Araujo, GA, Escudero Diez, C, Rodríguez Del Río, P, Morales-Cabeza, C et al. Olfactory and gustatory dysfunction in pediatric patients with coronavirus disease (COVID-19). J Investig Allergol Clin Immunol 2021;31:277–9CrossRefGoogle Scholar
Adedeji, IA, Abdu, YM, Bashir, MF, Adamu, AS, Gwarzo, GD, Yaro, BS et al. Profile of children with COVID-19 infection: a cross sectional study from North-East Nigeria. Pan Afr Med J 2020;35(suppl 2):145CrossRefGoogle ScholarPubMed
Alnajjar, AA, Dohain, AM, Abdelmohsen, GA, Alahmadi, TS, Zaher, ZF, Abdelgalil, AA. Clinical characteristics and outcomes of children with COVID-19 in Saudi Arabia. Saudi Med J 2021;42:391–8CrossRefGoogle ScholarPubMed
Arslan, G, Aktürk, H, Duman, M. Clinical characteristics of pediatric COVID-19 and predictors of PCR positivity. Pediatr Int 2021;63:1055–61CrossRefGoogle Scholar
Bai, K, Liu, W, Liu, C, Fu, Y, Hu, J, Qin, Y et al. Clinical analysis of 25 COVID-19 infections in children. Pediatr Infect Dis J 2020;39:e100–3CrossRefGoogle ScholarPubMed
Bardellini, E, Bondioni, MP, Amadori, F, Veneri, F, Lougaris, V, Meini, A et al. Non-specific oral and cutaneous manifestations of coronavirus disease 2019 in children. Med Oral Patol Oral Cir Bucal 2021;26:e549–53CrossRefGoogle ScholarPubMed
Bayesheva, D, Boranbayeva, R, Turdalina, B, Fakhradiyev, I, Saliev, T, Tanabayeva, S et al. COVID-19 in the paediatric population of Kazakhstan. Paediatr Int Child Health 2020;41:76–8CrossRefGoogle ScholarPubMed
Natera-de Benito, D, Aguilera-Albesa, S, Costa-Comellas, L, García-Romero, M, Miranda-Herrero, MC, Rúbies Olives, J et al. COVID-19 in children with neuromuscular disorders. J Neurol 2021;268:3081–5CrossRefGoogle ScholarPubMed
Böncüoğlu, E, Coşkun, M, Kıymet, E, Öztürk Atasoy, T, Şahinkaya, Ş, Cem, E et al. Can laboratory findings predict pulmonary involvement in children with COVID-19 infection? Pediatr Pulmonol 2021;56:2489–94CrossRefGoogle ScholarPubMed
Bustos-Cordova, E, Castillo-García, D, Cerón-Rodríguez, M, Soler-Quiñones, N. Clinical spectrum of COVID-19 in a Mexican pediatric population. Indian Pediatr 2020;58:126–8CrossRefGoogle Scholar
Cairoli, H, Raiden, S, Chiolo, MJ, Di Lalla, S, Ferrero, F. Patients assisted at the department of medicine of a pediatric hospital at the beginning of the COVID-19 pandemic in Buenos Aires, Argentina. Arch Argent Pediatr 2020;118:418–26Google ScholarPubMed
Calitri, C, Fantone, F, Benetti, S, Lupica, MM, Ignaccolo, MG, Banino, E et al. Long-term clinical and serological follow-up of paediatric patients infected by SARS-CoV-2. Infez Med 2021;29:216–23Google ScholarPubMed
Caro-Dominguez, P, Shelmerdine, SC, Toso, S, Secinaro, A, Toma, P, Damasio, MB et al. Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases. Pediatr Radiol 2020;50:1354–68CrossRefGoogle ScholarPubMed
CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020;69:422–6CrossRefGoogle Scholar
Chen, Z, Tong, L, Zhou, Y, Hua, C, Wang, W, Fu, J et al. Childhood COVID-19: a multicentre retrospective study. Clin Microbiol Infect 2020;26:1260.e1–4CrossRefGoogle ScholarPubMed
Chua, GT, Xiong, X, Choi, EH, Han, MS, Chang, SH, Jin, BL et al. COVID-19 in children across three Asian cosmopolitan regions. Emerg Microbes Infect 2020;9:2588–96CrossRefGoogle ScholarPubMed
Chua, GT, Wong, JSC, Lam, I, Ho, PPK, Chan, WH, Yau, FYS et al. Clinical characteristics and transmission of COVID-19 in children and youths during 3 waves of outbreaks in Hong Kong. JAMA Netw Open 2021;4:e218824CrossRefGoogle ScholarPubMed
Cleto-Yamane, TL, Rodrigues-Santos, G, de Magalhães-Barbosa, MC, Moura, PG, Vasconcelos, RD, Gouveia, JLS et al. Screening of COVID-19 in outpatient children with cancer or solid organ transplantation: preliminary report. Eur J Pediatr 2021;180:3237–41CrossRefGoogle ScholarPubMed
Concheiro-Guisan, A, Fiel-Ozores, A, Novoa-Carballal, R, González-Duran, ML, Portugués de la Red, M, Martínez-Reglero, C et al. Subtle olfactory dysfunction after SARS-CoV-2 virus infection in children. Int J Pediatr Otorhinolaryngol 2021;140:110539CrossRefGoogle ScholarPubMed
Costa, A, Almeida, H, Moniz, M, Alves, C. COVID-19 screening in a Portuguese pediatric population. Enferm Infecc Microbiol Clin (Engl Ed) 2022;40:28–31CrossRefGoogle Scholar
De Jacobis, IT, Vona, R, Cittadini, C, Marchesi, A, Cursi, L, Gambardella, L et al. Clinical characteristics of children infected with SARS-CoV-2 in Italy. Ital J Pediatr 2021;47:90CrossRefGoogle ScholarPubMed
Du, H, Dong, X, Zhang, J-J, Cao, Y-Y, Akdis, M, Huang, P-Q et al. Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status. Allergy 2020;76:510–32CrossRefGoogle ScholarPubMed
Duramaz, BB, Turel, O, Korkmaz, C, Karadogan, MT, Yozgat, CY, Iscan, A et al. A snapshot of pediatric patients with COVID-19 in a pandemic hospital. Klin Padiatr 2021;233:24–30Google Scholar
Elghoudi, A, Aldhanhani, H, Ghatasheh, G, Sharif, E, Narchi, H. Covid-19 in children and young adolescents in Al Ain, United Arab Emirates - a retrospective cross-sectional study. Front Pediatr 2021;8:603741CrossRefGoogle Scholar
Erat, T, Güler, Ş. Use of radiological tests in COVID-19 positive child cases: is chest computed tomography necessary? Int J Clin Pract 2021;75:e14259CrossRefGoogle ScholarPubMed
Fakiri, KE, Nassih, H, Sab, IA, Draiss, G, Bouskraoui, M. Epidemiology and clinical features of coronavirus disease 2019 in Moroccan children. Indian Pediatr 2020;57:808–10CrossRefGoogle ScholarPubMed
Foster, CE, Marquez, L, Davis, AL, Tocco, E, Koy, TH, Dunn, J et al. A surge in pediatric coronavirus disease 2019 cases: the experience of Texas Children's Hospital from March to June 2020. J Pediatric Infect Dis Soc 2021;10:593–8CrossRefGoogle Scholar
Gaborieau, L, Delestrain, C, Bensaid, P, Vizeneux, A, Blanc, P, Garraffo, A et al. Epidemiology and clinical presentation of children hospitalized with SARS-CoV-2 infection in suburbs of Paris. J Clin Med 2020;9:2227CrossRefGoogle Scholar
Garazzino, S, Lo Vecchio, A, Pierantoni, L, Calò Carducci, FI, Marchetti, F, Meini, A et al. Epidemiology, clinical features and prognostic factors of pediatric SARS-CoV-2 infection: results from an Italian multicenter study. Front Pediatr 2021;9:649358CrossRefGoogle ScholarPubMed
Geis, T, Brandstetter, S, Toncheva, AA, Laub, O, Leipold, G, Wagner, R et al. Serum neurofilament light chain (sNfL) values in a large cross-sectional population of children with asymptomatic to moderate COVID-19. J Neurol 2021;268:3969–74CrossRefGoogle Scholar
Goss, MB, Galván, NTN, Ruan, W, Munoz, FM, Brewer, ED, O'Mahony, CA et al. The pediatric solid organ transplant experience with COVID-19: an initial multi-center, multi-organ case series. Pediatr Transplant 2021;25:e13868CrossRefGoogle ScholarPubMed
Guo, CX, He, L, Yin, JY, Meng, XG, Tan, W, Yang, GP et al. Epidemiological and clinical features of pediatric COVID-19. BMC Med 2020;18:250CrossRefGoogle ScholarPubMed
Han, MS, Choi, EH, Chang, SH, Jin, B-L, Lee, EJ, Kim, BN et al. Clinical characteristics and viral RNA detection in children with coronavirus disease 2019 in the Republic of Korea. JAMA Pediatr 2021;175:73–80CrossRefGoogle ScholarPubMed
Hassan, M, Khalil, A, Magboul, S, Alomari, O, Abdalla, T, Alsliman, H et al. Neonates and young infants with Covid-19 presented with sepsis-like syndrome: a retrospective case controlled study. Front Pediatr 2021;9:634844CrossRefGoogle Scholar
Jamjoom, RS. Coronavirus disease 2019 (COVID-19) in pediatric emergency. Presentation and disposition. Saudi Med J 2021;42:105–9CrossRefGoogle Scholar
Li, J, Thoon, KC, Chong, CY, Maiwald, M, Kam, KQ, Nadua, K et al. Comparative analysis of symptomatic and asymptomatic SARS-CoV-2 infection in children. Ann Acad Med Singap 2020;49:530–7CrossRefGoogle ScholarPubMed
Kainth, MK, Goenka, PK, Williamson, KA, Fishbein, JS, Subramony, A, Barone, S et al. Early experience of COVID-19 in a US children's hospital. Pediatrics 2020;146:e2020003186CrossRefGoogle Scholar
Kanburoglu, MK, Tayman, C, Oncel, MY, Akin, IM, Can, E, Demir, N et al. A multicentered study on epidemiologic and clinical characteristics of 37 neonates with community-acquired COVID-19. Pediatr Infect Dis J 2020;39:e297–302CrossRefGoogle Scholar
Kanthimathinathan, HK, Dhesi, A, Hartshorn, S, Ali, SH, Kirk, J, Nagakumar, P et al. COVID-19: a UK children's hospital experience. Hosp Pediatr 2020;10:802–5CrossRefGoogle ScholarPubMed
Karbuz, A, Akkoc, G, Bedir Demirdag, T, Yilmaz Ciftdogan, D, Ozer, A, Cakir, D et al. Epidemiological, clinical, and laboratory features of children with COVID-19 in Turkey. Front Pediatr 2021;9:631547CrossRefGoogle ScholarPubMed
Kilani, MM, Odeh, MM, Shalabi, M, Al Qassieh, R, Al-Tamimi, M. Clinical and laboratory characteristics of SARS-CoV2-infected paediatric patients in Jordan: serial RT-PCR testing until discharge. Paediatr Int Child Health 2020;41:83–92CrossRefGoogle ScholarPubMed
Kim, K, Choi, JW, Moon, J, Akilov, H, Tuychiev, L, Rakhimov, B et al. Clinical features of COVID-19 in Uzbekistan. J Korean Med Sci 2020;35:e404CrossRefGoogle ScholarPubMed
King, JA, Whitten, TA, Bakal, JA, McAlister, FA. Symptoms associated with a positive result for a swab for SARS-CoV-2 infection among children in Alberta. CMAJ 2021;193:E1–9CrossRefGoogle ScholarPubMed
Korkmaz, MF, Türe, E, Dorum, BA, Kılıç, ZB. The epidemiological and clinical characteristics of 81 children with COVID-19 in a pandemic hospital in Turkey: an observational cohort study. J Korean Med Sci 2020;35:e236CrossRefGoogle Scholar
Krajcar, N, Stemberger Marić, L, Šurina, A, Kurečić Filipović, S, Trkulja, V, Roglić, S et al. Epidemiological and clinical features of Croatian children and adolescents with a PCR-confirmed coronavirus disease 2019: differences between the first and second epidemic wave. Croat Med J 2020;61:491–500CrossRefGoogle ScholarPubMed
Li, K, Li, L, Wang, X, Li, H, Chen, J, Liu, L et al. Comparative analysis of clinical features of SARS-CoV-2 and adenovirus infection among children. Virol J 2020;17:193CrossRefGoogle ScholarPubMed
Kumar, L, Kahlon, N, Jain, A, Kaur, J, Singh, M, Pandey, AK. Loss of smell and taste in COVID-19 infection in adolescents. Int J Pediatr Otorhinolaryngol 2021;142:110626CrossRefGoogle ScholarPubMed
Lavaine, O, Spizzo, J, Arbitre, C, Muller, J, Kuhn, P, Laugel, V et al. COVID-19 in children at Strasbourg University Hospital: a retrospective study of the first 2 months of the epidemic. Arch Pediatr 2021;28:405–10CrossRefGoogle ScholarPubMed
Lazzerini, M, Sforzi, I, Trapani, S, Biban, P, Silvagni, D, Villa, G et al. Characteristics and risk factors for SARS-CoV-2 in children tested in the early phase of the pandemic: a cross-sectional study, Italy, 23 February to 24 May 2020. Euro Surveill 2021;26:2001248CrossRefGoogle ScholarPubMed
Leung, C. The younger the milder clinical course of COVID-19: even in newborns? Pediatr Allergy Immunol 2020;32:358–62CrossRefGoogle ScholarPubMed
Liang, F, Wang, X, Shao, J, Chen, J, Liu, L, Li, H et al. Comparison of clinical features on admission between coronavirus disease 2019 and influenza A among children: a retrospective study in China. BMC Infect Dis 2021;21:365CrossRefGoogle ScholarPubMed
Liu, X, Tang, J, Xie, R, Li, W, Chen, J, Guo, Y et al. Clinical and epidemiological features of 46 children <1 year old with coronavirus disease 2019 in Wuhan, China: a descriptive study. J Infect Dis 2020;222:1293–7CrossRefGoogle ScholarPubMed
Luo, H, Liu, S, Wang, Y, Phillips-Howard, PA, Ju, S, Yang, Y et al. Age differences in clinical features and outcomes in patients with COVID-19, Jiangsu, China: a retrospective, multicentre cohort study. BMJ Open 2020;10:e039887CrossRefGoogle ScholarPubMed
Madhusoodhan, PP, Pierro, J, Musante, J, Kothari, P, Gampel, B, Appel, B et al. Characterization of COVID-19 disease in pediatric oncology patients: the New York-New Jersey regional experience. Pediatr Blood Cancer 2020;68:e28843Google ScholarPubMed
Mahmoudi, S, Mehdizadeh, M, Shervin Badv, R, Navaeian, A, Pourakbari, B, Rostamyan, M et al. The coronavirus disease 2019 (COVID-19) in children: a study in an Iranian children's referral hospital. Infect Drug Resist 2020;13:2649–55CrossRefGoogle Scholar
Mania, A, Mazur-Melewska, K, Lubarski, K, Kuczma-Napierała, J, Mazurek, J, Jończyk-Potoczna, K et al. Wide spectrum of clinical picture of COVID-19 in children - from mild to severe disease. J Infect Public Health 2021;14:374–9CrossRefGoogle ScholarPubMed
Mamishi, S, Heydari, H, Aziz-Ahari, A, Shokrollahi, MR, Pourakbari, B, Mahmoudi, S et al. Novel coronavirus disease 2019 (COVID-19) outbreak in children in Iran: atypical CT manifestations and mortality risk of severe COVID-19 infection. J Microbiol Immunol Infect 2020;54:839–44CrossRefGoogle ScholarPubMed
Mannheim, J, Gretsch, S, Layden, JE, Fricchione, MJ. Characteristics of hospitalized pediatric coronavirus disease 2019 cases in Chicago, Illinois, March-April 2020. J Pediatr Infect Dis Soc 2020;9:519–22CrossRefGoogle Scholar
He, M, Wang, C, Xu, L, Zhang, H, Liu, Y, Zhao, Y et al. Epidemiological and clinical characteristics of 35 children with COVID-19 in Beijing, China. Pediatr Investig 2020;4:230–5CrossRefGoogle ScholarPubMed
Mizrahi, B, Shilo, S, Rossman, H, Kalkstein, N, Marcus, K, Barer, Y et al. Longitudinal symptom dynamics of COVID-19 infection. Nat Commun 2020;11:6208CrossRefGoogle ScholarPubMed
Nallasamy, K, Angurana, SK, Jayashree, M, Mathew, JL, Bansal, A, Singh, MP et al. Clinical profile, hospital course and outcome of children with COVID-19. Indian J Pediatr 2021;88:979–84CrossRefGoogle ScholarPubMed
Ma, N, Li, P, Wang, X, Yu, Y, Tan, X, Chen, P et al. Ocular manifestations and clinical characteristics of children with laboratory-confirmed COVID-19 in Wuhan, China. JAMA Ophthalmol 2020;138:1079–86CrossRefGoogle ScholarPubMed
Nanavati, R, Mascarenhas, D, Goyal, M, Haribalakrishna, A, Nataraj, G. A single-center observational study on clinical features and outcomes of 21 SARS-CoV-2-infected neonates from India. Eur J Pediatr 2021;180:1895–906CrossRefGoogle ScholarPubMed
Nathan, N, Prevost, B, Sileo, C, Richard, N, Berdah, L, Thouvenin, G et al. The wide spectrum of COVID-19 clinical presentation in children. J Clin Med 2020;9:2950CrossRefGoogle ScholarPubMed
Ozkan, EA, Erdeniz, EH. Evaluation of children followed up for Covid-19 in a tertiary hospital. J Exp Clin Med (Turkey) 2021;38:125–31CrossRefGoogle Scholar
Parri, N, Lenge, M, Cantoni, B, Arrighini, A, Romanengo, M, Urbino, A et al. COVID-19 in 17 Italian pediatric emergency departments. Pediatrics 2020;146:e20201235CrossRefGoogle ScholarPubMed
Peng, X, Guo, Y, Xiao, H, Xia, W, Zhai, A, Zhu, B et al. Overview of chest involvement at computed tomography in children with coronavirus disease 2019 (COVID-19). Pediatr Radiol 2021;51:222–30CrossRefGoogle Scholar
Pérez-Gaxiola, G, Flores-Rocha, R, Valadez-Vidarte, JC, Hernández-Alcaraz, M, Herrera-Mendoza, G, Real-Lugo, MÁD. Clinical and epidemiological characteristics of children with SARS-CoV-2 infection: a case series in Sinaloa. Bol Med Hosp Infant Mex 2021;78:18–23Google ScholarPubMed
Pourakbari, B, Mahmoudi, S, Mahmoudieh, Y, Eshaghi, H, Navaeian, A, Rostamyan, M et al. SARS-CoV-2 RNAaemia in children: an Iranian referral hospital-based study. J Med Virol 2021;93:5452–7CrossRefGoogle ScholarPubMed
Qiu, H, Wu, J, Hong, L, Luo, Y, Song, Q, Chen, D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020;20:689–96CrossRefGoogle Scholar
Otto, WR, Geoghegan, S, Posch, LC, Bell, LM, Coffin, SE, Sammons, JS et al. The epidemiology of severe acute respiratory syndrome coronavirus 2 in a pediatric healthcare network in the United States. J Pediatr Infect Dis Soc 2020;9:523–9CrossRefGoogle Scholar
Rabha, AC, Oliveira Junior, FI, Oliveira, TA, Cesar, RG, Fongaro, G, Mariano, RF et al. Clinical manifestations of children and adolescents with Covid-19: report of the first 115 cases from Sabará Hospital Infantil. Rev Paul Pediatr 2020;39:e2020305CrossRefGoogle ScholarPubMed
Ramteke, S, Tikkas, R, Goel, M, Mandraha, S, Shrivastava, J. Paediatric COVID-19: milder presentation--a silver lining in dark cloud. J Trop Pediatr 2021;67:fmaa106CrossRefGoogle ScholarPubMed
Ranabothu, S, Onteddu, S, Nalleballe, K, Dandu, V, Veerapaneni, K, Veerapandiyan, A. Spectrum of COVID-19 in children. Acta Paediatr 2020;109:1899–900CrossRefGoogle ScholarPubMed
Rouger-Gaudichon, J, Thébault, E, Félix, A, Phulpin, A, Paillard, C, Alimi, A et al. Impact of the first wave of COVID-19 on pediatric oncology and hematology: a report from the French Society of Pediatric Oncology. Cancers (Basel) 2020;12:3398CrossRefGoogle ScholarPubMed
Rusetsky, Y, Meytel, I, Mokoyan, Z, Fisenko, A, Babayan, A, Malyavina, U. Smell status in children infected with SARS-CoV-2. Laryngoscope 2021;131:E2475–80CrossRefGoogle ScholarPubMed
Sarangi, B, Reddy, VS, Oswal, JS, Malshe, N, Patil, A, Chakraborty, M et al. Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic. Indian Pediatr 2020;57:914–17CrossRefGoogle ScholarPubMed
Sena, GR, Lima, TPF, Vidal, SA, Duarte M do, CMB, Bezerra, PGM, Fonseca Lima, EJ et al. Clinical characteristics and mortality profile of COVID-19 patients aged less than 20 years old in Pernambuco - Brazil. Am J Trop Med Hyg 2021;104:1507–12CrossRefGoogle ScholarPubMed
Shahbaznejad, L, Rouhanizadeh, H, Navaeifar, MR, Hosseinzadeh, F, Movahedi, FS, Rezai, MS. Clinical characteristics and outcomes of COVID-19 in children in Northern Iran. Int J Pediatr 2021;2021:e5558287CrossRefGoogle ScholarPubMed
Sharma, AK, Chapagain, RH, Bista, KP, Bohara, R, Chand, B, Chaudhary, NK et al. Epidemiological and clinical profile of Covid-19 in Nepali children: an initial experience. J Nepal Paediatr Soc 2020;40:202–9CrossRefGoogle Scholar
Siddiqui, M, Gültekingil, A, Bakırcı, O, Uslu, N, Baskın, E. Comparison of clinical features and laboratory findings of coronavirus disease 2019 and influenza A and B infections in children: a single-center study. Clin Exp Pediatr 2021;64:364–9CrossRefGoogle Scholar
Somekh, I, Yakub Hanna, H, Heller, E, Bibi, H, Somekh, E. Age-dependent sensory impairment in COVID-19 infection and its correlation with ACE2 expression. Pediatr Infect Dis J 2020;39:e270–2CrossRefGoogle ScholarPubMed
Song, X, Delaney, M, Shah, RK, Campos, JM, Wessel, DL, DeBiasi, RL. Comparison of clinical features of COVID-19 vs seasonal influenza A and B in US children. JAMA Netw Open 2020;3:e2020495CrossRefGoogle Scholar
Sousa, BLA, Sampaio-Carneiro, M, de Carvalho, WB, Silva, CA, Ferraro, AA. Differences among severe cases of Sars-CoV-2, influenza, and other respiratory viral infections in pediatric patients: symptoms, outcomes and preexisting comorbidities. Clinics (Sao Paulo) 2020;75:e2273CrossRefGoogle ScholarPubMed
Soysal, A, Gönüllü, E, Arslan, H, Kibar, BS, Pop, S, Yurttaş, GN et al. Comparison of clinical and laboratory features and treatment options of 237 symptomatic and asymptomatic children infected with SARS-CoV-2 in the early phase of the COVID-19 pandemic in Turkey. Jpn J Infect Dis 2020;74:273–9CrossRefGoogle ScholarPubMed
Sun, D, Zhu, F, Wang, C, Wu, J, Liu, J, Chen, X et al. Children infected with SARS-CoV-2 from family clusters. Front Pediatr 2020;8:386CrossRefGoogle ScholarPubMed
Szépfalusi, Z, Schmidthaler, K, Sieber, J, Kopanja, S, Götzinger, F, Schoof, A et al. Lessons from low seroprevalence of SARS-CoV-2 antibodies in schoolchildren: a cross-sectional study. Pediatr Allergy Immunol 2021;32:762–70CrossRefGoogle ScholarPubMed
Temel, H, Gündüz, M, Arslan, H, Ünal, F, Atağ, E, Cömert, M et al. Evaluation of the clinical features of 81 patients with COVID-19: an unpredictable disease in children. J Pediatr Infect Dis 2021;16:47–52Google Scholar
Tripathi, S, Gist, KM, Bjornstad, EC, Kashyap, R, Boman, K, Chiotos, K et al. Coronavirus disease 2019-associated PICU admissions: a report from the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry. Pediatr Crit Care Med 2021;22:603–15CrossRefGoogle Scholar
Wu, Q, Xing, Y, Shi, L, Li, W, Gao, Y, Pan, S et al. Coinfection and other clinical characteristics of COVID-19 in children. Pediatrics 2020;146:e20200961CrossRefGoogle ScholarPubMed
Xia, W, Guo, Y, Tian, Z, Luo, Y, Hu, D, Shao, J et al. Clinical features and temporal changes of RT-PCR and chest CT in COVID-19 pediatric patients. Front Pediatr 2020;8:579512CrossRefGoogle ScholarPubMed
Xiong, X, Chua, GT, Chi, S, Kwan, MYW, Sang Wong, WH, Zhou, A et al. A comparison between Chinese children infected with coronavirus disease-2019 and with severe acute respiratory syndrome 2003. J Pediatr 2020;224:30–6CrossRefGoogle ScholarPubMed
Xu, H, Liu, E, Xie, J, Smyth, RL, Zhou, Q, Zhao, R et al. A follow-up study of children infected with SARS-CoV-2 from western China. Ann Transl Med 2020;8:623CrossRefGoogle ScholarPubMed
Yilmaz, K, Gozupirinççioğlu, A, Aktar, F, Akin, A, Karabel, M, Yolbas, I et al. Evaluation of the novel coronavirus disease in Turkish children: preliminary outcomes. Pediatr Pulmonol 2020;55:3587–94CrossRefGoogle ScholarPubMed
Zhamankulov, A, Rozenson, R, Morenko, M, Shnayder, K, Akhmetova, U, Tyo, A. COVID-19 and recurrent respiratory infections in children of Kazakhstan. Russ Open Med J 2021;10:e0104CrossRefGoogle Scholar
Zhang, C, Gu, J, Chen, Q, Deng, N, Li, J, Huang, L et al. Clinical and epidemiological characteristics of paediatric SARS-CoV-2 infections in China: a multicenter case series. PLoS Med 2020;17:e1003130CrossRefGoogle ScholarPubMed
Zhang, Y, Xie, RM, He, YL, Xing, LH, Dong, L, Zhang, JZ et al. Clinical and imaging features of pediatric COVID-19. Ital J Pediatr 2020;46:153CrossRefGoogle ScholarPubMed
Zhang, L, Huang, S. Clinical features of 33 cases in children infected with SARS-CoV-2 in Anhui Province, China -- a multi-center retrospective cohort study. Front Public Health 2020;8:255CrossRefGoogle Scholar
Zheng, G, Wang, B, Zhang, H, Xie, C, Zhang, Y, Wen, Z et al. Clinical characteristics of acute respiratory syndrome with SARS-CoV-2 infection in children in South China. Pediatr Pulmonol 2020;55:2419–26CrossRefGoogle ScholarPubMed
Cui, X, Zhao, Z, Zhang, T, Guo, W, Guo, W, Zheng, J et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol 2021;93:1057–69CrossRefGoogle Scholar
Qiu, J, Yang, X, Liu, L, Wu, T, Cui, L, Mou, Y et al. Prevalence and prognosis of otorhinolaryngological symptoms in patients with COVID-19: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022;279:49–60CrossRefGoogle ScholarPubMed
Bruno, C, Locatello, LG, Cilona, M, Fancello, G, Vultaggio, A, Maltagliati, L et al. Seasonal allergic rhinitis symptoms in relation to COVID-19. Allergy Rhinol (Providence) 2020;11:2152656720968804CrossRefGoogle ScholarPubMed
Nguyen, NN, Hoang, VT, Lagier, J-C, Raoult, D, Gautret, P. Long-term persistence of olfactory and gustatory disorders in COVID-19 patients. Clin Microbiol Infect 2021;27:931–2CrossRefGoogle ScholarPubMed
Moein, ST, Hashemian, SM, Tabarsi, P, Doty, RL. Prevalence and reversibility of smell dysfunction measured psychophysically in a cohort of COVID-19 patients. Int Forum Allergy Rhinol 2020;10:1127–35CrossRefGoogle Scholar
Yan, Q, Qiu, D, Liu, X, Guo, X, Hu, Y. Prevalence of smell or taste dysfunction among children with COVID-19 infection: a systematic review and meta-analysis. Front Pediatr 2021;9:686600CrossRefGoogle ScholarPubMed
Kilic, O, Kalcioglu, MT, Cag, Y, Tuysuz, O, Pektas, E, Caskurlu, H et al. Could sudden sensorineural hearing loss be the sole manifestation of COVID-19? An investigation into SARS-COV-2 in the etiology of sudden sensorineural hearing loss. Int J Infect Dis 2020;97:208–11CrossRefGoogle ScholarPubMed
Elibol, E. Otolaryngological symptoms in COVID-19. Eur Arch Otorhinolaryngol 2021;278:1233–6CrossRefGoogle ScholarPubMed
Bhatta, S, Sharma, S, Sharma, D, Maharjan, L, Bhattachan, S, Sah, MK et al. Study of hearing status in COVID-19 patients: a multicentered review. Indian J Otolaryngol Head Neck Surg 2021. Epub 2021 Jul 12Google ScholarPubMed
Al-Ani, RM, Rashid, RA. Prevalence of dysphonia due to COVID-19 at Salahaddin General Hospital, Tikrit City, Iraq. Am J Otolaryngol 2021;42:103157CrossRefGoogle ScholarPubMed
Azzam, AAA, Samy, A, Sefein, I, ElRouby, I. Vocal disorders in patients with COVID 19 in Egypt. Indian J Otolaryngol Head Neck Surg 2021. Epub 2021 May 28CrossRefGoogle ScholarPubMed
Oran, DP, Topol, EJ. Prevalence of asymptomatic SARS-CoV-2 infection: a narrative review. Ann Intern Med 2020;173:362–7CrossRefGoogle ScholarPubMed
Syangtan, G, Bista, S, Dawadi, P, Rayamajhee, B, Shrestha, LB, Tuladhar, R et al. Asymptomatic SARS-CoV-2 carriers: a systematic review and meta-analysis. Front Public Health 2020;8:587374CrossRefGoogle ScholarPubMed
Bi, Q, Wu, Y, Mei, S, Ye, C, Zou, X, Zhang, Z et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis 2020;20:911–19CrossRefGoogle ScholarPubMed
Bunyavanich, S, Do, A, Vicencio, A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults. JAMA 2020;323:2427–9CrossRefGoogle ScholarPubMed
Fialkowski, A, Gernez, Y, Arya, P, Weinacht, KG, Kinane, TB, Yonker, LM. Insight into the pediatric and adult dichotomy of COVID-19: age-related differences in the immune response to SARS-CoV-2 infection. Pediatr Pulmonol 2020;55:2556–64CrossRefGoogle ScholarPubMed
Figure 0

Fig. 1. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (‘PRISMA’) flowchart.

Figure 1

Table 1. Characteristics of included studies

Figure 2

Fig. 2. Forest plot showing the pooled prevalence of cough. ES = effect size; CI = confidence interval; CDC = Centers for Disease Control and Prevention; Covid-19 = coronavirus disease 2019

Figure 3

Fig. 3. Forest plot showing the pooled prevalence of nasal discharge. ES = effect size; CI = confidence interval; CDC = Centers for Disease Control and Prevention; Covid-19 = coronavirus disease 2019

Figure 4

Fig. 4. Forest plot showing the pooled prevalence of sore throat. ES = effect size; CI = confidence interval; CDC = Centers for Disease Control and Prevention; Covid-19 = coronavirus disease 2019

Figure 5

Table 2. Pooled prevalence of various otorhinolaryngological manifestations

Figure 6

Fig. 5. Funnel plot for studies reporting (a) anosmia and (b) cough.

Figure 7

Table 3. Subgroup and sensitivity analysis for cough, sore throat and nasal discharge

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