#Effect of the #COVID19 pandemic response on intrapartum care, #stillbirth, and #neonatal #mortality #outcomes in #Nepal: a prospective observational study (Lancet Glob Health, abstract)

[Source: Lancet Global Health, full page: (LINK). Abstract, edited.]

Effect of the COVID-19 pandemic response on intrapartum care, stillbirth, and neonatal mortality outcomes in Nepal: a prospective observational study

Ashish KC, PhD  *, Rejina Gurung, MSc *, Mary V Kinney, MSc, Avinash K Sunny, MD, Md Moinuddin, PhD, Omkar Basnet, BSc, Prajwal Paudel, MD, Pratiksha Bhattarai, MA, Kalpana Subedi, MD, Mahendra Prasad Shrestha, MPH, Joy E Lawn, FMedSci †, Mats Målqvist, PhD †

Open Access | Published: August 10, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30345-4

 

Summary

Background

The COVID-19 pandemic response is affecting maternal and neonatal health services all over the world. We aimed to assess the number of institutional births, their outcomes (institutional stillbirth and neonatal mortality rate), and quality of intrapartum care before and during the national COVID-19 lockdown in Nepal.

Methods

In this prospective observational study, we collected participant-level data for pregnant women enrolled in the SUSTAIN and REFINE studies between Jan 1 and May 30, 2020, from nine hospitals in Nepal. This period included 12·5 weeks before the national lockdown and 9·5 weeks during the lockdown. Women were eligible for inclusion if they had a gestational age of 22 weeks or more, a fetal heart sound at time of admission, and consented to inclusion. Women who had multiple births and their babies were excluded. We collected information on demographic and obstetric characteristics via extraction from case notes and health worker performance via direct observation by independent clinical researchers. We used regression analyses to assess changes in the number of institutional births, quality of care, and mortality before lockdown versus during lockdown.

Findings

Of 22 907 eligible women, 21 763 women were enrolled and 20 354 gave birth, and health worker performance was recorded for 10 543 births. From the beginning to the end of the study period, the mean weekly number of births decreased from 1261·1 births (SE 66·1) before lockdown to 651·4 births (49·9) during lockdown—a reduction of 52·4%. The institutional stillbirth rate increased from 14 per 1000 total births before lockdown to 21 per 1000 total births during lockdown (p=0·0002), and institutional neonatal mortality increased from 13 per 1000 livebirths to 40 per 1000 livebirths (p=0·0022). In terms of quality of care, intrapartum fetal heart rate monitoring decreased by 13·4% (−15·4 to −11·3; p<0·0001), and breastfeeding within 1 h of birth decreased by 3·5% (−4·6 to −2·6; p=0·0032). The immediate newborn care practice of placing the baby skin-to-skin with their mother increased by 13·2% (12·1 to 14·5; p<0·0001), and health workers’ hand hygiene practices during childbirth increased by 12·9% (11·8 to 13·9) during lockdown (p<0·0001).

Interpretation

Institutional childbirth reduced by more than half during lockdown, with increases in institutional stillbirth rate and neonatal mortality, and decreases in quality of care. Some behaviours improved, notably hand hygiene and keeping the baby skin-to-skin with their mother. An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period.

Funding

Grand Challenges Canada.

Keywords: SARS-CoV-2; COVID-19; Pediatrics; Pregnancy; Gynaecology; Nepal.

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Multisystem #inflammatory #syndrome associated with #COVID19 in #children in #Pakistan (Lancet Child Adolesc Health, summary)

[Source: Lancet Child and Adolescent Health, full page: (LINK). Summary, edited.]

Multisystem inflammatory syndrome associated with COVID-19 in children in Pakistan

Masood Sadiq, Omeir Ali Aziz, Uzma Kazmi, Najam Hyder, Muhammad Sarwar, Nighat Sultana et al.

Published: August 10, 2020 | DOI: https://doi.org/10.1016/S2352-4642(20)30256-X

___

The knowledge of COVID-19 is evolving with new aspects of the disease continuing to  emerge. Children and adolescents younger than 20 years of age constitute 10·6% (24 625  of 231 818) of the total reported confirmed cases of COVID-19 in Pakistan as of July 8,  2020, with a mortality of 0·3% for those aged 10 years or younger and 0·5% for those  aged 11–20 years. Multisystem inflammatory syndrome in children (MIS-C), also known  as paediatric inflammatory multisystem syndrome temporally associated with severe  acute respiratory syndrome coronavirus 2 (PIMS-TS) is being reported primarily from  Europe and the USA. Many of these children meet the criteria for complete or incomplete  Kawasaki disease, but different clinical presentations of this inflammatory  disorder are being reported.  The ethnic origin of reported cases show that Black, Hispanic, and Asian children might be disproportionally affected.  Similarly, unlike  Kawasaki disease, these cases have occurred in older children and adolescents.  We  report our initial experience from The Children’s Hospital Lahore, Pakistan—the first  report of this new inflammatory syndrome from south Asia.

(…)

Keywords: SARS-CoV-2; COVID-19; Multisystem Inflammatory Syndrome; Pediatrics.

——

#Intussusception in two #children with #SARS-CoV-2 infection in children (J Pediatr Infect Dis Soc., abstract)

[Source: Journal of the Pediatrics Infectious Diseases Society, full page: (LINK). Abstract, edited.]

Intussusception in two children with SARS-CoV-2 infection in children

Heidi Makrinioti, MD, PhD, Alexander Mac Donald, MBChB, X Lu, MD, S Wallace, MBChB, Jobson Mathew, MBChB, F Zhang, MD, J Shao, MD, J Bretherton, MBChB, Mehmood Tariq, MBChB, E Eyre, MBChB, A Wong, MBChB, L Pakkiri, MBChB, Amulya K Saxena, MD, G W Wong, MD

Journal of the Pediatric Infectious Diseases Society, piaa096,  https://doi.org/10.1093/jpids/piaa096

Published: 08 August 2020

 

Abstract

This report compares intussusception as likely associated with SARS-CoV-2 infection in infants that presented in Wuhan and London. While the intussusception was reduced by enemas in Wuhan, the outcome was fatal. Whereas the intussusception was not reduced by enemas in London and required surgery, the outcome was favourable.

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; Gastroenterology; Pediatrics.

—–

#Clinical and #epidemiological #features of 46 #children under 1 year old with #coronavirus disease 2019 (#COVID19) in #Wuhan, #China: a descriptive study (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Clinical and epidemiological features of 46 children under 1 year old with coronavirus disease 2019 (COVID-19) in Wuhan, China: a descriptive study

Xinghua Liu, Rong Xie, Wei Li, Yan Guo, Bo Zhang, Yue Zhang, Juanjuan Wang, Cao Peng, Xiao Lei, Qunying Luo, Qiong Zhang, Jianqiao Tang, Yunqiao Li, Jianying Chen

The Journal of Infectious Diseases, jiaa472, https://doi.org/10.1093/infdis/jiaa472

Published: 06 August 2020

 

Abstract

The number of COVID-19 cases has exceeded 10 million. However, little is known about the epidemiology and clinical characteristics of COVID-19 infants. We collected medical information of 46 confirmed patients (0-1 year old) and retrospectively analyzed epidemiological history, clinical symptoms, and laboratory test results. The median age is 5 (IQR, 2-7) months. Sixteen cases had fever and 27 cases had cough. Moderate disease was present in 40 cases and cardiac injury occurred in 38 cases, following by liver dysfunction in 20 cases and lymphocytosis in no cases. Of all infant patients, two received invasive mechanical ventilation and one died with MODS.

children, clinical features, SARS-CoV-2, outcome

Topic:  heart injuries – epidemiology – cough – fever – child – china – infant – lymphocytosis – signs and symptoms – mechanical ventilation – liver dysfunction – laboratory test  finding – sars-cov-2 – covid-19

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; Pediatrics; China.

——

#COVID19–Associated Multisystem #Inflammatory #Syndrome in #Children — #USA, March–July 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020

Early Release / August 7, 2020 / 69

Shana Godfred-Cato, DO1; Bobbi Bryant, MPH1,2; Jessica Leung, MPH1; Matthew E. Oster, MD1; Laura Conklin, MD1; Joseph Abrams, PhD1; Katherine Roguski, MPH1; Bailey Wallace, MPH1,2; Emily Prezzato, MPH1; Emilia H. Koumans, MD1; Ellen H. Lee, MD3; Anita Geevarughese, MD3; Maura K. Lash, MPH3; Kathleen H. Reilly, PhD3; Wendy P. Pulver, MS4; Deepam Thomas, MPH5; Kenneth A. Feder, PhD6; Katherine K. Hsu, MD7; Nottasorn Plipat, MD, PhD8; Gillian Richardson, MPH9; Heather Reid10; Sarah Lim, MBBCh11; Ann Schmitz, DVM12,13; Timmy Pierce, MPH1,2; Susan Hrapcak, MD1; Deblina Datta, MD1; Sapna Bamrah Morris, MD1; Kevin Clarke, MD1; Ermias Belay, MD1; California MIS-C Response Team

Corresponding author: Shana Godfred-Cato, nzt6@cdc.gov.

1CDC COVID-19 Response Team; 2Oak Ridge Institute for Science and Education; 3New York City Department of Health and Mental Hygiene; 4New York State Department of Health; 5New Jersey Department of Health; 6Epidemic Intelligence Service, Prevention and Health Promotion Administration, Maryland Department of Health; 7Massachusetts Department of Public Health; 8Pennsylvania Department of Health; 9Louisiana Department of Health; 10Illinois Department of Public Health; 11Minnesota Department of Health; 12Florida Department of Health; 13Career Epidemiology Field Officer Program, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Suggested citation for this article: Godfred-Cato S, Bryant B, Leung J, et al. COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020. MMWR Morb Mortal Wkly Rep. ePub: 7 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e2

 

Summary

  • What is already known about this topic?
    • Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe condition that has been reported approximately 2–4 weeks after the onset of COVID-19 in children and adolescents.
  • What is added by this report?
    • Most cases of MIS-C have features of shock, with cardiac involvement, gastrointestinal symptoms, and significantly elevated markers of inflammation, with positive laboratory test results for SARS-CoV-2. Of the 565 patients who underwent SARS-CoV-2 testing, all had a positive test result by RT-PCR or serology.
  • What are the implications for public health practice?
    • Distinguishing MIS-C from other severe infectious or inflammatory conditions poses a challenge to clinicians caring for children and adolescents. As the COVID-19 pandemic continues to expand in many jurisdictions, health care provider awareness of MIS-C will facilitate early recognition, early diagnosis, and prompt treatment.

 

Abstract

In April 2020, during the peak of the coronavirus disease 2019 (COVID-19) pandemic in Europe, a cluster of children with hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome was reported in England* (1). The patients’ signs and symptoms were temporally associated with COVID-19 but presumed to have developed 2–4 weeks after acute COVID-19; all children had serologic evidence of infection with SARS-CoV-2, the virus that causes COVID-19 (1). The clinical signs and symptoms present in this first cluster included fever, rash, conjunctivitis, peripheral edema, gastrointestinal symptoms, shock, and elevated markers of inflammation and cardiac damage (1). On May 14, 2020, CDC published an online Health Advisory that summarized the manifestations of reported multisystem inflammatory syndrome in children (MIS-C), outlined a case definition,† and asked clinicians to report suspected U.S. cases to local and state health departments. As of July 29, a total of 570 U.S. MIS-C patients who met the case definition had been reported to CDC. A total of 203 (35.6%) of the patients had a clinical course consistent with previously published MIS-C reports, characterized predominantly by shock, cardiac dysfunction, abdominal pain, and markedly elevated inflammatory markers, and almost all had positive SARS-CoV-2 test results. The remaining 367 (64.4%) of MIS-C patients had manifestations that appeared to overlap with acute COVID-19 (2–4), had a less severe clinical course, or had features of Kawasaki disease.§ Median duration of hospitalization was 6 days; 364 patients (63.9%) required care in an intensive care unit (ICU), and 10 patients (1.8%) died. As the COVID-19 pandemic continues to expand in many jurisdictions, clinicians should be aware of the signs and symptoms of MIS-C and report suspected cases to their state or local health departments; analysis of reported cases can enhance understanding of MIS-C and improve characterization of the illness for early detection and treatment.

(…)

Keywords: SARS-CoV-2; COVID-19; Multisystem Inflammatory Syndrome; Pediatrics; USA.

——-

#Hospitalization #Rates and #Characteristics of #Children Aged <18 Years Hospitalized with Laboratory-Confirmed #COVID19 — COVID-NET, 14 States, March 1–July 25, 2020 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020

Early Release / August 7, 2020 / 69

Lindsay Kim, MD1,2; Michael Whitaker, MPH1,3; Alissa O’Halloran, MSPH1; Anita Kambhampati, MPH1,4; Shua J. Chai, MD1,5; Arthur Reingold, MD5,6; Isaac Armistead, MD7; Breanna Kawasaki, MPH8; James Meek, MPH9; Kimberly Yousey-Hindes, MPH9; Evan J. Anderson, MD10,11; Kyle P. Openo, DrPH11; Andy Weigel, MSW12; Patricia Ryan, MSc13; Maya L. Monroe, MPH13; Kimberly Fox, MPH14; Sue Kim, MPH14; Ruth Lynfield, MD15; Erica Bye, MPH15; Sarah Shrum Davis, MPH16; Chad Smelser, MD17; Grant Barney, MPH18; Nancy L. Spina, MPH18; Nancy M. Bennett, MD19; Christina B. Felsen, MPH19; Laurie M. Billing, MPH20; Jessica Shiltz, MPH20; Melissa Sutton, MD21; Nicole West, MPH21; H. Keipp Talbot, MD22; William Schaffner, MD22; Ilene Risk, MPA23; Andrea Price23; Lynnette Brammer, MPH1; Alicia M. Fry, MD1,2; Aron J. Hall, DVM1; Gayle E. Langley, MD1; Shikha Garg, MD1,2; COVID-NET Surveillance Team

Corresponding author: Lindsay Kim; LKim@cdc.gov.

1CDC COVID-NET Team; 2US Public Health Service, Rockville, Maryland; 3Eagle Global Scientific, Atlanta, Georgia; 4Cherokee Nation Assurance, Arlington, Virginia; 5California Emerging Infections Program, Oakland, California; 6School of Public Health, University of California, Berkeley, Berkeley, California; 7University of Colorado Anschutz Medical Campus, Aurora, Colorado; 8Colorado Department of Public Health & Environment, Denver, Colorado; 9Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut; 10Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, Georgia; 11Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia; 12Iowa Department of Public Health, Des Moines, Iowa; 13Maryland Department of Health, Baltimore, Maryland; 14Michigan Department of Health and Human Services, Lansing, Michigan; 15Minnesota Department of Health, St. Paul, Minnesota; 16New Mexico Emerging Infections Program, Albuquerque, New Mexico; 17New Mexico Department of Health, Santa Fe, New Mexico; 18New York State Department of Health, Albany, New York; 19University of Rochester School of Medicine and Dentistry, Rochester, New York; 20Ohio Department of Health, Columbus, Ohio; 21Public Health Division, Oregon Health Authority, Portland, Oregon; 22Vanderbilt University Medical Center, Nashville, Tennessee; 23Salt Lake County Health Department, Salt Lake City, Utah.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Evan Anderson reports personal fees from AbbVie, Pfizer and Sanofi Pasteur, and grants from MedImmune, Regeneron, PaxVax, Pfizer, GSK, Merck, Novavax, Sanofi Pasteur, Micron, and Janssen, outside the submitted work. William Schaffner reports personal fees from Pfizer and VBI Vaccines outside the submitted work. No other potential conflicts of interest were disclosed.

Suggested citation for this article: Kim L, Whitaker M, O’Halloran A, et al. Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States, March 1–July 25, 2020. MMWR Morb Mortal Wkly Rep. ePub: 7 August 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e3

 

Summary

  • What is already known about this topic?
    • Most reported SARS-CoV-2 infections in children aged <18 years are asymptomatic or mild. Less is known about severe COVID-19 in children requiring hospitalization.
  • What is added by this report?
    • Analysis of pediatric COVID-19 hospitalization data from 14 states found that although the cumulative rate of COVID-19–associated hospitalization among children (8.0 per 100,000 population) is low compared with that in adults (164.5), one in three hospitalized children was admitted to an intensive care unit.
  • What are the implications for public health practice?
    • Children are at risk for severe COVID-19. Public health authorities and clinicians should continue to track pediatric SARS-CoV-2 infections. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.

 

Abstract

Most reported cases of coronavirus disease 2019 (COVID-19) in children aged <18 years appear to be asymptomatic or mild (1). Less is known about severe COVID-19 illness requiring hospitalization in children. During March 1–July 25, 2020, 576 pediatric COVID-19 cases were reported to the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system that collects data on laboratory-confirmed COVID-19–associated hospitalizations in 14 states (2,3). Based on these data, the cumulative COVID-19-associated hospitalization rate among children aged <18 years during March 1–July 25, 2020, was 8.0 per 100,000 population, with the highest rate among children aged <2 years (24.8). During March 21–July 25, weekly hospitalization rates steadily increased among children (from 0.1 to 0.4 per 100,000, with a weekly high of 0.7 per 100,000). Overall, Hispanic or Latino (Hispanic) and non-Hispanic black (black) children had higher cumulative rates of COVID-19–associated hospitalizations (16.4 and 10.5 per 100,000, respectively) than did non-Hispanic white (white) children (2.1). Among 208 (36.1%) hospitalized children with complete medical chart reviews, 69 (33.2%) were admitted to an intensive care unit (ICU); 12 of 207 (5.8%) required invasive mechanical ventilation, and one patient died during hospitalization. Although the cumulative rate of pediatric COVID-19–associated hospitalization remains low (8.0 per 100,000 population) compared with that among adults (164.5),* weekly rates increased during the surveillance period, and one in three hospitalized children were admitted to the ICU, similar to the proportion among adults. Continued tracking of SARS-CoV-2 infections among children is important to characterize morbidity and mortality. Reinforcement of prevention efforts is essential in congregate settings that serve children, including childcare centers and schools.

(…)

Keywords: SARS-CoV-2; COVID-19; Pediatrics; USA.

—–

#Transmission #dynamics of #SARS‐CoV‐2 within #families with #children in #Greece: a study of 23 #clusters (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Transmission dynamics of SARS‐CoV‐2 within families with children in Greece: a study of 23 clusters

Helena C. Maltezou,  Rengina Vorou,  Kalliopi Papadima, Athanasios Kossyvakis, Nikolaos Spanakis,  Georgia Gioula,  Maria Exindari,  Symeon Metallidis,  Athanasia N. Lourida, Vasilios Raftopoulos,  Elisavet Froukala,  Beatriz Martinez‐Gonzalez,  Athanasios Mitsianis,  Emmanuel Roilides,  Andreas Mentis,  Athanasios Tsakris,  Anna Papa

First published: 07 August 2020 | DOI:  https://doi.org/10.1002/jmv.26394

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26394

 

Abstract

Background

There is limited information on SARS‐CoV‐2 infection clustering within families with children. We aimed to study the transmission dynamics of SARS‐CoV‐2 within families with children in Greece.

Methods

We studied 23 family clusters of COVID‐19. Infection was diagnosed by RT‐PCR in respiratory specimens. The level of viral load was categorized as high, moderate, or low based on the cycle threshold values.

Results

There were 109 household members (66 adults and 43 children). The median attack rate per cluster was 60% (range: 33.4%‐100%). An adult member with COVID‐19 was the first case in 21 (91.3%) clusters. Transmission of infection occurred from an adult to a child in 19 clusters and/or from an adult to another adult in 12 clusters. There was no evidence of child‐to‐adult or child‐to‐child transmission. In total 68 household members (62.4%) tested positive. Children were more likely to have an asymptomatic SARS‐CoV‐2 infection compared to adults (40% versus 10.5%, p‐value=0.021). In contrast, adults were more likely to develop a severe clinical course compared to children (8.8% versus 0%, p‐value=0.021). In addition, infected children were significantly more likely to have a low viral load while adults were more likely to have a moderate viral load (40.7% and 18.5% versus 13.8% and 51.7%, respectively; p‐value=0.016).

Conclusions

While children become infected by SARS‐CoV‐2, they do not appear to transmit infection to others. Furthermore, children more frequently have an asymptomatic or mild course compared to adults. Further studies are needed to elucidate the role of viral load on these findings.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Cluster of cases; Pediatrics; Greece.

——

#Report of #death in #children with #SARS‐CoV‐2 and Human #metapneumovirus (hMPV) co‐infection: is hMPV the trigger? (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Report of death in children with SARS‐CoV‐2 and Human metapneumovirus (hMPV) co‐infection: is hMPV the trigger?

Seyed Ahmad Hashemi MD,  Saghar Safamanesh MSc,  Hamed Ghasem Zadeh‐Moghaddam Ph.D.,  Majid Ghafouri MD,  Mina Sadat Mohajer Zadeh‐Heydari MD,  Hasan Namdar Ahmad Abad Ph.D.,  Azimian Amir PhD

First published: 07 August 2020 | DOI:  https://doi.org/10.1002/jmv.26401

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26401

 

Abstract

In the last month of 2019, a new virus called SARS‐CoV‐2 was discovered in Wuhan, China. This virus causes a wide range of symptoms, and respiratory tract illness is the most common disorder. To investigate the presence of other respiratory viruses, we performed a panel of virus detection through PCR and RT‐PCR tests to detect influenza virus, parainfluenza virus, Human metapneumovirus, Human bocavirus, adenovirus, and respiratory syncytial virus on nasopharyngeal swabs of all 74 SARS‐CoV‐2 positive dead patients. Here we report an interesting finding of the co‐infection of SARS‐CoV‐2 and Human metapneumovirus (hMPV) in three deceased children in North Khorasan Province, Iran.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Metapneumovirus; Pediatrics; Iran.

——

Multimodality #cardiac #evaluation in #children and young #adults with multisystem #inflammation associated with #COVID19 (Eur Heart J Cardiovasc Imaging, abstract)

[Source: European Heart Journal Cardiovascular Imaging, full page: (LINK). Abstract, edited.]

Multimodality cardiac evaluation in children and young adults with multisystem inflammation associated with COVID-19

Paraskevi Theocharis, James Wong, Kuberan Pushparajah, Sujeev K Mathur, John M Simpson, Emma Pascall, Aoife Cleary, Kirsty Stewart, Kaitav Adhvaryu, Alex Savis, Saleha R Kabir, Mirasol Pernia Uy, Hannah Heard, Kelly Peacock, Owen Miller

European Heart Journal – Cardiovascular Imaging, jeaa212,  https://doi.org/10.1093/ehjci/jeaa212

Published:  07 August 2020

 

Abstract

Aims

Following the peak of the UK COVID-19 epidemic, a new multisystem inflammatory condition with significant cardiovascular effects emerged in young people. We utilized multimodality imaging to provide a detailed sequential description of the cardiac involvement.

Methods and Results

Twenty consecutive patients (mean age 10.6 ± 3.8 years) presenting to our institution underwent serial echocardiographic evaluation on admission (median day 5 of illness), the day coinciding with worst cardiac function (median day 7), and the day of discharge (median day 15). We performed cardiac computed tomography (CT) to assess coronary anatomy (median day 15) and cardiac magnetic resonance imaging (CMR) to assess dysfunction (median day 20). On admission, almost all patients displayed abnormal strain and tissue Doppler indices. Three-dimensional (3D) echocardiographic ejection fraction (EF) was <55% in half of the patients. Valvular regurgitation (75%) and small pericardial effusions (10%) were detected. Serial echocardiography demonstrated that the mean 3D EF deteriorated (54.7 ± 8.3% vs. 46.4 ± 8.6%, P = 0.017) before improving at discharge (P = 0.008). Left main coronary artery (LMCA) dimensions were significantly larger at discharge than at admission (Z score –0.11 ± 0.87 vs. 0.78 ± 1.23, P = 0.007). CT showed uniform coronary artery dilatation commonly affecting the LMCA (9/12). CMR detected abnormal strain in all patients with global dysfunction (EF <55%) in 35%, myocardial oedema in 50%, and subendocardial infarct in 5% (1/20) patients.

Conclusions

Pancarditis with cardiac dysfunction is common and associated with myocardial oedema. Patients require close monitoring due to coronary artery dilatation and the risk of thrombotic myocardial infarction.

Hyper-inflammatory syndrome, Kawasaki, PIMS-TS, MIS-C, COVID-19, SARS-CoV-2

Issue Section: Original Paper

Keywords: SARS-CoV-2; COVID-19; Multisystem Inflammatory Syndrome; Cardiology; Pediatrics.

——

A systematic review and meta‐analysis of #children with #Coronavirus Disease 2019 (#COVID19) (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

A systematic review and meta‐analysis of children with Coronavirus Disease 2019 (COVID‐19)

Xiaojian Cui,  Zhihu Zhao,  Tongqiang Zhang,  Wei Guo,  Wenwei Guo,  Jiafeng Zheng, Jiayi Zhang,  Cuicui Dong,  Ren Na,  Lisheng Zheng,  Wenliang Li,  Zihui Liu,  Jia Ma, Jinhu Wang,  Sijia He,  Yongsheng Xu,  Ping Si,  Yongming Shen,  Chunquan Cai

First published: 06 August 2020 | DOI:  https://doi.org/10.1002/jmv.26398

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26398

 

Abstract

Objective

To provide a comprehensive and systematic analysis of demographic characteristics, clinical symptoms, laboratory findings and imaging features of coronavirus disease 2019 (COVID‐19) in pediatric patients.

Methods

A meta‐analysis was carried out to identify studies on COVID‐19 from December 25, 2019 to April 30, 2020.

Results

A total of 48 studies with 5829 pediatric patients were included. Children at all ages were at risk for COVID‐19. The main illness classification ranged as: 20% (95% CI: 14 to 26%, I2=91.4%) asymptomatic, 33% (95% CI: 23 to 43%, I2=95.6%) mild and 51% (95% CI: 42 to 61%, I2=93.4%) moderate. The typical clinical manifestations were fever 51% (95% CI: 45 to 57%, I2=78.9%) and cough 41% (95% CI: 35 to 47%, I2=81.0%). The common laboratory findings were normal white blood cell 69% (95% CI: 64 to 75%, I2=58.5%), lymphopenia 16% (95% CI: 11 to 21%, I2=76.9%) and elevated creatine‐kinase MB (CK‐MB) 37% (95% CI: 25 to 48%, I2=59.0%). The frequent imaging features were normal images 41% (95% CI: 30 to 52%, I2=93.4%) and ground‐glass opacity 36% (95% CI: 25 to 47%, I2=92.9%). Among children under 1‐year old, critical cases account for 14% (95% CI: 13 to 34%, I2=37.3%) that should be of concern. In addition, vomiting occurred in 33% (95% CI: 18 to 67%, I2=0.0%) cases that may also need attention.

Conclusions

Pediatric patients with COVID‐19 may experience milder illness with atypical clinical manifestations and rare lymphopenia. High incidence of critical illness and vomiting symptoms reward attention in children under 1‐year old.

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Keywords: SARS-CoV-2; COVID-19; Pediatrics.

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