Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis.

Objective: There is limited information on the severity of COVID-19 infection in children with comorbidities. We investigated the effects of pediatric comorbidities on COVID-19 severity by means of a systematic review and meta-analysis of published literature.

Methods: PubMed, Embase, and Medline databases were searched for publications on pediatric COVID-19 infections published January 1 to October 5, 2020. Articles describing at least one child with and without comorbidities, COVID-19 infection, and reported outcomes were included.

Results: 42 studies containing 275,661 children without comorbidities and 9,353 children with comorbidities were included. Severe COVID-19 was present in 5.1% of children with comorbidities, and in 0.2% without comorbidities. Random-effects analysis revealed a higher risk of severe COVID-19 among children with comorbidities than for healthy children; relative risk ratio 1.79 (95% CI 1.27 - 2.51; I = 94%). Children with underlying conditions also had a higher risk of COVID-19-associated mortality; relative risk ratio 2.81 (95% CI 1.31 - 6.02; I = 82%). Children with obesity had a relative risk ratio of 2.87 (95% CI 1.16 - 7.07; I = 36%).

Conclusions: Children with comorbidities have a higher risk of severe COVID-19 and associated mortality than children without underlying disease. Additional studies are required to further evaluate this relationship.