COVID-19 Publications

30

Jul, 2020

SARS-CoV-2 Infection in Febrile Neonates

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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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21

Jul, 2020

Co-infection and other clinical characteristics of COVID-19 in children

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Background and Objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly identified pathogen that mainly spreads by droplets. Most published studies have been focused on adult patients with coronavirus disease 2019 (COVID-19), but data concerning pediatric patients are limited. In this study, we aimed to determine epidemiological characteristics and clinical features of pediatric patients with COVID-19.

Methods We reviewed and analyzed data on pediatric patients with laboratory-confirmed COVID-19, including basic information, epidemiological history, clinical manifestations, laboratory and radiologic findings, treatment, outcome, and follow-up results.

Results A total of 74 pediatric patients with COVID-19 were included in this study. Of the 68 case patients whose epidemiological data were complete, 65 (65 of 68; 95.59%) were household contacts of adults. Cough (32.43%) and fever (27.03%) were the predominant symptoms of 44 (59.46%) symptomatic patients at onset of the illness. Abnormalities in leukocyte count were found in 23 (31.08%) children, and 10 (13.51%) children presented with abnormal lymphocyte count. Of the 34 (45.95%) patients who had nucleic acid testing results for common respiratory pathogens, 19 (51.35%) showed coinfection with other pathogens other than SARS-CoV-2. Ten (13.51%) children had real-time reverse transcription polymerase chain reaction analysis for fecal specimens, and 8 of them showed prolonged existence of SARS-CoV-2 RNA.

Conclusions Pediatric patients with COVID-19 presented with distinct epidemiological, clinical, and radiologic characteristics from adult patients. Nearly one-half of the infected children had coinfection with other common respiratory pathogens. It is not uncommon for pediatric patients to have prolonged fecal shedding of SARS-CoV-2 RNA during the convalescent phase.

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21

Jun, 2020

Clinical characteristics of acute respiratory syndrome with SARS-CoV-2 infection in children in South China

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Background A retrospective study was conducted to summarize the clinical information of childhood infections during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) epidemic.

Methods Children with SARS‐CoV‐2 infection in 11 hospitals from three provinces of South China were included in the study. Clinical information was collected and compared with children and adults infected by SARS‐CoV‐2 in Wuhan.

Results In total, 52 children were enrolled, including 28 boys. The median age was 9 years (interquartile range [IQR], 4‐12); 44.2% cases were of clustered occurrences, 40.4% patients had fever, 48.1% had cough, and 46.2% had a high lymphocyte count. No abnormalities were found in the liver and kidney function. Also, 82.7% of patients received antiviral therapy, but such therapy did not shorten the time to virus negativity or hospital stay (P = .082). The time to virus negativity was 12.0 days (IQR, 8.0‐16.8) and hospital stay was 14.5 days (IQR, 10.3‐17.9). Compared with reports in Wuhan, there were more acute upper respiratory tract infection (AURTI) and fewer pneumonia cases (P = .000). Compared with the non‐ICU adult COVID‐19 in Wuhan, these children’s diseases were relatively mild, with fewer complications.

Conclusions Children with SARS‐CoV‐2 infection had a mild fever, lymphocyte elevation was more common than reduction, and antiviral treatment had no obvious effect. The overall clinical manifestations were mild, and the prognosis was good.
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21

Jun, 2020

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

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Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic.

Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RTPCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission.

Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support.

Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed.

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7

Jun, 2020

Pediatric critical care and COVID19

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COVID-19, caused by SARS-CoV2, disproportionally affects adults (children <5% in most reports). Adult critical illness is characterized by acute hypoxemia, multi-organ failure, and high mortality. Reported risk factors for severe illness include age, cardiorespiratory comorbidities, obesity, and laboratory findings (lymphopenia and elevated D-dimer).

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7

Jun, 2020

Cardiac MRI of children with Multisystem Inflammatory Syndrome (MIS-C) associated with COVID-19: case series

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Abstract This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease-like features related to COVID-19. Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis/conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. SARS-CoV-2 RT-PCR was negative on nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2-STIR sequences and native-T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor post-infectious myocarditis in children and adolescents with COVID-19.

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7

Jun, 2020

Immune-related factors associated with Pneumonia in 127 children with Coronavirus Disease in 2019 in Wuhan

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Objective Information regarding the association of immune-related factors with pneumonia in children with coronavirus disease 2019 (COVID-19) is scarce. This study aims to summarize the immune-related factors and their association with pneumonia in children with COVID-19.

Methods Children with COVID-19 at Wuhan Children’s Hospital from 28 January to 12 March 2020 were enrolled. Pneumonia due to causes other than COVID-19 were excluded. The clinical and laboratory information including routine blood tests, blood biochemistry, lymphocyte subsets, immunoglobulins, cytokines, and inflammatory factors were analyzed retrospectively in 127 patients. Normal ranges and mean values of laboratory markers were applied as parameters for logistic regression analyses of their association with pneumonia.

Results In nonintensive care unit patients, 48.8% and 22.4% of patients had increased levels of procalcitonin and hypersensitive C-reactive protein (hs-CRP) respectively. A total 12.6% and 18.1% of patients had decreased levels of immunoglobulin A (IgA) and interleukin 10 (IL-10), respectively. Approximately 65.8% of patients had pneumonia. These patients had decreased levels of globulin (odds ratio [OR], 3.13; 95% confidence interval [CI] 1.41-6.93; P = .005), IgA (OR, 4.00; 95% CI, 1.13-14.18; P = .032), and increased levels of hs-CRP (OR, 3.14; 95% CI, 1.34-7.36; P = .008), procalcitonin (OR, 3.83; 95% CI, 2.03-7.24; P < .001), IL-10 (OR, 7.0; 95% CI, 1.59-30.80; P = .010), and CD4+ CD25+ T lymphocyte less than 5.0% (OR, 1.93; 95% CI, 1.04-3.61; P = 0.038).

Conclusion Decreased IgA and CD4+ CD25+ T lymphocyte percentage, and increased hs-CRP, procalcitonin, and IL-10 were associated with pneumonia, suggesting that the immune-related factors may participate in the pathogenesis of pneumonia in children with COVID-19.

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6

Jun, 2020

A case of an infant with SARS-CoV-2 hepatitis early after liver transplantation

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We present a case of a pediatric liver transplant recipient diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection four days after receiving a living donor liver allograft from her mother. The recipient was a 6-month-old with end-stage liver disease due to biliary atresia and failed Kasai. The infant had an uncomplicated implantation, excellent graft function and down-trending liver enzymes until developing fevers, diarrhea, and moderate respiratory distress requiring non-invasive respiratory support. SARS-CoV-2 testing (nasal swab Polymerase Chain Reaction) was positive on post-operative day (POD) 4. Liver enzymes peaked ~1000 U/L (5-fold higher than the previous day) on POD 6. Histology demonstrated a mixed picture of moderate acute hepatitis and classical elements of mild to moderate acute cellular rejection. Her hepatitis and respiratory symptoms improved coincident with completing treatment with hydroxychloroquine, reduced immunosuppression, and intravenous gamma globulin (IVIG).

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6

Jun, 2020

Infant with SARS-CoV-2 infection causing severe lung disease treated with Remdesivir

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We describe an ex-premature infant presenting with SARS-CoV-2 infection in the 5th week of life. Current reports indicate that acute symptomatic SARS-CoV-2 infection is relatively rare and much less severe than in adults. This case highlights that infection can be associated with life threatening pulmonary disease in young infants and that infection can follow a similar disease course to that described in adults. We provide first data on the use of the novel antiviral remdesivir in a young child and an innovative approach to expedited approval from a multidisciplinary clinical team and bioethics committee for compassionate access to the drug.

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6

Jun, 2020

A 3-month-old child with COVID-19: A case report.

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Introduction Coronavirus disease 2019 (COVID-19) is pandemic and is a medical issue. However, children account for a small portion of those with the disease, and there are few published reports of COVID-19 in children. The patient reported in this case report is the youngest case reported in Chengdu, China to date.

Patient concerns A 3-month-old male infant presented with cough and rhinorrhea.

Diagnosis Family members from Wuhan, the epicenter of the epidemic came to stay in the patient’s home 16 days before the onset of his disease, and his mother had been diagnosed with COVID-19. He was diagnosed with COVID-19 based on a history of exposure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), detected using reverse transcription polymerase chain reaction (RT-PCR).

Interventions The patient was admitted to hospital and treated symptomatically with oral medication.

Outcomes The patient recovered completely and was discharged after one month of hospitalization. He tested negative for SARS-CoV-2 using RT-PCR and a chest CT performed 4 weeks after admission showed marked improvement prior to discharge.

Conclusion Clinicians must be aware of the presentation of COVID-19 in children because it differs from that in adults.

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