COVID-19 Pediatric Update

12/03/2020

Coronavirus Infectionsin Children Including COVID-19 - An Overview of the Epidemiology, ClinicalFeatures, Diagnosis, Treatment and Prevention Options in Children.
The Pediatric Infectious Disease Journal, Special Article, online first.

Zimmermann P. et al.

This article provides an overview of coronavirus infections in children highlighting similarities and differences between common circulating human coronaviruses (HCoV2-229E, -HKU1, -NL63, -OC43), severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The seven human pathogenic coronaviruses are part of a large family of enveloped single-stranded, zoonotic RNA viruses belonging to the family Coronaviridea. Common circulating human coronaviruses are believed to have their origin in bats (229E, NL63), dromedary camels (229E) and cattle (OC43). The capacity of rapid mutation and recombination is leading to novel coronaviruses with spreading from animals to humans: SARS-CoV (originating from civet cats, bats as reservoirs), MERS-CoV (originating from dromedary camels, bats as reservoirs), SARS-CoV-2 (pangolins as suspected origin).

Clinical manifestations of COVID-19 in children are described using information from three case series from China, as this was an early review article

Generally, children seem to be less severely affected than adults. However, the importance of viral transmission by children remains unknown.

08/04/2020

Screening and Severityof Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain.
Journal of the American Medical Association, Tagarro A. et al., Research letter, online first.

Tagarro A. et al.

This study includes screening data of 30 secondary and tertiary hospitals in Madrid between March 2, 2020 and March 16, 2020 to report the proportion of pediatric SARS-CoV-2 infections (confirmed by RT PCR) and the severity of disease in children.

Screening criteria were significant disease, admission to hospital or typical clinical manifestations for COVID-19 with the risk of complication due to underlying medical conditions.

By March 16, 2020, 41 of 365 screened children (11.2%) tested positive for SARS-CoV-2.

The median age of the children with SARS-CoV-2 infection was 1 year. 25 children (60%) were hospitalized and 4 (9.7%) required intensive care and respiratory support beyond oxygen in nasal prongs. No patient died.

Initial clinical manifestations were classified as upper respiratory tract infection (34%), fever without a source (27%), viral-like pneumonia (15%), bronchiolitis (12%), gastroenteritis or vomiting (5%), bacterial-like pneumonia (5%) and asthma flare (2%). Co-infections with influenza B were reported in 2 patients.

06/04/2020

 Coronavirus Disease 2019 in Children — United States,February 12–April 2, 2020.
Centre for Disease Control and Prevention, Morbidity and Mortality Weekly Report, CDC Covid-19. Response Team, Early Release.

Bialek S. et al.

Preliminary description of pediatric U.S. COVID-19 cases reported to CDC between February 12, 2020 and April 2, 2020.

Among 149,082 laboratory-confirmed cases for which age was known, 2,572 (1.7%) were children aged <18 years. Median age was 11 years. Cases in the age groups of 15 to 17 and 10-14 years accounted together for the main part of pediatric cases with 32% and 27%, respectively.

Data on clinical manifestations were available for 11% of pediatric and 9.6% of adult cases aged 18-64 years. 73% of pediatric patients presented with fever, cough or shortness of breath compared with 93% of the adult patients. 56% of the pediatric patients had fever, 54% cough and 13% shortness of breath in contrast to 71%, 80% and 43% in the adult age group from 18-64 years.

Of the pediatric cases with known hospitalization status (29%), 20% received inpatient treatment and 2% required admission to ICU. In relation to all reported pediatric cases, 5.7% were hospitalized and 0.58% admitted to ICU. Three pediatric patients died. Highest proportions of hospitalization were in children aged < 1y (62%).

Information about underlying medical conditions was available in 13% of the pediatric cases. Among those 23% had at least one underlying condition. Most commonly reported were chronic lung disease, cardiovascular disease or immunosuppression.

Due to the high percentage of missing data, statistical comparisons were not done.

25/03/2020

Clinical and epidemiological features of 36children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: anobservational cohort study. The Lancet, Article, online first.

Qiu H. et al.

In this case series from three hospitals in China including 36 children with confirmed COVID-19 (by RT-PCR) 53% of the patients showed moderate clinical manifestation with pneumonia; 47% had mild symptoms or were asymptomatic.
The main route of transmission (89%) was close contact with family members with COVID-19.

Dry cough and fever (defined as ≥ 37.5 °C) were common symptoms on admission; other symptoms recorded were sore throat, pharyngeal congestion, vomiting or diarrhea. Six children (17%) required oxygen.

Mean duration of fever was 3 days and improvement of pneumonia was seen after 4-10 days.

24/03/2020

ClinicalCharacteristics of Children with Coronavirus Disease 2019 in Hubei, China. Current Medical Science, Article.

Zheng F. et al.

This multicenter study reports clinical characteristics of 25 pediatric COVID-19 cases (median age 3 years) confirmed by RT-PCR and admitted to 10 public hospitals across Hubei province between February 1, 2020 and February 10, 2020.

Reported symptoms were fever (52%), dry cough (44%), diarrhea (12%), nasal congestion (8%), dyspnea (8%), abdominal pain (8%) and vomiting (8%).

Laboratory findings showed lymphopenia in 10 patients and the median CRP was 14.5mg/l. Co-infections were reported in 6 patients (influenza B, Mycoplasma pneumoniae, Enterobacter aerogenes).

Chest CT revealed unilateral involvement in 20.8% and bilateral involvement in 45.8% of the patients with mostly patchy shadows or lung consolidations. Bilateral lung lesions were more common in children aged <3 years. A third of the children had a normal chest CT.

The clinical manifestations were classified as upper respiratory infection in 8 and as mild pneumonia in 15 cases.

Two patients with congenital heart disease (aged 8 and 12 months) were critically ill and required mechanical ventilation; in one case also including kidney replacement therapy.

Until the last day of data collection, the clinical condition of 24 patients improved and one patient was already discharged after full recovery.

19/03/2020

Clinical features ofsevere pediatric patients with coronavirus disease 2019 in Wuhan: a singlecenter’s observational study. World Journal of pediatrics, Original article, published online.

Sun D. et al.

This case series reports clinical features of 8 severely or critically ill children (aged 2 months to 15 years) with SARS-CoV-2 infection treated at ICU of the Wuhan Children’s Hospital between January 24, 2020 and February 24, 2020.

All patients had tachypnea. Fever and cough was present in six patients. Other observed symptoms were expectoration of sputum, vomiting, diarrhea, fatigue, myalgia, headache and constipation. Two patients developed septic shock as complication.

Radiology showed bilateral pneumonia in six and unilateral pneumonia in two patients. Multiple patch-like shadows and ground-glass opacities were most common radiological features.

Laboratory findings showed increased C-reactive protein, procalcitonin, lactate dehydrogenase in five patients and elevated alanine aminotransferase in four patients.

Considerable increased cytokine concentrations were seen for IL-6 and IFN-γ in two patients each and mildly elevated IL-10 in five patients. Highest IL-6 concentrations were seen in the most severely affected patients.

Among six patients receiving high-flow oxygen therapy, two patients required mechanical ventilation during disease progression. Antiviral treatments (virazole, oseltamivir and interferon) were established in all patients. At the end of data collection, five patients were discharged after recovery and three patients were still in intensive care.

18/03/2020

SARS-CoV-2 Infection in Children. The New England Journal of Medicine, Correspondence, published online.

Lu X. et al.

This study from the Wuhan Children’s Hospital determined the spectrum of disease in children by testing both symptomatic and asymptomatic children after contact with SARS-CoV-2 infected individuals.

A total of 1391 children were assessed of which 171 (12%) were confirmed to have SARS-CoV-2 infection. Median age in the infected was 6.7 years.

Three patients required intensive care support and invasive mechanical ventilation, all had coexisting conditions (hydronephrosis, leukemia in maintenance chemotherapy and intussusception). One patient, a 10-month-old child with intussusception, died with multiorgan failure 4 weeks after admission.

Of the positive 27 (15.8%) were asymptomatic without radiologic evidence of pneumonia and 12 (10%) had radiologic features of pneumonia but no symptoms.

17/03/2020

A 55-Day-Old Female Infant Infected With 2019 Novel Coronavirus Disease: Presenting With Pneumonia, Liver Injury, and Heart Damage.  The Journal of Infectious Diseases, Brief report, corrected proof.

Cui Y. et al.

This study reports the case of a previously healthy 55-day old infant with SARS-CoV-2 infection presenting with bilateral pneumonia, elevated cardiac biomarkers and liver enzymes.

Disease progression occurred from day 7 through 11 of illness with oxygen requirement. From day 12 onwards, the patient’s clinical condition gradually improved. Respiratory symptoms disappeared on day 16 of illness. The timing of our patient’s progression and duration of symptoms is consistent with that reported in adults.

The child and her parents had been in contact with relatives with cough and fever 12 to 4 days before disease onset.

The breast milk of the mother was tested for SARS-CoV-2 but remained negative.   

16/03/2020

Epidemiological Characteristics of 2143 Pediatric Patients with 2019 Coronavirus Disease in China. 
Pediatrics, Article, Pre-publication Release.

Dong Y. et al.

This Chinese nationwide case series aims to identify the epidemiological characteristics and transmission patterns of pediatric patients with COVID-19.

The study included 731 (34%) laboratory confirmed cases and 1412 (66%) suspected cases reported to the Chinese Center for Disease Control and Prevention.

Clinical manifestations in children were less severe compared to those in adult patients with over 90% asymptomatic, mild or moderate cases.

The proportion of severe and critical cases was highest in children below 1 year of age (10.6%). In the older age groups proportions were as follows 1-5y: 7.3%; 6-10y: 4.2%; 11-15y: 4.1% and ≥ 16y: 3.0%. One 14-year old boy died.

12/03/2020

Detection of Covid-19 in Children in Early January2020 in Wuhan, China.  The New England Journal of Medicine, Correspondence, online first.

Liu W. et al.

This case series describes clinical characteristics of six hospitalized children in Wuhan with SARS-CoV2 detection.

Median age was 3 years (range 1 to 7); all had fever > 39°C and cough. Four children showed vomiting. One patient required intensive care admission. Lymphytopenia was seen in six and neutropenia in three children.

All children recovered after median 7.5 (range 5-13) days.

28/02/2020

A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features.  Clinical Infectious Diseases, Accepted Manuscript.

Cai J. et al.

Case series of 10 children with confirmed SARS-CoV-2 infection (aged 3 to 131 months, mean 74 months) admitted to five children’s hospitals outside of Wuhan between January 19, 2020 and February 3, 2020.

The main route of transmission (70%) was direct contact with adults with transmission in the same family. In household exposure settings the mean number of secondary cases was 2.4.

The mean incubation period after direct exposure to a COVID-19 case was 6.5 days (2-10 days).

8 children had fever, 6 cough, 4 sore throat, 3 blocked nose and 2 sneezing and rhinorrhea. None of the patients showed dyspnea or diarrhea.

Nasopharyngeal swabs became negative for SARS-CoV-2 within 6-22 days (mean 12 days). Six patients feces were tested for SARS-CoV-2 with positive result. At the final day of data collection SARS-CoV-2 was still detectable in fecal samples of 5 patients (18-30 days after illness onset).
The impact of viral shedding in feces remains unclear and needs further investigation.

14/02/2020

Novel Coronavirus Infection in HospitalizedInfants Under 1 Year of Age in China.  Journal of the American Medical Association, Research letter, published online.

Wei M. et al.

This study included all hospitalized infants with COVID-19 (aged 28 days to 1 year) between December 8 2019 and February 6, 2020 in China. Nine infants were identified. 

None required intensive care admission or mechanical ventilation. 

Four infants had fever, two mild upper respiratory tract symptoms and 1 had no symptoms (2 had no information on symptoms available).

13/03/2020

Characteristics ofpediatric SARS-CoV-2 infection and potential evidence for persistent fecalviral shedding. Nature Medicine, Brief communication.

Xu Y. et al.

Single-centre prospective observational study screening children high suspicion (contact with confirmed case or with family related outbreak) of SARS-CoV-2 infection by nasopharyngeal swab real-time RT-PCR in Guangzhou between January 22, 2020 and February 20, 2020.

745 children were included of which 10 (1.3%) were confirmed to have SARS-CoV-2 infection. Applying the same screening criteria in adults, 3.5% (111 out of 3174) tested positive (2.7-fold difference, p = 0.002).

On admission of the ten infected children, 7 had fever, 5 cough, 2 nasal congestion and rhinorrhoea, 3 diarrhoea. One child was asymptomatic. There were no definite signs of pneumonia in chest x-rays. No co-infections with other respiratory viruses were detected and no admissions to intensive care units or respiratory support were required.

Follow-up nasopharyngeal and rectal swabs showed persistently positive results for rectal specimens in 8 patients after nasopharyngeal swabs already had become negative.

Cycle threshold values of the serial RT-PCR suggest greater and longer viral shedding from the digestive system than that from the respiratory tract.

As the presence of replication-competent viruses in feces remains unclear further investigation on potential fecal-oral transmission is needed.

05/03/2020

Clinical and CT featuresin pediatric patients with COVID‐19 infection: Different points from adults.
Pediatric pulmonology, Original article, online first.

Xia W. et al.

This case series of 20 children with SARS-CoV-2 infection (aged from 1 day to 14 years, median age of 2 years) compares pediatric clinical and CT features of COVID-19 to those of adults. 

The most common symptoms were fever (60%, defined as axillary temperature > 37.3°C) and cough (65%); other clinical manifestations recorded were diarrhea (15%), nasal discharge (15%), sore throat (5%), fatigue (5%), moist rales in pulmonary auscultation (15%), retractions sings (5%) and cyanosis (5%).

 80% of the affected children had an increased procalcitonin level (> 0.05 mg/L).

Co-infections were reported (40%) including Mycoplasma pneumoniae (n=4), influenza (n=3), RSV (n=1), CMV (n=1).

For radiological findings, 50% of the patients presented bilateral pulmonary lesions, 30% had unilateral lesions and 20% showed no abnormality on chest CT. Most common CT features were ground-glass opacities (60%) similar to those in adults. Consolidations with surrounding halo sign were detected in 50% of the patients and might be a typical sign in affected children.

28/02/2020

A Well Infant With Coronavirus Disease 2019 With High Viral Load. Clinical Infectious Diseases, Brief report, corrected proof.

Kam K. et al.

Case report of a 6-month-old, nearly asymptomatic boy with high viral load of SARS-CoV-2 who was admitted to KK Women’s and Children’s hospital in Singapore because of his parent’s inpatient treatment due to COVID-19.

On admission rRT-PCR of nasopharyngeal specimen showed a low cycle threshold for SARS-CoV-2, suggesting high viral load.

On day 2 of hospitalization the boy became viremic with detection of SARS-CoV-2 in his blood and was transiently febrile (38.5°C) for one hour during that period. Otherwise he remained asymptomatic.

Daily nasopharyngeal swabs became negative for SARS-CoV-2 on day 17 of admission.

Stool samples were negative for SARS-CoV-2 on day 2, but positive on day 8 of hospitalization without presentation of any gastrointestinal symptoms.

Urine samples were tested negative for SARS-CoV-2 on day 2 and 8 of admission.

03/04/2020

Coronavirus Disease 2019 and Children What Pediatric Health Care Clinicians Need to Know.
Journal of the American Medical Association, Viewpoint, online first.

Rasmussen S. et al.

This document summarizes the current level of knowledge regarding pediatric COVID-19 cases and makes recommendations to minimize exposure in health care institutions by establishing different waiting zones for suspected cases and cancelling non-urgent appointments after robust telephone triage.

The authors alert pediatricians to health disparities resulting through community mitigations interventions and suggest providing online mental health service for stress management for families.

01/04/2020

Strategic plan for management of COVID-19 in paediatric haematology and oncology departments. The Lancet, Comment, online first.

He Y. et al.

This document proposes a strategic plan for the management of COVID-19 outbreaks in paediatric haematology and oncology departments.

The authors recommend the formation of a COVID-19 expert committee to make medical decisions in multidisciplinary consultation meetings.

In order to reduce in-hospital infections the establishment of 4 zones within each hospital is suggested: surveillance and screening zone, suspected quarantine zone, COVID-19 confirmed quarantine zone, hematological oncology ward.

For patients with acute leukemia and acute non-lymphocytic leukemia scheduled chemotherapy should not be interrupted during induction treatment unless COVID-19 is suspected or confirmed. In general, no treatment delay of more than 7 days is recommended.

For patients with lymphoma or other solid tumors the authors suggest to avoid any delay until they are in complete remission. They propose a maximal treatment delay of 7 days for patients in complete remission.

For children in complete remission receiving maintenance chemotherapy the authors recommend treatment delay for no more than 14 days.

For children in primary disease remission treatment of COVID-19 should be prioritized. Individual decisions are necessary in children who are not in remission depending on their general condition.

13/04/2020

Universal Screening forSARS-CoV-2 in Women Admitted for Delivery.
The New England Journal of Medicine, Correspondence.

Sutton D. et al.

This document reports results from a universal screening for SARS-CoV-2 in pregnant women admitted for delivery to the New York-Presbyterian Allen Hospital and Columbia University Irving Medical Center between March 22, 2020 and April 4, 2020.

215 pregnant women were assessed of which 29 (13.7%) tested positive for SARS-CoV-2 without any symptoms. Only four SARS-CoV-2 positive women were symptomatic on admission. Three initially asymptomatic women with detection of SARS-CoV-2 developed fever postpartum. One woman with a negative result on admission became symptomatic after delivery and was confirmed to have SARS-CoV-2 infection in a second nasopharyngeal swab.

The authors propose a universal screening of hospitalized pregnant women due to the high proportion of asymptomatic SARS-CoV-2 affected patients in order to protect mothers, children and health care teams.

26/03/2020

Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn.  Journal of the American Medical Association, Research letter, online first.

Dong L. et al.

Case report of a 29-year-old pregnant woman with confirmed SARS-CoV-2 infection 4 weeks before birth with nasal congestion and 37.9°C temperature progressing to respiratory difficulties with oxygen demand. The CT scan showed bilateral ground-glass opacities.

One day antepartum maternal IgM and IgG antibody levels for SARS-CoV-2 were increased:   IgG 107.89 AU/mL and IgM 279.72 AU/mL.

The infant was delivered by Cesarean section at 38 weeks in a negative pressure isolation room. There was no contact between mother and child after birth. The child remained asymptomatic with normal chest CT and was transferred to the pediatric hospital.

At 2 hours of age the infants SARS-CoV-2 IgG level was 140.32 AU/mL and the IgM level was 45.83 AU/mL, which decreased to IgG 69.94 AU/mL and IgM 11.75 AU/mL at 16 days of age.

The infants SARS-CoV-2 testing remained negative on five nasopharyngeal swabs taken from 2 hours to 16 days of age.

The significance of the IgM antibodies in the neonate remain unclear and the authors speculate in-utero infection as IgM antibodies do not pass the placenta.

26/03/2020

Antibodies in Infants Born to Mothers With COVID-19 Pneumonia.  Journal of the American Medical Association, Research letter, online first.

Zeng H. et al.

This study reports serological characteristics for 6 neonates from mothers with confirmed COVID-19 and mild disease during the third trimester of pregnancy in Wuhan.

All infants were delivered by Cesarean section and immediately isolated from their mothers after birth and none developed symptoms.

Blood samples were collected from the mothers at delivery and neonatal blood and throat swab samples were collected at birth. Placenta, cord blood and amniotic fluid were not tested for SARS-CoV-2.

None of the neonates was positive for SARS-CoV-2 in throat swabs or blood.

5 mothers had elevated (> 10 AU/mL) IgG and 4 elevated (> 10 AU/mL) IgM.

2 neonates had elevated IgG and IgM and 3 had elevated IgG only.

One mother-child-pair had normal SARS-CoV-2 IgG and IgM.

The authors discuss two possibilities for elevated IgM antibodies in neonates: transfer from mother to child due to a COVID-19 induced placenta pathology or in-utero infection.

26/03/2020

Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. Journal of the American Medical Association, Research letter, online first.

Zeng L. et al.

Cohort study including all neonates born to mothers with COVID-19 in Wuhan Children’s Hospital from January to February 2020.

33 infants were identified of which three were confirmed to have SARS-CoV-2 infection. Nasopharyngeal and anal swab in the affected neonates were positive for SARS-CoV-2 on day 2 and 4 and became negative on day 6 to 7 of life.

Two term infants (40 weeks gestation) born by Cesarean section developed fever and lethargy or vomiting and radiologically-confirmed pneumonia. Laboratory investigations showed leukocytosis, lymphopenia and elevated creatinine kinase-MB fraction.

One infant born preterm at 31 weeks by Cesarean section required resuscitation and noninvasive ventilation with neonatal respiratory distress syndrome and pneumonia. Blood culture was positive for Enterobacter agglomerates. Laboratory findings showed leukocytosis, thrombocytopenia and coagulopathy. The severe manifestation in this child might have been caused by prematurity and sepsis.

24/03/2020

Clinical features and obstetric and neonataloutcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. 
The Lancet, Article, online first.

Yu N. et al.

This is a single-centre cases series of seven pregnant women with confirmed SARS-CoV-2 infection and their neonates. 

The mean age of the women was 32 years and mean gestational age was 39 (ranged 37 to 42) weeks.  All women had Cesarean section. Six women had bilateral and one women unilateral pneumonia. Co-infections with H1N1 influenza and Legionella pneumophilia were present in two women. The outcome of all women was good with no intensive care admissions.

The Apgar scores and birth weights in the infants were normal.

The infants were tested for SARS-CoV2 and one infants was positive in a throat swab at 36h after birth. This neonate had mild shortness of breath symptoms and signs for a mild pulmonary infection in the chest x-ray and was discharged after 2 weeks and following two negative swabs.

17/03/2020

Perinatal Transmissionof COVID-19 Associated SARS-CoV-2: Should We Worry? 
Clinical Infectious Diseases, Accepted Manuscript.

Fan C. et al.

This study reports two cases of good outcomes of neonates from mothers with SARS-CoV-2 infection during third trimester of pregnancy. Both infants were delivered by Cesarean section.

One infant was separated from her mother immediately after birth without skin-to-skin contact. The infant developed low-grade fever, abdominal distention, lymphopenia and bilateral pneumonia on day 3 of life. Specimens of maternal serum, cord blood, placenta tissue, amniotic fluid, vaginal swab, breast milk and newborn’s nasopharyngeal swab were negative for SARS-CoV2.

The second infant also developed lymphopenia and pneumonia without detection of SARS-CoV-2.

12/03/2020

A case report of neonatal COVID-19 infection in China. 
Clinical Infectious Diseases, Accepted Manuscript.

Wang S. et al.

This is a case report of a neonate with pharyngeal swab tested positive for SARS-CoV-2 36 hours after birth.

The mother became symptomatic shortly before emergency Cesarean section. The infant had no contact with the mother after birth.

The infant developed bilateral pneumonia on CT scan but remained clinically asymptomatic.

The mode of transmission remains unclear as there was no nucleic acid detection of SARS-CoV-2 in specimens of cord blood, placenta and breast milk.

As intrauterine and postnatal transmission could be possible the authors suggest to test all of the specimens in suspected pregnant women and their newborns, including pharyngeal swabs, peripheral blood, placental tissue after delivery, amniotic fluid, cord blood, newborn pharyngeal swabs, and breast milk, for in-depth study.

07/03/2020

Clinical characteristicsand intrauterine vertical transmission potential of COVID-19 infection in ninepregnant women: a retrospective review of medical records. The Lancet, Article, Volume 395, Issue 10226

Chen H. et al.

Cases series of nine pregnant women (aged 26 to 40 years) with confirmed SARS-CoV-2 infection during the third trimester of pregnancy. On admission, the range of gestational age was 36 to 39 weeks.

7 women had fever, 4 cough, 3 myalgia, 2 sore throat, 2 malaise and 1 diarrhea. Lymphopenia was seen in 5 and elevated aminotransferase levels in 3 patients. 8 patients showed ground-glass opacities in CT scans. All women received oxygen therapy. None required mechanical ventilation.

There were signs for fetal distress in two cases. All 9 neonates were delivered by Cesarean section with normal Apgar scores. None developed symptoms.

At delivery collected specimens of amniotic fluid, cord blood, neonatal throath swab and breastmilk of 6 mother-child-pairs were tested negative for SARS-CoV-2.

28/02/2020

A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clinical Infectious Diseases, Accepted Manuscript.

Wang X. et al.

Case report of a 30-week pregnant, 28-year-old woman with SARS-CoV-2 infection with intermittent fever for one week after travelling to Wuhan 3 weeks earlier. Laboratory findings showed lymphopenia and low levels of albumin. On admission, the fetal ultrasound was normal. The woman developed radiologically-confirmed bilateral pneumonia with increasing oxygen demand.

Six days after first presentation fetal movement disappeared with loss of variability of fetal heart rate and an emergency Cesarean section was performed.

Cord blood, placenta tissue and amniotic fluid, were negative for SARS-CoV-2.

The newborn was asymptomatic and gastric aspirate and throat swab at birth and 3 days later remained SARS-CoV-2 negative.

06/02/2020

 Clinical analysis of 10neonates born to mothers with 2019-nCoV pneumonia.
Translational Pediatrics, Original article.

 Zhu H. et al.

Case series reporting clinical features and outcomes of 10 neonates (including one pair of twins) from mothers with SARS-CoV-2 infection during pregnancy.

Positive results for SARS-CoV-2 by nucleic acid testing of throat swabs specimens were found in all pregnant women expect for the mother of the twins. Six women presented with first clinical manifestations before and 3 women after delivery. Common symptoms were fever and cough. CT scans showed typical changes

Seven women had Cesarean section and two delivered vaginally. Perinatal fetal distress was reported in six cases. Among the neonates, six were born prematurely (31 to 35 weeks of gestation).

In the neonates, shortness of breath was the most common symptom (60%). Other clinical manifestations recorded were gastrointestinal symptoms including bleeding (40%), fever (20%) and tachycardia (10%). Chest radiographies showed signs for infection (n=4), neonatal respiratory distress disorder (n=2) and pneumothorax (n=1). None of the neonates was positive for SARS-CoV-2 in throat swabs.

One infant died on day 9 of life due to refractory shock, multiple organ failure and disseminated intravascular coagulation.

At the end of data collection, 5 neonates have been cured and discharged and 4 remained hospitalized in stable condition.

07/04/2020

COVID-19, school closures, and child poverty: asocial crisis in the making. The Lancet, Comment, online first.

Van Lancker W.

This document discusses how school closures affect children in the USA and Europe in low-income families. Exacerbating of food insecurity for those depending on free school meals and an increasing gap between children from lower and higher socioeconomic backgrounds resulting from lack of an adequate study place and internet access.

31/03/2020

Protecting the psychological health of children through effective communication about COVID-19.  The Lancet, Comment, online first.

Dalton L. et al.

This document emphasizes the importance of honest, age-based information for children about changes due to the current COVID-19 pandemic in order to protect their psychological health.

25/03/2020

Parenting in a time ofCOVID-19. The Lancet, Correspondence, online first.

Cluver L. et al.

This document indicates evidence that child abuse increases during periods of school closures associated with health emergencies and informs about health institutions providing online parenting resources during COVID-19.