+++ Pediatrics +++
* * * Next update: 24 November. In the meantime, find the global updates at 7 Days. * * *
Stonoga ETS, Lanzoni LA, Rebutini PZ, Olveira ALP, Chiste JA, Fugaça CA, et al. Intrauterine transmission of SARS-CoV-2. Emerg Infect Dis. 2021 February. Full-text: https://doi.org/10.3201/eid2702.203824
A case of fetal death associated with intrauterine transmission of SARS-CoV-2 in a 42 yr old woman at 27 weeks’ gestation. Placenta and fetal tissue showed chronic histiocytic intervillositis, maternal and fetal vascular malperfusion, microglial hyperplasia, and lymphocytic infiltrates. Placenta and umbilical cord blood tested positive for the virus by PCR, confirming transplacental transmission.
Gale C, Quigley MA, Placzek A, et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. Lancet November 09, 2020. Full-text: https://doi.org/10.1016/S2352-4642(20)30342-4
A prospective UK population-based cohort study of 66 babies with confirmed SARS-CoV-2 infection in the first 28 days of life who received in-patient care between March and April. Of these, 28 (42%) had severe neonatal SARS-CoV-2 infection and 16 (24%) were born preterm. Only half were of white ethnic groups. Of 17 (26%) babies with confirmed infection who were born to mothers with known perinatal SARS-CoV-2 infection, only two (3%) were considered to have possible vertically acquired infection. As of July 28, 2020, 58 (88%) babies had been discharged home, seven (11%) were still in hospital, and one (2%) had died of a cause unrelated to SARS-CoV-2 infection.
Hurst JH, Heston SM, Chambers HN, et al. SARS-CoV-2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study. Clin Infect Dis 2020, published 3 November. Full-text: https://doi.org/10.1093/cid/ciaa1693
Children ages 6-13 years are frequently asymptomatic (39%) and have respiratory symptoms less often than younger children (29% vs. 48%) or adolescents (29% vs. 60%). However, Matthew Kelly, Jillian Hurst and colleagues found no differences in nasopharyngeal viral load by age or between symptomatic and asymptomatic children.
|6-13 years||14-20 years|
|Disease duration||4 (IQR 3,8)||7 (4,12)|
Martinez OM, Bridges ND, Goldmunth E, et al. The immune roadmap for understanding multi-system inflammatory syndrome in children: opportunities and challenges. Nat Med (2020). Full-text: https://doi.org/10.1038/s41591-020-1140-9
In June 2020, immunologists and clinicians met to identify key questions surrounding the ‘multi-system inflammatory syndrome in children’ (MIS-C). This Meeting Report describes the main findings from the workshop. Read about B cell immunity, T cell immunity, innate immunity, genetics and epigenetics.
Belhadjer Z, Auriau J, Méot M, et al. Addition of Corticosteroids to Immune Globulins is Associated with Recovery of Cardiac Function in Multi-inflammatory Syndrome in Children (MIS-C). Circulation, 28 October 2020. Full-text: https://doi.org/10.1161/CIRCULATIONAHA.120.050147
Steroids may help in MIS-C: 18 patients admitted before 1 May received immune globulins (IVIG 2g/Kg once) as first line treatment, and the 22 patients admitted after this date received a combination of IVIG and intravenous methylprednisolone (0.8mg/kg/day during 5 days). These two populations had similar clinical, cardiac and biological characteristics at baseline. The main finding was the reduction of time to recovery of left ventricle ejection fraction (LVEF) and isovolumic relaxation time (IVRT), as well as pediatric intensive care unit (PICU) stay in the group receiving a combination of IVIG and steroids compared to the group receiving only IVIG: respectively 2.9 vs. 5.4 days, 6.4 vs. 20.6 days, and 3.4 vs. 5.3 days (p<0.05).
Hippich M, Holthaus L, Assfalg R, et al. Public health antibody screening indicates a six-fold higher SARS-CoV-2 exposure rate than reported cases in children. Med 2020, published 28 October. Full-text: https://doi.org/10.1016/j.medj.2020.10.003a
In Bavaria, Germany, antibody surveillance in children during 2020 showed frequencies of 0.08% in January to March, 0.61% in April, 0.74% in May, 1.13% in June and 0.91% in July. Antibody prevalence from April 2020 was six-fold higher than the incidence of authority-reported cases (156 per 100,000 children) and was not associated with age or sex. Another important finding: the authors found no association between SARS-Cov-2 antibodies and type 1 diabetes autoimmunity.
Von Kohorn I, Stein SR, Shikani BT, et al. In utero SARS-CoV-2 Infection. J Pediatric Inf Dis Society, October 22, piaa127. Full-text: https://doi.org/10.1093/jpids/piaa127
This infant most likely acquired SARS-CoV-2 hematogenously from mother at or prior to delivery. All caregivers were aware of the mother’s COVID-19 diagnosis prior to delivery. According to the authors, it is extremely unlikely that the infant could have acquired infection from the mother via the respiratory route with the brief and distant exposure in the delivery room. However, SARS-CoV-2 RNA was not found in placental tissue.
Feldstein LR, Rose EB, Horwitz SM. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med 2020; 383:334-346. Full-text: https://doi.org/10.1056/NEJMoa2021680
SARS-CoV-2-associated multisystem inflammatory syndrome in children (MIS-C) is a life-threatening illness even in previously healthy children and adolescents. This is the result of a study presented by Manish M. Patel, Leora Feldstein and colleagues reporting on 186 children in pediatric health centers across the US. The median age was 8.3 years, and organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). A total of 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died.
Dumitriu D, Emeruwa UN, Hanft E, et al. Outcomes of Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection at a Large Medical Center in New York City. JAMA Pediatr. Published online October 12, 2020. Full-text: https://doi.org/10.1001/jamapediatrics.2020.4298
Of 101 neonates born to mothers with perinatal SARS-CoV-2 infections at a single institution, 2 (2.0%) had positive test results for SARS-CoV-2, but none had clinical evidence of COVID-19, despite most infants rooming-in with mothers and direct breastfeeding. This study endorses the benefits of rooming-in, establishing breastfeeding, and delaying bathing on newborn outcomes and suggests that separating mothers positive for SARS-CoV-2 and their newborns and avoiding direct breastfeeding may not be warranted to prevent SARS-CoV-2 transmission.