SARS-COV-2 infection in children and newborns: a systematic review

Eur J Pediatr. 2020 Jul;179(7):1029-1046. doi: 10.1007/s00431-020-03684-7. Epub 2020 May 18.


A recent outbreak of a novel Coronavirus responsible for a Severe Acute Respiratory Syndrome (SARS-CoV-2) is spreading globally. The aim of this study was to systematically review main clinical characteristics and outcomes of SARS-CoV-2 infections in pediatric age. An electronic search was conducted in PubMed database. Papers published between 1 January and 1 May 2020 including children aged 0-18 years were selected. Sixty-two studies and three reviews were included, with a total sample size of 7480 children (2428/4660 males, 52.1%; weighted mean age 7.6 years). Patients showed mainly mild (608/1432, 42.5%) and moderate (567/1432, 39.6%) signs of the infection. About 2% of children were admitted to the pediatric intensive care unit. The most commonly described symptoms were fever (51.6%) and cough (47.3%). Laboratory findings were often unremarkable. Children underwent a chest CT scan in 73.9% of all cases, and 32.7% resulted normal. Overall, the estimated mortality was 0.08%. A higher proportion of newborns was severely ill (12%) and dyspnea was the most common reported sign (40%).Conclusion: SARS-CoV-2 affects children less severely than adults. Laboratory and radiology findings are mainly nonspecific. Larger epidemiological and clinical cohort studies are needed to better understand possible implications of COVID-19 infection in children.What is Known:• A novel Coronavirus has been recently identified as responsible for a new Severe Acute Respiratory Syndrome (SARS-CoV-2) spreading globally.• There is limited evidence on SARS-CoV2 infection in children.What is New:• Systematically reviewed available evidence showed that children with SARS-CoV-2 infection may have a less severe pattern of disease in comparison to adults.• Blood tests and radiology findings are mainly nonspecific in children but may help to identify those who are severely ill.

Keywords: COVID-19; Infectious disease; Neonatal; Novel coronavirus; Pandemic; Pediatrics.

Publication types

  • Systematic Review

MeSH terms

  • Adolescent
  • Betacoronavirus* / isolation & purification
  • COVID-19
  • COVID-19 Testing
  • Child
  • Child, Preschool
  • Clinical Laboratory Techniques / methods
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / therapy
  • Global Health
  • Humans
  • Infant
  • Infant, Newborn
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / therapy
  • Prognosis
  • SARS-CoV-2
  • Severity of Illness Index
  • Tomography, X-Ray Computed