Novel coronavirus infection (COVID-19) in children younger than one year: A systematic review of symptoms, management and outcomes.
Level 4 - case-series / case-control
Systematic review composed primarily of case reports, case series, and cross-sectional studies.
PubMed 32557789 · doi:10.1111/apa.15422
What was done
Authors conducted a systematic review searching MEDLINE, PubMed, CINAHL, Embase, and EBSCO from January 1, 2020, to April 7, 2020. They included studies evaluating clinical manifestations, laboratory results, imaging findings, and outcomes of COVID-19 in neonates and children under one year of age. The review included 18 peer-reviewed papers (17 from China, 1 from Vietnam) encompassing 160 infants, consisting of eight cross-sectional studies, eight case reports, one case series, and one prospective cohort study.
What was found
The most frequent symptoms in infants were fever (54%) and cough (33%). Management was primarily symptomatic alongside frequent empirical medications. Eleven infants (7%) were admitted to intensive care, and one infant died (abstract states a mortality rate of 0.006%). Overall outcomes were favorable in the majority of cases.
Why it matters
This review provides an early-pandemic benchmark on how COVID-19 affects infants under one year old, showing that while most recover with mild disease, a minority require intensive care support.
Limits
The total sample size was small (160 infants) and almost entirely limited to a single country (China). The underlying data relied heavily on case reports and cross-sectional studies with no control groups, creating substantial risk of publication and selection bias.
Cited by
- supports Infants younger than one year of age are more likely to develop severe COVID-19 illness than older children.