Corona Virus Disease 2019, a growing threat for children?

by Bhushan

Posted on March 13, 2020 at 12:00 AM

The first infected-child case was identified in Wuhan, the initial location of the COVID-19 outbreak, on January 28, 2020, eight days later than the first infected-child case recorded in Shenzhen, 1000 kilometers away from Wuhan. It does not mean, however, that children in Wuhan did not suffer from COVID-19 during the outbreak time, nor did the signs of infection appear later than the other regions. The potential reasons for children's delayed diagnosis in Wuhan are the unnecessarily stringent screening standards and the early stage lack of research reagent. The number of children subsequently confirmed has risen significantly as the testing criteria relaxed and nucleic ac released

The treatment of infected children is slightly milder compared with infected adults, with quicker healing, reduced time for virus shedding and improved prognosis. By far, only 2 important cases, one of which was a 7-month-old infant with congenital heart failure, were identified. The other patient was 13 months old and had bilateral hydronephrosis and left kidney calculus. Both cases progressed quickly to respiratory collapse after initiation and needed intrusive mechanical ventilation assistance.

This indicates that children with chronic disabilities continue to advance to serious and crucial situations, and we can pay careful attention to these communities and strengthen monitoring. The blood cell count and procalcitonin (PCT) were relatively normal in the laboratory studies portion, the normal or slightly elevated C-reactive protein (CRP). Many cases require proof with two or even three checks. This indicates that while a positive viral nucleic acid test is the "gold standard," the possible cause of infection is still therapeutic "false negative" babies. In suspicious clinical cases, a continuous and regular collection of samples is needed to boost accuracy

Another important question that we are facing is how antiviral treatment can be handled. No effective anti-SARS-CoV-2 treatment has been verified successfully in clinical practice so far. Interferons (IFN), Lopinavir / Ritonavir, Arbidol, and even Oseltamivir were approved for clinical trials after the outbreak of SARS-CoV-2. IFN has been shown to have no effect on a number of respiratory viral infections, the largest being influenza or HIV infection

Remdesivir is successful in some adult cases6 but the proof-based clinical data for children is still missing. Because most children with respiratory virus infection have only minor effects and can be self-healed, we are of the view that antiviral medications need not be regularly used, unless they are in serious situations. Treatment goals would be to relieve complications and restore the equilibrium between immune systems.

The COVID-19 disease characteristics in children are not yet apparent, which presents a significant problem for pediatric care personnel. Special attention should be given to the following aspects: First, most children are asymptomatic or have moderate symptoms. Even if there are no signs, SARS-CoV-2 will be tested for children from families with associated infections to remove possible causes of infection7. Third, to date two important cases have been reported in adolescents.

Both cases made fast progress. So, in the epidemic season, children with underlying diseases should be protected by isolation as soon as possible. Thirdly, pregnant women who become infected by infected mothers after late pregnancy and newborns delivered. Clarification of the transmission route of mother-to-child vertical or postnatal exposure in neonatal infection is relevant

No evidence of vertical communication between mother and child has been identified. Finally, it is important to avoid potent broad-spectrum antibiotics and corticosteroids9. During the COVID-19 outbreak time, the occurrence and fatality rate of extreme cases in Hubei province, especially in Wuhan City, is significantly higher than in other regions of China, which could be affected by the misuse of antibiotics and corticosteroids. Premature use and inadequate antibiotic and corticosteroid coverage may result in secondary infection10.

In brief, SARS-CoV-2 is generally vulnerable to individuals of all ages. Infections in infants are often population groups with minimal health signs. Early isolation should be done to protect infants with latent conditions, and safety during birth should be improved and newborns should be separated immediately after arrival.

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