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Mathew L, Schmolze M, Carter KV. SARS-CoV-2 Infection Among Newborn Infants: A Scoping Review. Adv Neonatal Care 2024; 24:268-276. [PMID: 38629868 DOI: 10.1097/anc.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of mothers may increase the risk of complications and adverse birth outcomes among newborn infants born more than 37 weeks' gestation. PURPOSE The aim of this scoping review is to identify the research gaps in the literature on SARS-CoV-2 positive newborn infants born at more than 37 weeks' gestation in United States (U.S.). DATA SOURCES A search for relevant articles was conducted using multiple resources including three databases CINAHL, Ovid MEDLINE, and Web of Science. This scoping review included case reports, case series, cohort, and retrospective studies focusing on newborn infants born more than 37 weeks of gestation with SARS-CoV-2 infection. STUDY SELECTION A total of 4262 citations were screened, and 12 articles met the eligibility criteria. DATA EXTRACTION Two authors independently screened the articles using a multi-step approach. RESULTS This review identified the gaps in literature on newborn infants up to one month of age. Few studies have focused on SARS-CoV-2 positive newborn infants born more than 37 gestational weeks. This review demonstrates a higher prevalence of community-acquired SARS-CoV-2 infections among infants following discharge. IMPLICATIONS OF PRACTICE AND RESEARCH Few U.S. based studies have focused on newborn infants born more than 37 weeks' gestation with SARS-CoV-2 infection. Future follow-up studies are essential on these infants especially during the first 30 days of life. Discharge teaching on SARS-CoV-2 infection is vital in reducing community transmission, admissions, and emergency department visits.
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Affiliation(s)
- Liji Mathew
- Schools of Nursing (Dr Mathew) and Medicine (Mss Schmolze and Carter), University of Texas Rio Grande Valley, Edinburg, Texas
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Hernández-Bou S, Trenchs V, Diego P, Seguí A, Luaces C. Bacterial coinfection in young febrile infants with SARS-CoV-2 infection. Eur J Pediatr 2024; 183:281-288. [PMID: 37872349 DOI: 10.1007/s00431-023-05212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
We aimed to assess the prevalence of serious bacterial infections (SBIs) in febrile infants < 90 days of age with SARS-CoV-2 infection versus SARS-CoV-2-negative febrile infants. A retrospective cohort study was conducted in a tertiary pediatric emergency department between March 2020 and October 2022. Febrile infants < 90 days of age who underwent SARS-CoV-2 testing were included. SBIs were defined as urinary tract infection (UTI), bacteremia, and/or bacterial meningitis; bacteremia and bacterial meningitis were considered invasive bacterial infections (IBIs). SBIs rates were compared between SARS-CoV-2-positive and negative infants and stratified by age. We included 779 infants: 221 (28.4%) SARS-CoV-2-positive and 558 (71.6%) SARS-CoV-2-negative. The SBI rate in the SARS-CoV-2-positive group was 5.9% vs 22.9% in the SARS-CoV-2-negative group (p < 0.001; relative risk (RR) 0.26; [95% CI 0.15-0.44]); the most common infections were UTI (5.4% vs 22.0%; p < 0.001). The IBI rate was 0.5% in the SARS-CoV-2-positive group vs. 3.2% in the negative group (p = 0.024; RR 0.14 [95% CI 0.02-1.04]). There were no cases of bacterial meningitis in the positive infants. SARS-CoV-2-positive infants > 28 days of age had a decreased likelihood of SBI (RR 0.22 [95% CI 0.11-0.43]), with no cases of IBI identified. Conclusions: Febrile infants < 90 days of age with SARS-CoV-2 infection are at significantly lower risk of SBIs than those who are SARS-CoV-2-negative. Nevertheless, the rate of UTI remains considerable in SARS-CoV-2-positive infants. SARS-CoV-2 detection may be relevant in considering IBI risk for well-appearing febrile infants 29-89 days of age. What is Known: • Febrile infants with laboratory-confirmed viral infections have a significantly lower risk of serious bacterial infections when compared to those without them. Data focusing on very young febrile infants with a SARS-CoV-2 infection is still limited. What is New: • Young febrile infants with SARS-CoV-2 infection are at significantly lower risk of serious bacterial infections than those who are SARS-CoV-2-negative. Nevertheless, the rate of urinary tract infection remains considerable. SARS-CoV-2 detection may be relevant in considering invasive bacterial infection risk for well-appearing febrile infants 29-89 days of age.
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Affiliation(s)
- Susanna Hernández-Bou
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Victoria Trenchs
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
| | - Patricia Diego
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Aina Seguí
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Carles Luaces
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
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3
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Santos NMVD, Brito DHSD, Santos TGFTD, Silva MCPMD, Lavôr JRD, Heimer MV, Rosenblatt A. Oral manifestations in hospitalized children with COVID-19. Braz Oral Res 2022; 36:e139. [PMID: 36477216 DOI: 10.1590/1807-3107bor-2022.vol36.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Abstract
As the pandemic progressed, the incidence of viruses among children also increased. This study investigates the presence of oral lesions in hospitalized children by analyzing data collected from medical records of infants seen at the pediatric Infectious disease unit at the General Hospital of the University of Pernambuco, Recife, Brazil, from March to August 2020. This study includes children aged 0 to 12 years diagnosed with severe symptoms of COVID-19. The data describe the frequencies and percentages of categorical variables, expressed as mean, median, and standard deviation. The chi-square test evaluated the association of oral manifestations according to the presence of comorbidities. Of 89 children, 20.2% had oral manifestations, and mucositis was the most prevalent lesion (12.4%). Of the 18 children with oral manifestations, 12 did not present comorbidities, but 7.9% had multisystem inflammatory syndrome and 5.6% had Kawasaki disease. Results show that children with oral lesions had longer hospital stays. These findings indicate the need for further studies to clarify the relationship between the oral manifestations of COVID-19 in pediatric patients for screening of the virus by dentists.
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Affiliation(s)
| | | | | | | | - Juliane Rolim de Lavôr
- Universidade de Pernambuco - UPE, School of Dentistry, Department of Pediatric Dentistry, Recife, PE, Brazil
| | - Monica Vilela Heimer
- Universidade de Pernambuco - UPE, School of Dentistry, Department of Pediatric Dentistry, Recife, PE, Brazil
| | - Aronita Rosenblatt
- Universidade de Pernambuco - UPE, School of Dentistry, Department of Pediatric Dentistry, Recife, PE, Brazil
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Gupta A, Kamity R, Sharma R, Caprio M, Mally P, Verma S. Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic. Am J Perinatol 2022; 39:1764-1778. [PMID: 35738288 DOI: 10.1055/s-0042-1749635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal-newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. KEY POINTS: · COVID-19 in pregnancy can cause perinatal morbidities.. · Breastfeeding and breast milk are safe for newborns.. · COVID-19 vaccination reduces the risk for morbidities..
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Affiliation(s)
- Arpit Gupta
- Division of Neonatology, Department of Pediatrics, NYC Health, Hospitals/Metropolitan, New York City, New York
| | - Ranjith Kamity
- Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, New York City, New York
| | - Rishika Sharma
- Department of Pediatrics, Family Healthcare Network, Visalia, California
| | - Martha Caprio
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Pradeep Mally
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
| | - Sourabh Verma
- Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York City, New York
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Güngör A, Bodur İ, Göktuğ A, Güneylioğlu MM, Öztürk B, Yaradılmış RM, Yalçınkaya R, Karacan CD, Tuygun N. COVID-19 Infection in Well-Appearing 30- to 90-Day-Old Infants with Fever without a Source. J Trop Pediatr 2022; 68:6602428. [PMID: 35666180 PMCID: PMC9214102 DOI: 10.1093/tropej/fmac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Fever without a source (FWS) is common clinical status in the young infants. The aim of this study was to evaluate the clinical and laboratory findings of coronavirus disease (COVID-19) infection in well-appearing infants with FWS. Well-appearing febrile infants between 30 and 90 days who were evaluated as FWS in the pediatric emergency department and tested for COVID-19 were divided into two groups: COVID-19 (+) and (-). The clinical and laboratory findings of the patients were compared. The study included 95 febrile infants with FWS, and the mean age was 59.62 ± 16.82 days. The nasopharyngeal COVID-19 polymerase chain reaction test results of 29/95 (30.5%) patients were positive, while 66/95 (69.5%) were negative. The complaints of irritability and nasal congestion were found to be significantly more common in COVID-19-positive patients (p = 0.04 and p = 0.041, respectively). The hospitalization rate (p = 0.009), length of hospital stay (p = 0.026), initiation of antibiotic treatment (p < 0.001) and duration of antibiotic treatment (p = 0.036) were significantly lower in the COVID-19 (+) patients. The C-reactive protein (CRP, p < 0.001), absolute neutrophil count (ANC, p < 0.001), absolute lymphocyte count (ALC, p = 0.015), white blood cell (WBC, p < 0.001) and systemic immune-inflammation index (SII, p < 0.001) were found to be significantly lower in the COVID-19 (+) patient group. There was no significant difference between the groups in terms of neutropenia, lymphopenia or leukopenia. COVID-19 infection may present as an FWS. During the pandemic period, testing for COVID-19 among infants who were evaluated as FWS may reduce unnecessary hospitalizations and antibiotic treatments, and shorten hospital stays and duration of antibiotics.
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Affiliation(s)
- Ali Güngör
- Correspondence: Ali Güngör, Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey. E-mail <>.
| | - İlknur Bodur
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Muhammed Mustafa Güneylioğlu
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Raziye Merve Yaradılmış
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Rumeysa Yalçınkaya
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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COVID-19 in Neonates with Positive RT–PCR Test. Systematic Review. Arch Med Res 2022; 53:252-262. [PMID: 35321802 PMCID: PMC8919773 DOI: 10.1016/j.arcmed.2022.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/18/2022] [Accepted: 03/04/2022] [Indexed: 12/24/2022]
Abstract
Background Objective Methods Results Conclusion
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Christophers B, Marin BG, Oliva R, Powell WT, Savage TJ, Michelow IC. Trends in clinical presentation of children with COVID-19: a systematic review of individual participant data. Pediatr Res 2022; 91:494-501. [PMID: 32942286 PMCID: PMC7965792 DOI: 10.1038/s41390-020-01161-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND There are sparse patient-level data available for children with novel coronavirus disease (COVID-19). Therefore, there is an urgent need for an updated systematic literature review that analyzes individual children rather than aggregated data in broad age groups. METHODS Six databases (MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar, medRxiv) were searched for studies indexed from January 1 to May 15, 2020, with MeSH terms: children, pediatrics, COVID-19, SARS-CoV-2. 1241 records were identified, of which only unique papers in English with individual patient information and documented COVID-19 testing were included. This review of 22 eligible studies followed Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data guidelines. RESULTS A total of 123 patients from five countries were identified. 46% were females. The median age was 5 years (IQR = 8). At presentation, 62% had a fever, 32% had a cough, 58% had a single symptom, and 21% were asymptomatic. Abnormal chest imaging was seen in 62% (65/105) of imaged and 76.9% (20/26) of asymptomatic children. A minority of children had elevated platelets, CRP, lactate dehydrogenase, and D-dimer. CONCLUSION Data from this independent participant data systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom. IMPACT This systematic review revealed that the majority of children with COVID-19 presented with either no symptoms or a single, non-respiratory symptom. By using an independent participant data approach, this analysis underscores the challenge of diagnosing COVID-19 in pediatric patients due to the wide variety of symptoms and seemingly poor correlation of imaging findings with symptomatic disease. The data presented from individual patients from case series or cohort studies add more granularity to the current description of pediatric COVID-19.
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Affiliation(s)
- Briana Christophers
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA.
| | | | - Rocío Oliva
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Weston T. Powell
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, WA,Department of Pediatrics, University of Washington, Seattle, WA
| | - Timothy J. Savage
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, MA,Harvard Medical School, Boston, MA
| | - Ian C. Michelow
- Warren Alpert Medical School of Brown University, Providence, Rhode Island,Department of Pediatrics, Division of Infectious Diseases and Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
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8
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Abstract
Unique pneumonia due to an unknown source emerged in December 2019 in the city of Wuhan, China. Consequently, the World Health Organization (WHO) declared this condition as a new coronavirus disease-19 also known as COVID-19 on February 11, 2020, which on March 13, 2020 was declared as a pandemic. The virus that causes COVID-19 was found to have a similar genome (80% similarity) with the previously known acute respiratory syndrome also known as SARS-CoV. The novel virus was later named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 falls in the family of Coronaviridae which is further divided into Nidovirales and another subfamily called Orthocoronavirinae. The four generations of the coronaviruses belongs to the Orthocoronavirinae family that consists of alpha, beta, gamma and delta coronavirus which are denoted as α-CoV, β-CoV, γ-CoV, δ-CoV respectively. The α-CoV and β-CoVs are mainly known to infect mammals whereas γ-CoV and δ-CoV are generally found in birds. The β-CoVs also comprise of SARS-CoV and also include another virus that was found in the Middle East called the Middle East respiratory syndrome virus (MERS-CoV) and the cause of current pandemic SARS-CoV-2. These viruses initially cause the development of pneumonia in the patients and further development of a severe case of acute respiratory distress syndrome (ARDS) and other related symptoms that can be fatal leading to death.
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Tamrazova OB, Stadnikova AS, Rudikova EV. Cutaneous manifestations in children with the new coronavirus infection COVID-19. RUDN JOURNAL OF MEDICINE 2021. [DOI: 10.22363/2313-0245-2021-25-1-16-24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In late 2019, a new viral infection appeared in China, which spread around the world, causing a pandemic. The causative agent of the new coronavirus infection COVID-19 is the SARS-CoV-2 coronavirus. The review presents modern data on the epidemiology, pathogenesis and course of the novel coronavirus infection COVID-19 in children. Chinese, American and European scientists have described a variety of cutaneous manifestations in children with COVID-19. The article provides a literature review of the cutaneous manifestations of COVID-19 coronavirus infection in children. During our own observation of 301 patients with coronavirus infection COVID-19 caused by SARS-CoV-2 at the Bashlyaevs Children Hospital in Moscow from May 17 to November 16, 2020, it was revealed that 39 (13 %) patients had skin manifestations. The article presents a classification of skin manifestations characteristic of COVID-19. A brief description of each group is given.
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Affiliation(s)
- Philip Zachariah
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA.
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Sanie-Jahromi F, NejatyJahromy Y, Jahromi RR. A Review on the Role of Stem Cells against SARS-CoV-2 in Children and Pregnant Women. Int J Mol Sci 2021; 22:11787. [PMID: 34769218 PMCID: PMC8584228 DOI: 10.3390/ijms222111787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/10/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022] Open
Abstract
Since the COVID-19 outbreak was acknowledged by the WHO on 30 January 2020, much research has been conducted to unveil various features of the responsible SARS-CoV-2 virus. Different rates of contagion in adults, children, and pregnant women may guide us to understand the underlying infection conditions of COVID-19. In this study, we first provide a review of recent reports of COVID-19 clinical outcomes in children and pregnant women. We then suggest a mechanism that explains the curious case of COVID-19 in children/pregnant women. The unique stem cell molecular signature, as well as the very low expression of angiotensin-converting enzyme 2 and the lower ACE/ACE2 ratio in stem cells of children/pregnant women compared to adults might be the cause of milder symptoms of COVID-19 in them. This study provides the main molecular keys on how stem cells can function properly and exert their immunomodulatory and regenerative effects in COVID-19-infected children/pregnant women, while failing to replicate their role in adults. This can lay the groundwork for both predicting the pattern of spread and severity of the symptoms in a population and designing novel stem cell-based treatment and prevention strategies for COVID-19.
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Affiliation(s)
- Fatemeh Sanie-Jahromi
- Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz 7134997446, Iran;
| | - Yaser NejatyJahromy
- Institut für Physikalische und Theoretische Chemie, Rheinische Friedrich-Wilhelms-Universität Bonn, 53012 Bonn, Germany
| | - Rahim Raoofi Jahromi
- Department of Infectious Disease, Peymanieh Hospital, Jahrom University of Medical Science, Jahrom 7414846199, Iran
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12
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Paret M, Lalani K, Hedari C, Jaffer A, Narayanan N, Noor A, Lighter J, Madan RP, Shust GF, Ratner AJ, Raabe VN. SARS-CoV-2 Among Infants <90 Days of Age Admitted for Serious Bacterial Infection Evaluation. Pediatrics 2021; 148:peds.2020-044685. [PMID: 34193619 DOI: 10.1542/peds.2020-044685] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in infants hospitalized for a serious bacterial infection (SBI) evaluation and clinically characterize young infants with SARS-CoV-2 infection. METHODS A retrospective chart review was conducted on infants <90 days of age hospitalized for an SBI evaluation. The study was conducted at 4 inpatient facilities in New York City from March 15, 2020, to December 15, 2020. RESULTS We identified 148 SBI evaluation infants who met inclusion criteria. A total of 22 infants (15%) tested positive for SARS-CoV-2 by nasopharyngeal reverse transcription polymerase chain reaction; 31% of infants admitted during periods of high community SARS-CoV-2 circulation tested positive for SARS-CoV-2, compared with 3% when community SARS-CoV-2 circulation was low (P < .001). The mean age of infants with SARS-CoV-2 was higher than that of SARS-CoV-2-negative infants (33 [SD: 17] days vs 23 [SD: 23] days, respectively; P = .03), although no age difference was observed when analysis was limited only to febrile infants. An isolated fever was the most common presentation of SARS-CoV-2 (n = 13; 59%). Admitted infants with SARS-CoV-2 were less likely to have positive urine culture results (n = 1 [5%] versus n = 25 [20%], respectively; P = .002), positive cerebrospinal culture results (n = 0 [0%] versus n = 5 [4%], respectively; P = .02), or be admitted to intensive care (n = 2 [9%] versus n = 47 [37%]; P < .001), compared with infants without SARS-CoV-2. CONCLUSIONS SARS-CoV-2 was common among young infants hospitalized for an SBI evaluation during periods of high but not low community SARS-CoV-2 circulation in New York City, although most infants did not require intensive care admission.
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Affiliation(s)
| | - Karim Lalani
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York
| | | | - Annum Jaffer
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York
| | - Nisha Narayanan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Asif Noor
- Division of Infectious Diseases and Immunology, Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | | | | | | | - Adam J Ratner
- Division of Pediatric Infectious Diseases.,Division of Pediatric Infectious Diseases, Department of Pediatrics, Long Island School of Medicine, New York University, Mineola, New York
| | - Vanessa N Raabe
- Division of Pediatric Infectious Diseases .,Department of Microbiology, Grossman School of Medicine, New York University, New York, New York
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13
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A Systematic Review of Characteristics Associated with COVID-19 in Children with Typical Presentation and with Multisystem Inflammatory Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168269. [PMID: 34444014 PMCID: PMC8394392 DOI: 10.3390/ijerph18168269] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022]
Abstract
Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C.
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14
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Ben-Shimol S, Livni G, Megged O, Greenberg D, Danino D, Youngster I, Shachor-Meyouhas Y, Dabaja-Younis H, Scheuerman O, Mor M, Somekh E, Yakub Hanna H, Givon-Lavi N, Guri A, Leibovitz E, Alkan Y, Grupel D, Rubinstein U, Steinberg Ben Zeev Z, Bamberger E, Asher Kuperman A, Grisaru-Soen G, Tasher D, Gottesman G, Glikman D, Stein M. COVID-19 in a Subset of Hospitalized Children in Israel. J Pediatric Infect Dis Soc 2021; 10:757-765. [PMID: 34129032 PMCID: PMC8344587 DOI: 10.1093/jpids/piab035] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. METHODS An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). RESULTS Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. CONCLUSIONS At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.
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Affiliation(s)
- Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Corresponding Author: Shalom Ben-Shimol, MD, Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel. E-mail:
| | - Gilat Livni
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Orli Megged
- Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Danino
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Youngster
- Pediatric Infectious Diseases Unit, Shamir Medical Center, Zerifin, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shachor-Meyouhas
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Halima Dabaja-Younis
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Meirav Mor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Infection Control Unit and Emergency Department, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Eli Somekh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Husam Yakub Hanna
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alex Guri
- Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Eugene Leibovitz
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Alkan
- Clalit Health Services, Sharon Shomron District, Israel
| | - Daniel Grupel
- Infectious Diseases Unit, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | | | - Ellen Bamberger
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Asher Kuperman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Diana Tasher
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Giora Gottesman
- Pediatric Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Glikman
- Infectious Diseases Unit, The Baruch Padeh Medical Center, Poriya, Israel,Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Michal Stein
- Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel,Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
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15
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Hassoun A, Dahan N, Kelly C. A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments. Clin Pediatr (Phila) 2021; 60:247-251. [PMID: 33853371 DOI: 10.1177/00099228211006688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.
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Affiliation(s)
- Ameer Hassoun
- New York-Presbyterian Queens Hospital and Weill Cornell Medicine, Flushing, NY, USA
| | - Nessy Dahan
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Christopher Kelly
- New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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16
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Dyer H. Evaluation and Management of the Febrile Young Infant (<90 days old) in the Absence of Universally Accepted Criteria for the Risk of Serious Bacterial Infection (SBI). Curr Probl Pediatr Adolesc Health Care 2021; 51:100997. [PMID: 34052124 DOI: 10.1016/j.cppeds.2021.100997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fever (≥38°C) in young infants (<90 days of age) represents a common clinical challenge for pediatricians in both outpatient and inpatient settings. While the majority of febrile infants will ultimately be determined to have no serious infection, serious infections when present can cause significant morbidity and mortality in affected patients. Since the evaluation and empiric treatment of presumptive serious infection has associated risks (e.g. medication side effects, stress/disruption of hospitalization, nosocomial infection, etc.) as well as substantial costs, attempts have been made to clearly define an accurate method that enables clinicians to correctly stratify which infants are at relatively low risk for serious bacterial infection (SBI) and may therefore be safely managed less aggressively. Although this topic has been extensively studied and discussed, no single protocol has been universally adopted and clinical practices continue to vary. This paper discusses multiple distinct protocols currently in use, as well as the evidence upon which they are based and the points on which the evidence is not yet definitive.
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Affiliation(s)
- Heather Dyer
- Division Chief of Pediatric Hospital Medicine, Dayton Children's Hospital, Assistant Professor in Pediatrics, Boonshoft School of Medicine at Wright State University.
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17
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Kim DH. Clinical implications of coronavirus disease 2019 in neonates. Clin Exp Pediatr 2021; 64:157-164. [PMID: 33539697 PMCID: PMC8024123 DOI: 10.3345/cep.2020.01795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019, a small number of coronavirus disease 2019 (COVID-19) cases in neonates have been reported worldwide. Neonates currently account for only a minor proportion of the pediatric population affected by COVID-19. Thus, data on the epidemiological and clinical features of COVID-19 in neonates are limited. Approximately 3% of neonates born to mothers with COVID-19 reportedly tested positive for SARS-CoV-2. Current limited data on neonates with COVID-19 suggest that neonatal COVID-19 shows a relatively benign course despite a high requirement for mechanical ventilation. However, neonates with pre-existing medical conditions and preterm infants appear to be at a higher risk of developing severe COVID-19. The greatest perinatal concern of the COVID-19 pandemic is the possibility of vertical transmission, especially transplacental transmission of SARS-CoV-2. Although direct evidence of the vertical transmission of SARS-CoV-2 is lacking, its possibility during late pregnancy cannot be ruled out. This review summarizes available case studies on COVID-19 in neonates and introduces what is currently known about neonatal COVID-19 with focus on its vertical transmission.
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Affiliation(s)
- Do-Hyun Kim
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
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18
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Li X, Sun L, Li T. Updates in neonatal coronavirus disease 2019: What can we learn from detailed case reports? (Review). Mol Med Rep 2021; 23:351. [PMID: 33760212 PMCID: PMC7974256 DOI: 10.3892/mmr.2021.11990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/04/2021] [Indexed: 12/31/2022] Open
Abstract
Although the COVID-19 epidemic has lasted for months, it has not yet been successfully controlled, and little is known about neonatal COVID-19. Therefore, literature search was conducted for references in PubMed, Science Direct, ProQuest, Web of Science and China National Knowledge Infrastructure for detailed case reports on neonatal COVID-19 published as of July 15, 2020, to facilitate the clinical treatment, epidemic prevention and control of neonatal COVID-19. Forty nonoverlapping case reports focusing mainly on the demographic characteristics, transmission modes, clinical features, treatments and prognosis of neonatal COVID-19, including 3 in Chinese and 37 in English, were available.
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Affiliation(s)
- Xingchao Li
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Li Sun
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Tao Li
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
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19
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Stanoeva KR, van der Eijk AA, Meijer A, Kortbeek LM, Koopmans MPG, Reusken CBEM. Towards a sensitive and accurate interpretation of molecular testing for SARS-CoV-2: a rapid review of 264 studies. Euro Surveill 2021; 26:2001134. [PMID: 33706863 PMCID: PMC7953531 DOI: 10.2807/1560-7917.es.2021.26.10.2001134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/20/2020] [Indexed: 01/19/2023] Open
Abstract
BackgroundSensitive molecular diagnostics and correct test interpretation are crucial for accurate COVID-19 diagnosis and thereby essential for good clinical practice. Furthermore, they are a key factor in outbreak control where active case finding in combination with isolation and contact tracing are crucial.AimWith the objective to inform the public health and laboratory responses to the pandemic, we reviewed current published knowledge on the kinetics of SARS-CoV-2 infection as assessed by RNA molecular detection in a wide range of clinical samples.MethodsWe performed an extensive search on studies published between 1 December 2019 and 15 May 2020, reporting on molecular detection and/or isolation of SARS-CoV-2 in any human laboratory specimen.ResultsWe compiled a dataset of 264 studies including 32,515 COVID-19 cases, and additionally aggregated data points (n = 2,777) from sampling of 217 adults with known infection timeline. We summarised data on SARS-CoV-2 detection in the respiratory and gastrointestinal tract, blood, oral fluid, tears, cerebrospinal fluid, peritoneal fluid, semen, vaginal fluid; where provided, we also summarised specific observations on SARS-CoV-2 detection in pregnancy, infancy, children, adolescents and immunocompromised individuals.ConclusionOptimal SARS-CoV-2 molecular testing relies on choosing the most appropriate sample type, collected with adequate sampling technique, and with the infection timeline in mind. We outlined knowledge gaps and directions for future well-documented systematic studies.
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Affiliation(s)
- Kamelia R Stanoeva
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Adam Meijer
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Laetitia M Kortbeek
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Marion P G Koopmans
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Chantal B E M Reusken
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Department of Viroscience, Erasmus University Medical Center, Rotterdam, the Netherlands
- Global Outbreak Alert and Response Network (GOARN), Geneva, Switzerland
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20
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Leibowitz J, Krief W, Barone S, Williamson KA, Goenka PK, Rai S, Moriarty S, Baodhankar P, Rubin LG. Comparison of Clinical and Epidemiologic Characteristics of Young Febrile Infants with and without Severe Acute Respiratory Syndrome Coronavirus-2 Infection. J Pediatr 2021; 229:41-47.e1. [PMID: 33045235 PMCID: PMC7546714 DOI: 10.1016/j.jpeds.2020.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine features that distinguish febrile young infants with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. STUDY DESIGN Retrospective single-center study included febrile infants <57 days of age evaluated in the emergency department of Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, from March 1 to April 30 of 2018, 2019, and 2020. Sociodemographic and clinical features were compared between those seen during the 2020 coronavirus disease-2019 pandemic and previous years, as well as between infants with SARS-CoV-2 infection and infants without SARS-CoV-2 infection (SARS-CoV-2 negative or evaluated during 2018 and 2019). RESULTS In all, 124 febrile infants <57 days of age were identified; 38 during the 2-month study period in 2018, 33 in 2019, and 53 in 2020. During 2020, fewer febrile infants had a serious bacterial infection or a positive respiratory viral panel than in prior years (6% vs 21% [P = .02]; 15% vs 53% [P < .001], respectively). SARS-CoV-2 was the most frequent pathogen detected in 2020; of 30 infants tested, 20 tested positive. Infants with SARS-CoV-2 were more likely to identify as Hispanic (P = .004), have public insurance or be uninsured (P = .01), exhibited lethargy (P = .02), had feeding difficulties (P = .002), and had lower white blood cell (P = .001), neutrophil (P < .001), and lymphocyte counts (P = .005) than the 81 infants without SARS-CoV-2 infection. None of the infants with SARS-CoV-2 had concurrent serious bacterial infection or detection of another virus. Overall, disease in infants with SARS-CoV-2 was mild. CONCLUSIONS During the peak of the pandemic, SARS-CoV-2 was the predominant pathogen among febrile infants. Socioeconomic, historical, and laboratory features differed significantly between infants infected or not infected with SARS-CoV-2. None of the 20 infants with SARS-CoV-2 infection had an identified coviral or serious bacterial infection.
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Affiliation(s)
- Jill Leibowitz
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY.
| | - William Krief
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY
| | - Stephen Barone
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY
| | - Kristy A. Williamson
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY
| | - Pratichi K. Goenka
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY
| | - Shipra Rai
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Shannon Moriarty
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Prachi Baodhankar
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY
| | - Lorry G. Rubin
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY
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21
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Bhuiyan MU, Stiboy E, Hassan MZ, Chan M, Islam MS, Haider N, Jaffe A, Homaira N. Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis. Vaccine 2021; 39:667-677. [PMID: 33342635 PMCID: PMC7833125 DOI: 10.1016/j.vaccine.2020.11.078] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Emerging evidence suggests young children are at greater risk of COVID-19 infection than initially predicted. However, a comprehensive understanding of epidemiology of COVID-19 infection in young children under five years, the most at-risk age-group for respiratory infections, remain unclear. We conducted a systematic review and meta-analysis of epidemiological and clinical characteristics of COVID-19 infection in children under five years. METHOD Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses , we searched several electronic databases (Pubmed, EMBASE, Web of Science, and Scopus) with no language restriction for published epidemiological studies and case-reports reporting laboratory-confirmed COVID-19 infection in children under five years until June 4, 2020. We assessed pooled prevalence for key demographics and clinical characteristics using Freeman-Tukey double arcsine random-effects model for studies except case-reports. We evaluated risk of bias separately for case-reports and other studies. RESULTS We identified 1,964 articles, of which, 65 articles were eligible for systematic review that represented 1,214 children younger than five years with laboratory-confirmed COVID-19 infection. The pooled estimates showed that 50% young COVID-19 cases were infants (95% CI: 36% - 63%, 27 studies); 53% were male (95% CI: 41% - 65%, 24 studies); 43% were asymptomatic (95% CI: 15% - 73%, 9 studies) and 7% (95% CI: 0% - 30%, 5 studies) had severe disease that required intensive-care-unit admission. Of 139 newborns from COVID-19 infected mothers, five (3.6%) were COVID-19 positive. There was only one death recorded. DISCUSSION This systematic review reports the largest number of children younger than five years with COVID-19 infection till date. Our meta-analysis shows nearly half of young COVID-19 cases were asymptomatic and half were infants, highlighting the need for ongoing surveillance to better understand the epidemiology, clinical pattern, and transmission of COVID-19 to develop effective preventive strategies against COVID-19 disease in young paediatric population.
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Affiliation(s)
- Mejbah Uddin Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Western Australia, Australia.
| | - Eunice Stiboy
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Md Zakiul Hassan
- Program for Emerging Infections, Infectious Diseases Division, icddr,b, Bangladesh
| | - Mei Chan
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Md Saiful Islam
- Program for Emerging Infections, Infectious Diseases Division, icddr,b, Bangladesh; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Najmul Haider
- The Royal Veterinary College, University of London, Hatfield, Hertfordshire, AL9 7TA, UK
| | - Adam Jaffe
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Nusrat Homaira
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
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22
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Mark EG, Golden WC, Gilmore MM, Sick-Samuels A, Curless MS, Nogee LM, Milstone AM, Johnson J. Community-Onset Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Young Infants: A Systematic Review. J Pediatr 2021; 228:94-100.e3. [PMID: 32910943 PMCID: PMC7477627 DOI: 10.1016/j.jpeds.2020.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To summarize and evaluate current reports on community-onset severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in young infants. STUDY DESIGN We performed a systematic review to identify reports published from November 1, 2019, until June 15, 2020, on laboratory-confirmed community-onset SARS-CoV-2 infection in infants younger than 3 months of age. We excluded studies reporting neonates with perinatal coronavirus disease 2019 (COVID-19) exposure and diagnosis before hospital discharge and hospital-onset disease, as well as clinically diagnosed cases without confirmation. Two independent reviewers performed study screening, data abstraction, and risk of bias assessment. Variables of interest included patient age, exposure to COVID-19, medical history, clinical symptoms, SARS-CoV-2 testing, laboratory findings, clinical course, and disposition. RESULTS In total, 38 publications met inclusion criteria, including 23 single case reports, 14 case series, and 1 cohort study, describing 63 infants younger than 3 months of age with laboratory-confirmed SARS-CoV-2 infection. Most cases were mild to moderate. Fever, respiratory, gastrointestinal, cardiac, and neurologic findings were reported. Laboratory abnormalities included neutropenia, lymphopenia, and elevated serum levels of inflammatory markers and aminotransferases. Fifty-eight (92%) infants were hospitalized, 13 (21%) were admitted to the intensive care unit, and 2 (3%) required mechanical ventilation. No death was reported. CONCLUSIONS Among young infants with laboratory-confirmed SARS-CoV-2 infection, most cases were mild to moderate and improved with supportive care. Our results demonstrate a need for a high index of suspicion for SARS-CoV-2 infection in young infants presenting with generalized symptoms such as fever or decreased feeding, even in the absence of respiratory symptoms.
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Affiliation(s)
- Elyse G Mark
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - W Christopher Golden
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Maureen M Gilmore
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Anna Sick-Samuels
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Melanie S Curless
- Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MD
| | - Lawrence M Nogee
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Aaron M Milstone
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Julia Johnson
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, MD.
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23
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Polcwiartek LB, Polcwiartek C, Andersen MP, Østergaard L, Broccia MD, Gislason GH, Køber L, Torp-Pedersen C, Schou M, Fosbøl E, Kragholm K, Hagstrøm S. Consequences of coronavirus disease-2019 (COVID-19) lockdown on infection-related hospitalizations among the pediatric population in Denmark. Eur J Pediatr 2021; 180:1955-1963. [PMID: 33555426 PMCID: PMC7868522 DOI: 10.1007/s00431-021-03934-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/30/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
It remains unknown how Coronavirus disease-2019 (COVID-19) prevention measures implemented on March 12, 2020, have affected the rate of pediatric infection-related hospitalizations in Denmark. Therefore, we investigated the rate of pediatric infection-related hospitalizations during the COVID-19 pandemic. We used a retrospective cohort design and included all Danish children < 18 years. Infection-related hospitalizations were assessed during study periods in 2020 vs. 2018/2019, and we computed incidence rate ratios (IRRs) with 95% confidence intervals (CIs) using Poisson regression. In the 2020 study period, 3093 children were hospitalized with an infection, while the corresponding figures for 2018 and 2019 study periods were 4824 and 3830, respectively. When comparing the 2020 to the 2018/2019 study period prior to nationwide lockdown, we observed a decline in infection-related hospitalizations (12.68 (95% CI, 12.22-13.16) vs. 15.49 (95% CI, 15.12-15.86) per 1000 person-years). We further observed decreased IRRs, especially during the lockdown period (week 11: 0.64 (95% CI, 0.55-0.75); week 12: 0.26 (95% CI, 0.21-0.33); week 13: 0.13 (95% CI, 0.10-0.19)).Conclusion: The rate of pediatric infection-related hospitalizations in Denmark declined during the COVID-19 pandemic in 2020 compared to that in 2018/2019, with a 36% decline during initiation of the nationwide lockdown period. What is Known: • Due to the COVID-19 pandemic, several countries have implemented mitigation strategies such as lockdown of non-critical business functions. Most of these strategies have previously been proven effective on interruption of infection transmission. • It remains unclear how the mitigation strategies have affected the rate of pediatric infection-related hospitalizations. What is New: • Insight on how COVID-19 prevention measures have affected the frequency of infection-related hospitalization. • Valuable knowledge on how to act in potential future pandemics.
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Affiliation(s)
- Laura Bech Polcwiartek
- Department of Pediatrics, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Mikkel Porsborg Andersen
- Department of Clinical Research, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Marcella D. Broccia
- Department of Clinical Research, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark ,Department of Obstetrics and Gynecology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Gunnar H. Gislason
- The Danish Heart Foundation, Vognmagergade 7, 3. sal, 1120 Copenhagen, Denmark ,Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark ,Department of Clinical Research, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark ,Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjørring, Denmark ,Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Søren Hagstrøm
- Department of Pediatrics, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark ,Center for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjørring, Denmark ,Department of Clinical Medicine, Aalborg University, Hobrovej 18-22, 9000 Aalborg, Denmark
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24
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Centeno‐Tablante E, Medina‐Rivera M, Finkelstein JL, Rayco‐Solon P, Garcia‐Casal MN, Rogers L, Ghezzi‐Kopel K, Ridwan P, Peña‐Rosas JP, Mehta S. Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci 2021; 1484:32-54. [PMID: 32860259 PMCID: PMC7970667 DOI: 10.1111/nyas.14477] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full-text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID-19 cases based on RT-PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID-19 were positive for SARS-CoV-2 RNA; of the exposed infants, four were positive and two were negative for COVID-19. Currently, there is no evidence of SARS-CoV-2 transmission through breast milk. Studies are needed with longer follow-up periods that collect data on infant feeding practices and on viral presence in breast milk.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn,
Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | - Lisa Rogers
- Department of Nutrition and Food
SafetyWorld Health OrganizationGenevaSwitzerland
| | | | - Pratiwi Ridwan
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| | | | - Saurabh Mehta
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
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25
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Zhou B, Yuan Y, Wang S, Zhang Z, Yang M, Deng X, Niu W. Risk profiles of severe illness in children with COVID-19: a meta-analysis of individual patients. Pediatr Res 2021; 90:347-352. [PMID: 33753892 PMCID: PMC7984508 DOI: 10.1038/s41390-021-01429-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND We prepared a meta-analysis on case reports in children with COVID-19, aiming to identify potential risk factors for severe illness and to develop a prediction model for risk assessment. METHODS Literature retrieval, case report selection, and data extraction were independently completed by two authors. STATA software (version 14.1) and R programming environment (v4.0.2) were used for data handling. RESULTS This meta-analysis was conducted based on 52 case reports, including 203 children (96 boys) with COVID-19. By severity, 26 (12.94%), 160 (79.60%), and 15 (7.46%) children were diagnosed as asymptomatic, mild/moderate, and severe cases, respectively. After adjusting for age and sex, 11 factors were found to be significantly associated with the risk of severe illness relative to asymptomatic or mild/moderate illness, especially for dyspnea/tachypnea (odds ratio, 95% confidence interval, P: 6.61, 4.12-9.09, <0.001) and abnormal chest X-ray (3.33, 1.84-4.82, <0.001). A nomogram modeling age, comorbidity, cough, dyspnea or tachypnea, CRP, and LDH was developed, and prediction performance was good as reflected by the C-index. CONCLUSIONS Our findings provide systematic evidence for the contribution of comorbidity, cough, dyspnea or tachypnea, CRP, and LDH, both individually and jointly, to develop severe symptoms in children with asymptomatic or mild/moderate COVID-19. IMPACT We have identified potential risk factors for severe illness in children with COVID-19. We have developed a prediction model to facilitate risk assessment in children with COVID-19. We found the contribution of five risk factors to develop severe symptoms in children with asymptomatic or mild/moderate COVID-19.
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Affiliation(s)
- Bo Zhou
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Yuan Yuan
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Shunan Wang
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Zhixin Zhang
- grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Min Yang
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Xiangling Deng
- grid.24695.3c0000 0001 1431 9176Graduate School, Beijing University of Chinese Medicine, Beijing, China ,grid.415954.80000 0004 1771 3349International Medical Services, China-Japan Friendship Hospital, Beijing, China
| | - Wenquan Niu
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.
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26
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Khatami F, Saatchi M, Zadeh SST, Aghamir ZS, Shabestari AN, Reis LO, Aghamir SMK. A meta-analysis of accuracy and sensitivity of chest CT and RT-PCR in COVID-19 diagnosis. Sci Rep 2020; 10:22402. [PMID: 33372194 PMCID: PMC7769992 DOI: 10.1038/s41598-020-80061-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
Nowadays there is an ongoing acute respiratory outbreak caused by the novel highly contagious coronavirus (COVID-19). The diagnostic protocol is based on quantitative reverse-transcription polymerase chain reaction (RT-PCR) and chests CT scan, with uncertain accuracy. This meta-analysis study determines the diagnostic value of an initial chest CT scan in patients with COVID-19 infection in comparison with RT-PCR. Three main databases; PubMed (MEDLINE), Scopus, and EMBASE were systematically searched for all published literature from January 1st, 2019, to the 21st May 2020 with the keywords "COVID19 virus", "2019 novel coronavirus", "Wuhan coronavirus", "2019-nCoV", "X-Ray Computed Tomography", "Polymerase Chain Reaction", "Reverse Transcriptase PCR", and "PCR Reverse Transcriptase". All relevant case-series, cross-sectional, and cohort studies were selected. Data extraction and analysis were performed using STATA v.14.0SE (College Station, TX, USA) and RevMan 5. Among 1022 articles, 60 studies were eligible for totalizing 5744 patients. The overall sensitivity, specificity, positive predictive value, and negative predictive value of chest CT scan compared to RT-PCR were 87% (95% CI 85-90%), 46% (95% CI 29-63%), 69% (95% CI 56-72%), and 89% (95% CI 82-96%), respectively. It is important to rely on the repeated RT-PCR three times to give 99% accuracy, especially in negative samples. Regarding the overall diagnostic sensitivity of 87% for chest CT, the RT-PCR testing is essential and should be repeated to escape misdiagnosis.
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Affiliation(s)
- Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saatchi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Alireza Namazi Shabestari
- Department of Geriatric Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Leonardo Oliveira Reis
- UroScience and Department of Surgery (Urology), School of Medical Sciences, University of Campinas, Unicamp, and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, São Paulo, Brazil
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27
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Rawson TM, Moore LSP, Zhu N, Ranganathan N, Skolimowska K, Gilchrist M, Satta G, Cooke G, Holmes A. Bacterial and Fungal Coinfection in Individuals With Coronavirus: A Rapid Review To Support COVID-19 Antimicrobial Prescribing. Clin Infect Dis 2020; 71:2459-2468. [PMID: 32358954 PMCID: PMC7197596 DOI: 10.1093/cid/ciaa530] [Citation(s) in RCA: 694] [Impact Index Per Article: 173.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To explore and describe the current literature surrounding bacterial/fungal coinfection in patients with coronavirus infection. METHODS MEDLINE, EMBASE, and Web of Science were searched using broad-based search criteria relating to coronavirus and bacterial coinfection. Articles presenting clinical data for patients with coronavirus infection (defined as SARS-1, MERS, SARS-CoV-2, and other coronavirus) and bacterial/fungal coinfection reported in English, Mandarin, or Italian were included. Data describing bacterial/fungal coinfections, treatments, and outcomes were extracted. Secondary analysis of studies reporting antimicrobial prescribing in SARS-CoV-2 even in absence of coinfection was performed. RESULTS 1007 abstracts were identified. Eighteen full texts reporting bacterial/fungal coinfection were included. Most studies did not identify or report bacterial/fungal coinfection (85/140; 61%). Nine of 18 (50%) studies reported on COVID-19, 5/18 (28%) on SARS-1, 1/18 (6%) on MERS, and 3/18 (17%) on other coronaviruses. For COVID-19, 62/806 (8%) patients were reported as experiencing bacterial/fungal coinfection during hospital admission. Secondary analysis demonstrated wide use of broad-spectrum antibacterials, despite a paucity of evidence for bacterial coinfection. On secondary analysis, 1450/2010 (72%) of patients reported received antimicrobial therapy. No antimicrobial stewardship interventions were described. For non-COVID-19 cases, bacterial/fungal coinfection was reported in 89/815 (11%) of patients. Broad-spectrum antibiotic use was reported. CONCLUSIONS Despite frequent prescription of broad-spectrum empirical antimicrobials in patients with coronavirus-associated respiratory infections, there is a paucity of data to support the association with respiratory bacterial/fungal coinfection. Generation of prospective evidence to support development of antimicrobial policy and appropriate stewardship interventions specific for the COVID-19 pandemic is urgently required.
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Affiliation(s)
- Timothy M Rawson
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,Centre for Antimicrobial Optimisation, Imperial College London, London, United Kingdom.,Department of Infectious Diseases, Imperial College London, South Kensington, United Kingdom
| | - Luke S P Moore
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom.,Chelsea & Westminster NHS Foundation Trust, London, United Kingdom
| | - Nina Zhu
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom
| | - Nishanthy Ranganathan
- Department of Infectious Diseases, Imperial College London, South Kensington, United Kingdom.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Keira Skolimowska
- Department of Infectious Diseases, Imperial College London, South Kensington, United Kingdom.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Mark Gilchrist
- Department of Infectious Diseases, Imperial College London, South Kensington, United Kingdom.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Giovanni Satta
- Department of Infectious Diseases, Imperial College London, South Kensington, United Kingdom.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Graham Cooke
- Department of Infectious Diseases, Imperial College London, South Kensington, United Kingdom.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Alison Holmes
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,Centre for Antimicrobial Optimisation, Imperial College London, London, United Kingdom.,Department of Infectious Diseases, Imperial College London, South Kensington, United Kingdom.,Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
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28
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Slaats MALJ, Versteylen M, Gast KB, Oude Munnink BB, Pas SD, Bentvelsen RG, van Beek R. Case report of a neonate with high viral SARSCoV-2 loads and long-term virus shedding. J Infect Public Health 2020; 13:1878-1884. [PMID: 33158806 PMCID: PMC7590917 DOI: 10.1016/j.jiph.2020.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND SARS-CoV-2 has spread globally. Currently, literature of SARS-CoV-2 in neonates is scarce. We present a case of a neonate with a high viral load and prolonged virus shedding. METHODS Epidemiology, clinical characteristics, treatment, laboratory data and follow-up information and the treatment of a neonate with COVID-19 were recorded. RESULTS A 7-day-old boy was admitted to the hospital with fever, lethargy and apnoea. He was found SARS-CoV-2 RNA positive with an exceptionally high viral load in nasopharyngeal swab and stool. The father and two maternity nurses at home had detectable SARS-CoV-2 RNA as well. Sequencing showed all strains belonged to the same cluster. The father was asymptomatic and the maternity nurses developed symptoms after visiting. In the mother, no SARS-CoV-2 RNA could be found. Six days after admission, the neonate was discharged after clinical improvement with oral antibiotics because of a possible pyelonephritis. Monitoring the course of this infection showed that SARS-CoV-2 RNA was detectable in the nasopharynx until day 19 and in stool until day 42 after symptom onset. CONCLUSIONS This case shows that neonates can have a high viral load of SARS-CoV-2 and can shed the virus for over one month in stool. Despite the high viral load in the neonate, the mother and a sibling did not get infected.
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Affiliation(s)
- Monique A L J Slaats
- Department of Pediatrics, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands.
| | - Maud Versteylen
- Department of Pediatrics, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Karin B Gast
- Microvida, Location Amphia, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - Bas B Oude Munnink
- Department of Viroscience, WHO Collaborating Centre for Arbovirus and Viral Hemorrhagic Fever Reference and Research, Erasmus University Medical Center, Molewaterplein 50, 3015 CE, Rotterdam, The Netherlands
| | - Suzan D Pas
- Microvida, Location Amphia, Molengracht 21, 4818 CK, Breda, The Netherlands
| | | | - Ron van Beek
- Department of Pediatrics, Amphia Hospital, Molengracht 21, 4818 CK, Breda, The Netherlands
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29
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Martins MM, Prata-Barbosa A, Magalhães-Barbosa MCD, Cunha AJLAD. CLINICAL AND LABORATORY CHARACTERISTICS OF SARS-COV-2 INFECTION IN CHILDREN AND ADOLESCENTS. ACTA ACUST UNITED AC 2020; 39:e2020231. [PMID: 33206842 PMCID: PMC7669216 DOI: 10.1590/1984-0462/2021/39/2020231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/02/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To present the current evidence on clinical and laboratory characteristics of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during childhood and adolescence. DATA SOURCE This is a narrative review conducted in the databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Latin American and Caribbean Health Sciences Literature in the Virtual Health Library (LILACS/VHL), Scopus, Web of Science, Cochrane Library, portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The terms used were SARS-CoV-2, COVID-19, novel coronavirus, child, newborn, and adolescent. DATA SYNTHESIS Unlike adults, most children infected by SARS-CoV-2 have mild or asymptomatic clinical presentations. Symptomatic children mainly have low fever and cough, with some associated gastrointestinal symptoms. Severe cases are rare and occur especially in infants under one year of age. Detection of viral particles in feces seems to be more persistent in children and can be used as a tool for diagnosis and control of the quarantine period. Different from adults, children can present distinct inflammatory responses, as has happened in new cases of Kawasaki-like syndrome associated with SARS-CoV-2 infection. CONCLUSIONS Most children have asymptomatic or mild presentations, with a prevalence of fever, cough, and gastrointestinal symptoms. New cases with different systemic inflammatory reactions in children have been reported, with clinical manifestations distinct from those typically found in adults.
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30
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Wardell H, Campbell JI, VanderPluym C, Dixit A. Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Febrile Neonates. J Pediatric Infect Dis Soc 2020; 9:630-635. [PMID: 32645175 PMCID: PMC7454701 DOI: 10.1093/jpids/piaa084] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 12/27/2022]
Abstract
Most severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in pediatric patients are mild or asymptomatic. However, infants have emerged at higher risk of hospitalization and severe outcomes in pediatric coronavirus disease 2019 (COVID-19). We report a case series of 4 full-term neonates hospitalized with fever and found to have SARS-CoV-2 infection with a spectrum of illness severities. Two neonates required admission to the intensive care unit for respiratory insufficiency and end organ involvement. Half of the patients were found to have a coinfection. One neonate received antiviral therapy with remdesivir and is, to our knowledge, the youngest patient to receive this drug for COVID-19. All neonates had favorable outcomes.
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Affiliation(s)
- Hanna Wardell
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey I Campbell
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Christina VanderPluym
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Avika Dixit
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
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31
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Raschetti R, Vivanti AJ, Vauloup-Fellous C, Loi B, Benachi A, De Luca D. Synthesis and systematic review of reported neonatal SARS-CoV-2 infections. Nat Commun 2020; 11:5164. [PMID: 33060565 PMCID: PMC7566441 DOI: 10.1038/s41467-020-18982-9] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022] Open
Abstract
A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70% and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother-neonate separation from birth is associated with late SARS-CoV-2 infection (OR 4.94 (95% CI: 1.98-13.08), p = 0.0002; adjusted OR 6.6 (95% CI: 2.6-16), p < 0.0001), while breastfeeding is not (OR 0.35 (95% CI: 0.09-1.18), p = 0.10; adjusted OR 2.2 (95% CI: 0.7-6.5), p = 0.148). Our findings add to the literature on neonatal SARS-CoV-2 infections.
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Affiliation(s)
- Roberto Raschetti
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Christelle Vauloup-Fellous
- Division of Virology, "Paul Brousse" Hospital, Paris Saclay University Hospitals, APHP, Villejuif, France
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Centre, Paris Saclay University Hospitals, APHP, Clamart, France.
- Physiopathology and Therapeutic Innovation Unit-INSERM, Paris Saclay University, U999, Le Plessis Robinson, France.
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32
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Manti S, Licari A, Montagna L, Votto M, Leonardi S, Brambilla I, Castagnoli R, Foiadelli T, Marseglia GL, Cardinale F, Caffarelli C, Tosca MA, Cravidi C, Duse M, Chiappini E. SARS-CoV-2 infection in pediatric population. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020003. [PMID: 33004773 PMCID: PMC8023063 DOI: 10.23750/abm.v91i11-s.10298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
n December 2019, in Wuhan (Hubei, China), the first COVID-19 cases due to SARS-COV-2 had been reported. On July 1st 2020, more than 10.268.839 million people had developed the disease, with at least 506.064 deaths. At present, Italy is the third country considering the number of cases (n=240.760), after Spain, and the second for the cumulative number of deaths (n=249.271), after the United States. As regard pediatric COVID-19 cases, more than 4000 cases (have been reported; however, these figures are likely to be underestimated since they are influenced by the number of diagnostic tests carried out. Three pediatric deaths have been reported in Italy to date. We aimed to review the peculiar aspects of SARS-COV-2 infection in the pediatric population.
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Affiliation(s)
- Sara Manti
- 1UOC Broncopneumologia Pediatrica e Fibrosi Cistica, AOUP "Vittorio-Emanuele", San Marco Hospital, Università di Catania, Catania, Italy.
| | - Amelia Licari
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Lorenza Montagna
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Martina Votto
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Salvatore Leonardi
- UOC Broncopneumologia Pediatrica e Fibrosi Cistica, AOUP "Vittorio-Emanuele", San Marco Hospital, Università di Catania, Catania, Italy.
| | - Ilaria Brambilla
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Riccardo Castagnoli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Thomas Foiadelli
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
| | - Gian Luigi Marseglia
- Pediatric Clinic Department of Pediatrics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria Consorziale-Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
| | - Carlo Caffarelli
- Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Italy.
| | - Maria Angela Tosca
- Allergy Center, Department of Pediatrics, Istituto G. Gaslini, Genoa, Italy.
| | - Claudio Cravidi
- Agenzia Tutela della Salute, ATS (National Healthcare System), Pavia, Italy.
| | - Marzia Duse
- Department of Pediatrics, Sapienza University, Rome, Italy.
| | - Elena Chiappini
- Division of Paediatric Infectious Disease, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy..
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Rozycki HJ, Kotecha S. Covid-19 in pregnant women and babies: What pediatricians need to know. Paediatr Respir Rev 2020; 35:31-37. [PMID: 32709462 PMCID: PMC7293440 DOI: 10.1016/j.prrv.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022]
Abstract
Beginning in late 2019, a novel coronavirus labeled SARS-CoV-2 spread around the world, affecting millions. The impact of the disease on patients and on health care delivery has been unprecedented. Here, we review what is currently known about the effects of the virus and its clinical condition, Covid-19 in areas of relevance to those providing care to neonates. While aspects of pregnancy, including higher expression of the cell receptor for the virus, ACE2, could put these women at higher risk, preliminary epidemiological information does not support this. Viral carriage prevalence based on universal screening show that rates vary from 13% in "hot spots" such as New York City, to 3% in areas with lower cases. Vertical transmission risks are unknown but 3.1% of 311 babies born to mothers with Covid-19 were positive within a week of birth. The clinical description of 26 neonates <30 days of age showed no deaths and only one requiring intensive care. Risks for breast-feeding and for milk banks are discussed.
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MESH Headings
- Abortion, Induced
- Abortion, Spontaneous/epidemiology
- Betacoronavirus
- Breast Feeding
- COVID-19
- Coronavirus Infections/epidemiology
- Coronavirus Infections/physiopathology
- Coronavirus Infections/therapy
- Coronavirus Infections/transmission
- Female
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Milk Banks
- Milk, Human/virology
- Pandemics
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Pneumonia, Viral/transmission
- Pregnancy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/physiopathology
- Pregnancy Complications, Infectious/therapy
- SARS-CoV-2
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Affiliation(s)
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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Jones J, Jones S, Jones V. Several neonates reported positive for COVID-19. Infect Dis (Lond) 2020; 52:575-576. [PMID: 32427018 DOI: 10.1080/23744235.2020.1762920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Joshua Jones
- Department of Radiology, Stony brook University Hospital, Stony Brook, NY, USA
| | - Stephen Jones
- Good Samaritan Hospital Medical Center, West Islip, NY, USA
| | - Vinci Jones
- Good Samaritan Hospital Medical Center, West Islip, NY, USA
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35
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He Y, Tang J, Zhang M, Wang HR, Li WX, Xiong T, Li YP, Mu DZ. [Clinical features of coronavirus disease 2019 in children: a systemic review of severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:844-853. [PMID: 32800031 PMCID: PMC7441511 DOI: 10.7499/j.issn.1008-8830.2005172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To systematically summarize the clinical features of coronavirus disease 2019 (COVID-19) in children. METHODS PubMed, Embase, Web of Science, The Cochrane Library, CNKI, Weipu Database, and Wanfang Database were searched for clinical studies on COVID-19 in children published up to May 21, 2020. Two reviewers independently screened the articles, extracted data, and assessed the risk of bias of the studies included. A descriptive analysis was then performed for the studies. Related indices between children with COVID-19 and severe acute respiratory syndromes (SARS) or Middle East respiratory syndrome (MERS) were compared. RESULTS A total of 75 studies were included, with a total of 806 children with COVID-19. The research results showed that the age of the children ranged from 36 hours after birth to 18 years, with a male-female ratio of 1.21 : 1. Similar to SARS and MERS, COVID-19 often occurred with familial aggregation, and such cases accounted for 74.6% (601/806). The children with COVID-19, SARS, and MERS had similar clinical symptoms, mainly fever and cough. Some children had gastrointestinal symptoms. The children with asymptomatic infection accounted for 17.9% (144/806) of COVID-19 cases, 2.5% (2/81) of SARS cases, and 57.1% (12/21) of MERS cases. The children with COVID-19 and MERS mainly had bilateral lesions on chest imaging examination, with a positive rate of lesions of 63.4% (421/664) and 26.3% (5/19) respectively, which were lower than the corresponding positive rates of viral nucleic acid detection, which were 99.8% and 100% respectively. The chest radiological examination of the children with SARS mainly showed unilateral lesion, with a positive rate of imaging of 88.9% (72/81), which was higher than the corresponding positive rate of viral nucleic acid detection (29.2%). Viral nucleic acid was detected in the feces of children with COVID-19 or SARS, with positive rates of 60.2% (56/93) and 71.4% (5/7) respectively. The children with COVID-19 had a rate of severe disease of 4.6% (31/686) and a mortality rate of 0.1% (1/806), the children with SARS had a rate of severe disease of 1.5% (1/68) and a mortality rate of 0%, and those with MERS had a rate of severe disease of 14.3% (3/21) and a mortality rate of 9.5% (2/21). CONCLUSIONS Children with COVID-19 have similar symptoms to those with SARS or MERS, mainly fever and cough. Asymptomatic infection is observed in all three diseases. Children with COVID-19 or SARS have milder disease conditions than those with MERS. COVID-19 in children often occurs with familial aggregation. Epidemiological contact history, imaging examination findings, and viral nucleic acid testing results are important bases for the diagnosis of COVID-19.
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Affiliation(s)
- Yang He
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, China. )
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36
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He Y, Tang J, Zhang M, Wang HR, Li WX, Xiong T, Li YP, Mu DZ. [Clinical features of coronavirus disease 2019 in children: a systemic review of severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:844-853. [PMID: 32800031 PMCID: PMC7441511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/24/2020] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To systematically summarize the clinical features of coronavirus disease 2019 (COVID-19) in children. METHODS PubMed, Embase, Web of Science, The Cochrane Library, CNKI, Weipu Database, and Wanfang Database were searched for clinical studies on COVID-19 in children published up to May 21, 2020. Two reviewers independently screened the articles, extracted data, and assessed the risk of bias of the studies included. A descriptive analysis was then performed for the studies. Related indices between children with COVID-19 and severe acute respiratory syndromes (SARS) or Middle East respiratory syndrome (MERS) were compared. RESULTS A total of 75 studies were included, with a total of 806 children with COVID-19. The research results showed that the age of the children ranged from 36 hours after birth to 18 years, with a male-female ratio of 1.21 : 1. Similar to SARS and MERS, COVID-19 often occurred with familial aggregation, and such cases accounted for 74.6% (601/806). The children with COVID-19, SARS, and MERS had similar clinical symptoms, mainly fever and cough. Some children had gastrointestinal symptoms. The children with asymptomatic infection accounted for 17.9% (144/806) of COVID-19 cases, 2.5% (2/81) of SARS cases, and 57.1% (12/21) of MERS cases. The children with COVID-19 and MERS mainly had bilateral lesions on chest imaging examination, with a positive rate of lesions of 63.4% (421/664) and 26.3% (5/19) respectively, which were lower than the corresponding positive rates of viral nucleic acid detection, which were 99.8% and 100% respectively. The chest radiological examination of the children with SARS mainly showed unilateral lesion, with a positive rate of imaging of 88.9% (72/81), which was higher than the corresponding positive rate of viral nucleic acid detection (29.2%). Viral nucleic acid was detected in the feces of children with COVID-19 or SARS, with positive rates of 60.2% (56/93) and 71.4% (5/7) respectively. The children with COVID-19 had a rate of severe disease of 4.6% (31/686) and a mortality rate of 0.1% (1/806), the children with SARS had a rate of severe disease of 1.5% (1/68) and a mortality rate of 0%, and those with MERS had a rate of severe disease of 14.3% (3/21) and a mortality rate of 9.5% (2/21). CONCLUSIONS Children with COVID-19 have similar symptoms to those with SARS or MERS, mainly fever and cough. Asymptomatic infection is observed in all three diseases. Children with COVID-19 or SARS have milder disease conditions than those with MERS. COVID-19 in children often occurs with familial aggregation. Epidemiological contact history, imaging examination findings, and viral nucleic acid testing results are important bases for the diagnosis of COVID-19.
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Affiliation(s)
- Yang He
- Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, China. )
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37
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Zare-Zardini H, Soltaninejad H, Ferdosian F, Hamidieh AA, Memarpoor-Yazdi M. Coronavirus Disease 2019 (COVID-19) in Children: Prevalence, Diagnosis, Clinical Symptoms, and Treatment. Int J Gen Med 2020; 13:477-482. [PMID: 32848446 PMCID: PMC7425102 DOI: 10.2147/ijgm.s262098] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
Abstract
In this article, we have reviewed the prevalence, diagnosis, symptoms, and treatment of COVID-19 in children. The incidence of COVID-19 among children under 18 years was 2.1% based on the reported studies, where the mortality rate in the same age group was 0.2%. No death has been reported in children under 9-years old. There are some articles that report children with COVID-19 having symptoms similar to Kawasaki's disease. In these cases, heart complications were observed. The best markers for diagnosing the severity of the disease in children are the levels of bilirubin and hepatic enzymes. Large number of angiotensin converting enzyme 2 (ACE2) receptors on cell surfaces, effective innate immune system, and high level of blood lymphocyte have been reported to be the potent reasons for lower incidence of severe symptoms of COVID-19 among children. Children can very well be the carriers of this virus. Children with severe COVID-19 clinical symptoms, especially those suffering from pneumonia, must be hospitalized similar to adults, while quarantine is required for those having mild symptoms. Antiviral medication (lopinavir, darunavir, favipiravir, remdesivir, ribavirin, oseltamivir, tocilizumab, and umifenovir), ACE inhibitors, interferon-α2b, co-therapy with azithromycin, inhaling iNO, and oxygen therapy can be used for treatment. For the treatment of children without any clinical and infection symptoms, home isolation protocol has been recommended.
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Affiliation(s)
- Hadi Zare-Zardini
- Department of Sciences, Farhangian University, Isfahan, Iran.,Hematology and Oncology Research Center, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Soltaninejad
- Stem Cell and Regenerative Medicine Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Ferdosian
- Department of Pediatrics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
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38
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Lingappan K, Karmouty-Quintana H, Davies J, Akkanti B, Harting MT. Understanding the age divide in COVID-19: why are children overwhelmingly spared? Am J Physiol Lung Cell Mol Physiol 2020; 319:L39-L44. [PMID: 32491949 PMCID: PMC7324935 DOI: 10.1152/ajplung.00183.2020] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
The rapid emergence and subsequent global dissemination of SARS-CoV-2 disease (COVID-19) has resulted in over 4 million cases worldwide. The disease has a marked predilection for adults, and children are relatively spared. Understanding the age-based differences in pathophysiological pathways and processes relevant to the onset and progression of disease both in the clinical course and in experimental disease models may hold the key to the identification of therapeutic targets. The differences in the clinical course are highlighted by the lack of progression of the SARS-CoV-2 infection beyond mild symptoms in a majority of children, whereas in adults the disease progresses to acute lung injury and an acute respiratory distress syndrome (ARDS)-like phenotype with high mortality. The pathophysiological mechanisms leading to decreased lung injury in children may involve the decreased expression of the mediators necessary for viral entry into the respiratory epithelium and differences in the immune system responses in children. Specifically, decreased expression of proteins, including angiotensin-converting enzyme 2 (ACE2) and Transmembrane Serine Protease 2 (TMPRSS2) in the airway epithelium in children may prevent viral entry. The immune system differences may include a relative preponderance of CD4+ T cells, decreased neutrophil infiltration, decreased production of proinflammatory cytokines, and increased production of immunomodulatory cytokines in children compared with adults. Notably, the developing lung in children may have a greater capacity to recover and repair after viral infection. Understanding the relative contributions of the above processes to the protective phenotype in the developing lung can guide the trial of the appropriate therapies in adults.
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Affiliation(s)
- K. Lingappan
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - H. Karmouty-Quintana
- Department of Biochemistry and Molecular Biology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - J. Davies
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - B. Akkanti
- Divisions of Pulmonary, Critical Care, Sleep Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - M. T. Harting
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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39
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Trippella G, Ciarcià M, Ferrari M, Buzzatti C, Maccora I, Azzari C, Dani C, Galli L, Chiappini E. COVID-19 in Pregnant Women and Neonates: A Systematic Review of the Literature with Quality Assessment of the Studies. Pathogens 2020; 9:E485. [PMID: 32570959 PMCID: PMC7350364 DOI: 10.3390/pathogens9060485] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
The SARS-CoV-2 virus emerged in December 2019 and then spread globally. Little is still known about the impact of COVID-19 on pregnant women and neonates. A review of the literature was performed according to the PRISMA guideline recommendations, searching the MEDLINE and EMBASE databases. Studies' quality assessments were performed using the JBI Critical Appraisal Checklist. A total of 37 studies were included, involving 275 pregnant women with COVID-19 and 248 neonates. The majority of pregnant women presented with mild to moderate symptoms, only 10 were admitted in the ICU, and one died. Two stillbirths were reported and the incidence of prematurity was 28%. Sixteen neonates were tested positive for SARS-CoV-2 by RT-PCR, and nine of them were born from mothers infected during pregnancy. Neonatal outcomes were generally good: all the affected neonates recovered. RT-PCR for SARS-CoV-2 yielded negative results on amniotic fluid, vaginal/cervical fluids, placenta tissue, and breast milk samples. SARS-CoV-2 infection in pregnant women appeared associated with mild or moderate disease in most cases, with a low morbidity and mortality rate. The outcomes of neonates born from infected women were mainly favorable, although neonates at risk should be closely monitored. Further studies are needed to investigate the possibility of vertical transmission.
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Affiliation(s)
- Giulia Trippella
- Post-Graduate School of Pediatrics, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (G.T.); (M.C.); (M.F.); (C.B.); (I.M.)
| | - Martina Ciarcià
- Post-Graduate School of Pediatrics, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (G.T.); (M.C.); (M.F.); (C.B.); (I.M.)
| | - Marta Ferrari
- Post-Graduate School of Pediatrics, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (G.T.); (M.C.); (M.F.); (C.B.); (I.M.)
| | - Chiara Buzzatti
- Post-Graduate School of Pediatrics, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (G.T.); (M.C.); (M.F.); (C.B.); (I.M.)
| | - Ilaria Maccora
- Post-Graduate School of Pediatrics, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Florence, Italy; (G.T.); (M.C.); (M.F.); (C.B.); (I.M.)
| | - Chiara Azzari
- Division of Pediatric Immunology, Department of Health Sciences, University of Florence and Meyer Children’s Hospital, 50100 Florence, Italy;
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, 50100 Florence, Italy;
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Florence, Italy;
| | - Elena Chiappini
- Division of Pediatric Infectious Disease, Anna Meyer Children’s University Hospital, Department of Health Sciences, University of Florence, 50100 Florence, Italy;
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