ABSTRACT
Introduction: Severe COVID-19 is infrequent in children, with a lethality rate of about 0.08%. This study aims to explore differences in the pediatric mortality rate between countries. Methods: Countries with populations over 5 million that report COVID-19 deaths disaggregated data by quinquennial or decennial age groups were analyzed. Data were extracted from COVID-19 Cases and Deaths by Age Database, national ministries of health, and the World Health Organization. Results: 23 countries were included in the analysis. Pediatric mortality varied from 0 to 12.1 deaths per million people of the corresponding age group, with the highest rate in Peru. In most countries, deaths were more frequent in the 0-4 years old age group, except for Brazil. The pediatric/ general COVID-19 mortality showed a great variation between countries and ranged from 0 (Republic of Korea) to 10.4% (India). Pediatric and Pediatric/general COVID mortality have a strong correlation with 2018 neonatal mortality (r=0.77, p<0.001 and r= 0.88, p<0.001 respectively), while it has a moderate or absent (r=0.47, p=0.02 and r=0.19, p=0.38, respectively) correlation with COVID-19 mortality in the general population. Conclusions: There is an important heterogenicity in pediatric COVI-19 mortality between countries that parallels historical neonatal mortality. Neonatal mortality is a known index of the quality of a country s Health System which points to the importance of social determinants of health in pediatric COVID-19 mortality disparities, an issue which should be further explored.