Abnormal liver enzymes in children and infants with COVID-19: A narrative review of case-series studies

As of April, 17, 2020, the outbreak of the coronavirus disease 2019 (COVID-19) pandemic has caused more than 2.0 million infections and 130,000 deaths.1 Current research suggests that obesity is a high risk factor for the severity of covid-19 in adults.2 However, there is a lack of relevant evidence among children. Current evidence suggests that the virus may also adversely affect extra-pulmonary organs, such as the liver.3 It is possible that some differences in COVID-19 related liver injury might also exist between the adult and pediatric infected populations. To date, the aggregated data on liver injury in children with COVID-19 are rare. This paper summarizes the findings of a narrative literature review of the current knowledge of COVID-19 related liver injury in children. We systematically searched PubMed database for relevant studies published up to March 29, 2020, for pediatric patients (aged <18 years) with laboratory-confirmed COVID-19, including seven case reports and seven case series articles (Supplementary Material 1). "Newborn/child/pediatric and COVID-19/SARS-CoV-2" as key words of literature search. Also, we included seven pediatric patients from our center (Table 1). Among the 280 (165 boys, 58·9% of total) cases of children with COVID-19, the age ranged from new born infants to 17-years of age. As shown in the table, although in the large majority of these pediatric cases, COVID-19 related suspected liver injury (abnormal ALT and/or AST) was found to be mild, its overall prevalence was approximately 29%. Of the 32 cases for which specific data are available, 5 (15.6%) had abnormal ALT (Table 1).