COVID-19 virus and children: What do we know?

Deep Convolutional Neural Networks for Detecting COVID-19 Using Medical Images: A Survey

Coronavirus Disease 2019 (COVID-19), which is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2), surprised the world in December 2019 and has threatened the lives of millions of people. Countries all over the world closed worship places and shops, prevented gatherings, and implemented curfews to stand against the spread of COVID-19. Deep Learning (DL) and Artificial Intelligence (AI) can have a great role in detecting and fighting this disease. Deep learning can be used to detect COVID-19 symptoms and signs from different imaging modalities, such as X-Ray, Computed Tomography (CT), and Ultrasound Images (US). This could help in identifying COVID-19 cases as a first step to curing them. In this paper, we reviewed the research studies conducted from January 2020 to September 2022 about deep learning models that were used in COVID-19 detection. This paper clarified the three most common imaging modalities (X-Ray, CT, and US) in addition to the DL approaches that are used in this detection and compared these approaches. This paper also provided the future directions of this field to fight COVID-19 disease.

Investigation of severe acute respiratory syndrome coronavirus 2 antibodies among the paediatric population in Mogadishu, Somalia

BACKGROUND

We undertook this cross-sectional study to determine the level of circulating anti-severe acute respiratory syndrome coronavirus 2 immunoglobulins (IgM and IgG) in children, as well as to evaluate other potential risk factors.

METHODS

Children attending the outpatient department of the SOS and Benadir Hospitals in Mogadishu from 26 July to 8 August 2021 were selected following parental consent. The children (aged <18 y) were screened using the coronavirus disease 2019 (COVID-19) rapid test lateral flow immune-assay kit.

RESULTS

Of the 500 children screened for COVID-19, 32 (6.4%) tested positive, out of which 26 (5.2%) had IgG antibodies, while five (1%) had IgM, with the other child (0.2%) having both circulating IgG and IgM antibodies. Also, 46.9% of the COVID-19-positive children were asymptomatic without any clinical signs of the disease. Children aged >6 y and those attending school were the most affected (p=0.002). The most common clinical features among positive children were fever (22.6%), cough (22.2%), shortness of breath (5.8%) and loss of smell (2.6%) and taste (2.2%). Similarly, not wearing a facemask as a preventive measure was found to be a significant risk factor (p=0.007).

CONCLUSIONS

This study shows that children are at risk of contracting COVID-19 infection. Our study also shows evidence of a high rate of IgG antibodies in school-aged children having close contact with infected adults, in those not wearing facemasks, as well as in those with a family history of comorbidities.

Delta variant effect on the clinical course of adolescent COVID-19 patients

OBJECTIVE

The clinical course of new COVID-19 variants in adolescents is still unknown. The aim of this study is to evaluate the clinical characteristics of COVID-19 in adolescents and compare the differences between the original version and the delta variant.

MATERIALS AND METHODS

The medical records of patients aged 10-18 years treated for COVID-19 between April 1, 2020 and March 31, 2022 were retrospectively reviewed. Patients were divided into four groups (asymptomatic, mild, moderate, and severe) for COVID-19 severity and into two groups according to the diagnosis date (first-second year). The primary endpoint of the study was hospital admission.

RESULTS

The mean age of patients was 171.81 ± 29.5 months, and most of them were males (n: 435, 53.3%). While the patient number was 296 (43.52%) in the first year of pandemic, it raised to 520 (54.11%) in the second year (p < 0.01). The severity of COVID-19 was mild in 667 (81.7%) patients. In the comparison of patients according to the diagnosis date (first-second years); the parameters of anosmia, ageusia, weakness, muscle pain, vomiting, hospital admission, and length of stay in hospital were statistically different (p < 0.05). In the comparison of hospitalized patients between years, the necessity of oxygen support (p < 0.001), endotracheal intubation rates (p < 0.05), length of stay in the hospital (p < 0.001), and the severity of COVID-19 (p < 0.05) was significantly higher in the second year.

CONCLUSION

The clinical course for adolescents diagnosed with COVID-19 has linearly changed with the delta variant. Our results confirmed that the delta variant is more transmissible, requires more oxygen support, increases endotracheal intubation, and prolongs the length of stay in the hospital.

Preschool Environment: Teacher Experiences during the COVID-19 Pandemic in Ghana

Background: In Ghana, the COVID-19 pandemic led to the government’s decision to shut down schools for nearly nine months. This study explores the experiences of preschool teachers in Ghana during the COVID-19 pandemic. Methods: The study was carried out using the Qualitative Description approach and aspects of Albert Bandura’s Social Learning Theory. Twenty-five teachers agreed to carry out face-to-face interviews with the researchers. An audio recorder device was used to record the interviews, with each interview lasting between 35–55 min. The analysis was carried out by two researchers who served as coders, and MAXQDA 2022 (VERBI Software GmbH) was used to do the analysis. Results: All twenty-five participants indicated their awareness of COVID-19. Participants said they were so “Scared” when they heard about COVID-19 that it could spell the doom for all humanity. Participants also talked about the extra workload that came upon them as a result of the pandemic and the “financial challenges” that they went through during the pandemic because they had no income since they were not teaching. Study participants indicated that one benefit of the pandemic was the heightened awareness of the need to practice hygienic behavior in their classroom. Conclusion: Participants’ beliefs about the virus being lethal led to mask wearing and the practice of hygienic behavior. Thus, although the COVID-19 pandemic negatively impacted the emotional and financial status of the studied participants, a positive outcome was the participants’ awareness of the need to practice positive health behavior, which will contribute to the overall health and safety of everyone in the preschool environment.

Management of Multisystem Inflammatory Syndrome in Children with Combined Use of Corticosteroids and Intravenous Immunoglobulin—Report from Bursa, Turkey

Objective In this article, we aimed to evaluate the clinical, laboratory, and radiological findings and outcomes of patients treated with corticosteroids and intravenous immunoglobulin (IVIG) with the multisystem inflammatory syndrome in children (MIS-C) in two centers in Bursa, Turkey.

Methods We retrospectively collected the clinical characteristics, laboratory results, and treatment outcomes of MIS-C cases treated in two centers from April 2020 to February 2021. Patients were compared both according to their clinical categorization and the place they were hospitalized in, as well as with studies published in the literature.

Results Fifty-six patients were included. Thirty-six (64.3%) were male with a mean age of 67.95 ± 50.87 months. Thirty patients (53.5%) were categorized as Kawasaki-like disease, 17 (30.3%) sepsis-like disease, and 9 (16%) were toxic shock syndrome (TSS). Admission symptoms were fever (100%), rash (71.4%), myalgia (69.6%), and abdominal pain (62.5%). Seventeen (30.3%) patients were hospitalized in pediatric intensive care unit. Elevated C-reactive protein levels, procalcitonin, erythrocyte sedimentation rate, D-dimer, and troponin were found in 100, 77, 84, 84, and 23.2% of the patients, respectively. Of all, 55 (98.2%) received IVIG, 54 (96.4%) corticosteroids, 56 (100%) antibiotic therapy, 22 (40%) albumin infusion, and 13 (23.2%) inotropic support. Fifty patients (89.3%) received low-molecular-weight heparin: enoxaparin, followed by acetylsalicylic acid treatment. Only one patient who was resistant to both IVIG and steroid treatment received Anakinra. One patient (1.7%) with TSS died within 1 hour of hospitalization.

Conclusion Combined use of IVIG and corticosteroids is an effective way of treatment in MIS-C patients resulting in low mortality.

Critically Ill Pediatric Patient and SARS-CoV-2 Infection

In December 2019 SARS-CoV-2 initiated a worldwide COVID-19 pandemic, which is still ongoing in 2022. Although adult elderly patients with chronic preexisting diseases had been identified as the most vulnerable group, COVID-19 has also had a significant impact on pediatric intensive care. Early in 2020, a new disease presentation, multisystemic inflammatory syndrome, was described in children. Despite the vaccination that is available for all age categories, due to its selection process, new viral mutations and highly variable vaccination rate, COVID-19 remains a significant clinical challenge in adult and pediatric intensive care in 2022.

Chest X-ray lung imaging features in pediatric COVID-19 and comparison with viral lower respiratory infections in young children

RATIONALE

Chest radiography (CXR) is a noninvasive imaging approach commonly used to evaluate lower respiratory tract infections (LRTIs) in children. However, the specific imaging patterns of pediatric coronavirus disease 2019 (COVID-19) on CXR, their relationship to clinical outcomes, and the possible differences from LRTIs caused by other viruses in children remain to be defined.

METHODS

This is a cross-sectional study of patients seen at a pediatric hospital with polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 95). Patients were subdivided in infants (0-2 years, n = 27), children (3-10 years, n = 27), and adolescents (11-19 years, n = 41). A sample of young children (0-2 years, n = 68) with other viral lower respiratory infections (LRTI) was included to compare their CXR features with the subset of infants (0-2 years) with COVID-19.

RESULTS

Forty-five percent of pediatric patients with COVID-19 were hospitalized and 20% required admission to intensive care unit (ICU). The most common abnormalities identified were ground-glass opacifications (GGO)/consolidations (35%) and increased peribronchial markings/cuffing (33%). GGO/consolidations were more common in older individuals and perihilar markings were more common in younger subjects. Subjects requiring hospitalization or ICU admission had significantly more GGO/consolidations in CXR (p < .05). Typical CXR features of pediatric viral LRTI (e.g., hyperinflation) were more common in non-COVID-19 viral LRTI cases than in COVID-19 cases (p < .05).

CONCLUSIONS

CXR may be a complemental exam in the evaluation of moderate or severe pediatric COVID-19 cases. The severity of GGO/consolidations seen in CXR is predictive of clinically relevant outcomes. Hyperinflation could potentially aid clinical assessment in distinguishing COVID-19 from other types of viral LRTI in young children.

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

Background

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently constitutes the leading and overwhelming health issue worldwide. In comparison with adults, children present milder symptoms, with most having an asymptomatic course. We hypothesized that COVID-19 infection has a negative impact on the continuation of chemotherapy and increases nonrelapse mortality.

Material and methods

This study was performed to assess the course of SARS-CoV-2 among children with hematological or oncological malignancies and its impact on cancer therapy. Records of SARS-CoV-2 infection in 155 children with malignancies from 14 Polish centers for pediatric hematology and oncology were collected and analyzed.

Results

SARS-CoV-2 replication was observed in 155 patients. Forty-nine patients were symptomatic, with the following being the most common manifestations: fever (31 patients), gastrointestinal symptoms (10), coryza (13), cough (13) and headache (8). In children who were retested, the median time of a positive PCR result was 16 days (range 1–70 days), but 12.7% of patients were positive beyond day + 20. The length of viral PCR positivity correlated with the absolute neutrophil count at diagnosis. Seventy-six patients did not undergo further SARS-CoV-2 testing and were considered convalescents after completion of isolation. Antibiotic therapy was administered in 15 children, remdesivir in 6, convalescent plasma in 4, oxygen therapy in 3 (1—mechanical ventilation), steroids in 2, intravenous immunoglobulins in 2, and heparin in 4. Eighty patients were treated with chemotherapy within 30 days after SARS-CoV-2 infection diagnosis or were diagnosed with SARS-CoV-2 infection during 30 days of chemotherapy administration. Respiratory symptoms associated with COVID-19 and associated with oxygen therapy were present in 4 patients in the study population, and four deaths were recorded (2 due to COVID-19 and 2 due to progressive malignancy). The probability of 100-day overall survival was 97.3% (95% CI 92.9–99%). Delay in the next chemotherapy cycle occurred in 91 of 156 cases, with a median of 14 days (range 2–105 days).

Conclusions

For the majority of pediatric cancer patients, SARS-CoV-2 infection does not result in a severe, life-threatening course. Our data show that interruptions in therapy are common and can result in suboptimal therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13045-021-01181-4.

SARS-CoV-2 viral clearance during bone marrow aplasia after allogeneic hematopoietic stem cell transplantation-A case report

Respiratory viral infections are known causes of mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Here, we report a unique case of a child with viral pneumonia caused by coinfection with human metapneumovirus (MPV), respiratory syncytial virus (RSV), and SARS-CoV-2 after HSCT. A 9-year-old girl with acute lymphoblastic leukemia underwent allogeneic HSCT from a matched, unrelated donor. During the post-transplant period, in profound leukopenia (below 10 leukocytes/µL), she was diagnosed with SARS-CoV-2, MPV, and RSV pneumonia and was treated with ribavirin and chloroquine. Before leukocyte recovery, the girl became asymptomatic, and SARS-CoV-2 and RSV clearance was achieved. The shedding of SARS-CoV-2 stopped before immune system recovery, and one may hypothesize that the lack of an inflammatory response might have been a contributing factor to the mild clinical course. Post-transplant care in HSCT recipients with COVID-19 infection is feasible in regular transplant units, provided the patient does not present with respiratory failure. Early and repeated testing for SARS-CoV-2 in post-transplant patients with concomitant infection mitigation strategies should be considered in children after HSCT who develop fever, respiratory symptoms, and perhaps gastrointestinal symptoms to control the spread of COVID-19 both in patients and in healthcare workers in hospital environments. Training of staff and the availability of personal protective equipment are crucial for containing SARS-CoV-2 infection.

Epidemiological analysis of burn injuries in children during the first COVID-19 lockdown, and a comparison with the previous five years

Background

Child burns rank among the most frequent domestic accidents in France. COVID-19 lockdown between March 16th and May 11th of 2020 increased time spent at home by children.

Material

This retrospective, observational study described the epidemiological impact of COVID-19 lockdown on child burns in a pediatric surgery department compared with previous five years. Child burns in the previous five years constituted the “before COVID-19 group” as the reference group. Child burns during the first lockdown formed the “COVID-19 group”. Demographics characteristics, the delay before first attendance at the surgery department, burns characteristics, the place of the incident, need of skin graft, and child reactions to trauma or isolation were recorded for these two groups.

Results

A total of thirty-seven children were included, 16 of them in the COVID-19 group. In the COVID-19 group, burned children were mainly boys, with a median age of 18 months. The median time before first attendance was four days. Main burns characteristics were to be deep partial thickness burns, involved lower limbs, caused by scalding. All burns occurred at home. Half parents reported child reactions to trauma or isolation among their children before burn injury.

Conclusion

The incidence of child burn injuries in the COVID-19 group was higher compared to the before COVID-19 group, but no increased delay to attendance recorded. Time spent at home and psychosocial impact of lockdown might partially explain this high incidence rate of child burns.

Level of evidence

IV.

Post-discharge telephonic follow-up of pediatric patients affected by SARS-CoV2 infection in a single Italianpediatric COVID center: a safe and feasible way to monitor children after hospitalization

BACKGROUND

SARS-CoV-2 infection in children is often non severe and in the majority of cases does not require long term hospitalization, nevertheless it is burdened with social issues and managing difficulties. To our knowledge there is no literature on telephonic follow up in pediatric patients with positive PCR for SARS-CoV-2 on rhino-pharyngeal swab after discharge. The aim of the study is to describe our experience in a telephonic follow up which can allow early and safe discharge from hospital while keeping the patients under close clinical monitoring.

MATERIALS AND METHODS

Sixty-five children were admitted for SARS-CoV-2 infection at Bambino Gesù Pediatric Hospital COVID Center from 16th March to 3rd July. We monitored through a telephonic follow-up, using a specific survey, the patients discharged still presenting a positive PCR for SARS-CoV-2. We checked if any symptoms occurred at home until recovery, defined as two consecutive negative PCR for SARS-CoV-2 on rhino-pharyngeal swabs.

RESULTS

During the follow up 7 patients had mild and self-limited symptoms related to SARS-CoV-2 infection, while 2 patients were re-hospitalized. One patient had Multisystem Inflammatory Syndrome in Children (MIS-C), the other patient had an increase in troponin and D-dimers. We also monitored the average time of viral shedding, resulting in a median duration of 28 days.

CONCLUSION

Our experience describes the daily telephonic follow up as safe in pediatric patients discharged with positive PCR. As a matter of fact it could avoid long term hospitalization and allow to promptly re-hospitalize children with major complications such as MIS-C.

Psychological effects of the COVID-19 outbreak on nurses working in tertiary women's and children's hospitals from Sichuan, China: A cross-sectional study

The evolving COVID-19 pandemic is placing unprecedented pressures on health systems. Accumulative studies suggest that nurses were more likely to develop negative psychiatric outcomes following a public health disaster than other medical staffs, due to their more frequent and closer contact with patients. We examined the psychological status of nurses working in the tertiary women's and children's hospitals in Sichuan, China, in order to explore the possible effect of the COVID-19. The cross-sectional survey was conducted at the peak period of COVID-19 among 1971 nurses. Their anxiety, depression and self-efficacy were assessed by the seven-item anxiety scale (GAD-7), the nine-item Patient Health Questionnaire (PHQ-9), and the General Self-efficacy Scale (GSES), respectively. 1934 valid questionnaires were returned with a response rate of 98.1%. We found that 29.3% and 22.7% of the nurses were identified with anxiety and depressive symptoms, respectively. The median score of GSES was 30, which was at the upper middle level among all populations. Nurses having longer working years and cold-like symptoms, those who were at work during breakout period and working in pediatric ward were significantly associated with the presence of anxiety and depression. Findings suggest that the epidemic of COVID-19 does not necessarily affect the psychological health of nurses working in women's and children's hospitals in Sichuan. The results of this study could serve as valuable suggestions to direct the promotion of psychological well-being among targeted nurses.

Safety evaluation of providing trauma service during COVID-19 phase one lockdown

AIMS

To evaluate the safety and transmission of COVID-19 in trauma patients during the coronavirus pandemic at a time of rapid reorganization of hospital health services.

METHODS

All patients sustaining trauma requiring surgery treated in our institution during the lockdown period were included. Retrospective data for all admissions were collected, including outcomes, length of stay and complications. Telephone interviews were performed with all patients, families or their carers to assess COVID-19 transmission at minimum of 6 week post-discharge.

RESULTS

161 patients underwent surgery, 107 females and 54 males with average age of 56 (2-99). There were lower limb related procedures, upper limb related respectively. 13 people died during this period, of these one was directly attributed to COVID-19 related morbidity. 75% responded to telephone interviews and found no cases of symptomatic spread to any patient or household members.

CONCLUSION

Following reorganization, our experience has shown that trauma services can be safely resumed with little to no significant adverse effect to patient or spread into community, especially as concerns of second wave risk overwhelming the NHS. We advocate that rigorous testing of COVID pre-operatively and with development of local COVID-19 standard operating protocols will also reduce and prevent the spread of COVID-19.

Case Report: A Severe SARS-CoV-2 Infection in a Teenager With Angelman Syndrome

Teenagers generally present mild to no symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the present report, we present the case of a 14-year-old boy with Angelman syndrome (AS) who presented with severe COVID-19 symptoms. He spent 20 days in the ICU with elevated inflammatory biomarkers (C-reactive protein and D-dimer) and increased peaks of neutrophil-to-lymphocyte ratio, which is uncommon for teenagers diagnosed with COVID-19. Although he showed physiological instability, he was able to produce neutralizing antibodies, suggesting a functional immune response. The literature concerning the immune response to infections in patients with AS is still poor, and to our knowledge, this was the first report of a patient with AS diagnosed with COVID-19. As such, the present study may alert other patients with AS or other rare diseases that they lack a competent immune response and could suffer severe consequences of SARS-CoV-2 infection.

[Medical child protection during the coronavirus lockdown]

Background

There are indications that during the lockdown and the measures of social distancing due to the coronavirus disease 2019 (COVID-19) pandemic, physical and sexual child abuse and neglect may have increased. Additionally, decreased social control may have led to a lower detection rate of child protection cases.

Objective

This study aimed to better understand the impact of the lockdown in Germany on the frequency and severity of child abuse and neglect. To do so the quantity and quality of cases of suspected child abuse and neglect in German pediatric departments and outpatient departments for medical child protection were examined.

Methods

In May 2020 a total of 343 institutions of medical child protection were invited to fill in a questionnaire with items describing their institution and items depicting cases of child protection in March and April 2019 and 2020 regarding age, form and severity of abuse as well as items to describe particular remarks and ideas for child protection during the pandemic.

Results

Out of the 343 pediatric departments and outpatient departments of medical child protection invited, the participation rate was 46%. In this study 81 institutions reported the total cases of suspected child abuse or neglect for both March and April 2019 and 2020. The number of cases dropped from 454 to 387 (-15%) in outpatient child abuse clinics and from 307 to 246 (-20%) in pediatric inpatient departments. Regarding the age of affected children and the form of abuse no significant differences were found.

Conclusion

The study found a decrease in reported cases of suspected child abuse and neglect during the lockdown in March and April 2020 compared to 2019. While the results do not show an increase of total child abuse and neglect, as suspected by many professionals, the decrease in reported cases may be explained by a steep increase in unreported cases due to reduced social control.

Effects of vitamin D on macrophages and myeloid-derived suppressor cells (MDSCs) hyperinflammatory response in the lungs of COVID-19 patients

Vitamin D regulates homeostasis, anti-microbial response, and inflammation. The vitamin D receptors are expressed in the macrophages and other immune cells, regulating the transcription of many different genes, including those coding the anti-microbial peptides. One of the most severe complications of the SARS-CoV-2 infection is the acute respiratory distress syndrome (ARDS) caused by the hyperinflammatory response (commonly called cytokine storm) of the lung macrophages. Studies showed that Vitamin D deficiency increases the severity of the ARDS in COVID-19 infection. We discuss here how the vitamin D supplementation may influence macrophage and myeloid-derived suppressor cells (MDSCs) inflammatory response, subdue the hyperinflammatory response, and lessen the ARDS in COVID-19 patients.

Overview of chest involvement at computed tomography in children with coronavirus disease 2019 (COVID-19)

BACKGROUND

Chest computed tomography (CT) findings in children with coronavirus disease 2019 (COVID-19) have been rarely reported in a comprehensive and systematic manner.

OBJECTIVE

We investigated the chest CT findings in children with COVID-19, and explored the differences in these findings between symptomatic patients and asymptomatic patients.

MATERIALS AND METHODS

Demographic findings, clinical characteristics, duration of hospital stay and viral shedding, and chest CT findings in 201 children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were retrospectively analyzed from January 15 to March 20, 2020, and divided into two groups: symptomatic group (n=136) and asymptomatic group (n=65). Chi-square test and Student's t-test were used for statistical analysis.

RESULTS

Symptomatic patients were mainly young children ≤3 years old (54/63, 86%),while asymptomatic patients were mainly children ≥ 6 years old (51/111, 46%). Fever (41%) and cough (41%) were the most common symptoms. Overall, 119/201 (59%) patients had chest CT findings, and symptomatic patients accounted for 82% (98/119). The CT findings presented as bilateral multiple lesions (60/119, 50.4%), ground-glass opacities (83/119, 70%) and/or consolidation (44/119, 37%) with a peripheral and subpleural distribution (62/83, 75%). Fifteen of 87 (7.2%) patients with lung lesions showed complete lesion absorption, and 42/87 (48%) improved within a mean of 9.1 (standard deviation [SD] 3.2) days. The mean duration of viral shedding was 8.7 (SD 4.9) days. Pleural effusion was very rare. No lymphadenopathy was found in either group.

CONCLUSION

Symptoms associated with pulmonary involvement were most common in infants and young children. The lung lesions of most patients were absorbed and improved in about 9 days.

A dor que não pode calar: reflexões sobre o luto em tempos de Covid-19

Resumo A Covid-19 provocou número elevado de perdas e mudanças nos processos de cuidado e despedida, fatores que podem dificultar a elaboração do luto. Objetivamos, assim, compreender as particularidades do luto no âmbito da Covid-19, ressaltando a importância da adaptação e da criação de estratégias voltadas ao cuidado da saúde mental nos processos de luto. O ensaio realiza um panorama teórico, indicando elementos presentes na pandemia com potencial para interferir no luto, e apresenta um levantamento de iniciativas adaptadas a tal contexto. A pandemia trouxe mudanças na forma de experienciar o morrer. Evidenciam-se iniciativas na tentativa de mitigar os efeitos emocionais, cognitivos e comportamentais. O momento convoca a repensar conceitos e (re)criar compreensões acerca da morte e do luto, ressaltando-se a importância da Rede de Saúde Mental, com o fortalecimento de ações de base sociocomunitária, reconhecimento de diferentes níveis de complexidade das demandas e acesso organizado à atenção especializada.

Pediatric lung imaging features of COVID-19: A systematic review and meta-analysis

RATIONALE

Pediatric COVID-19 studies have been mostly restricted to case reports and small case series, which have prevented the identification of specific pediatric lung disease patterns in COVID-19. The overarching goal of this systematic review and meta-analysis is to provide the first comprehensive summary of the findings of published studies thus far describing COVID-19 lung imaging data in the pediatric population.

METHODS

A systematic literature search of PubMed was performed to identify studies assessing lung-imaging features of COVID-19 pediatric patients (0-18 years). A single-arm meta-analysis was conducted to obtain the pooled prevalence and 95% confidence interval (95% CI).

RESULTS

A total of 29 articles (n = 1026 children) based on chest computerized tomography (CT) images were included. The main results of this comprehensive analysis are as follows: (1) Over a third of pediatric patients with COVID-19 (35.7%, 95% CI: 27.5%-44%) had normal chest CT scans and only 27.7% (95% CI: 19.9%-35.6%) had bilateral lesions. (2) The most typical pediatric chest CT findings of COVID-19 were ground-glass opacities (GGO) (37.2%, 95% CI: 29.3%-45%) and the presence of consolidations or pneumonic infiltrates (22.3%, 95% CI: 17.8%-26.9%). (3) The lung imaging findings in children with COVID-19 were overall less frequent and less severe than in adult patients. (4) Typical lung imaging features of viral respiratory infections in the pediatric population such as increased perihilar markings and hyperinflation were not reported in children with COVID-19.

CONCLUSION

Chest CT manifestations in children with COVID-19 could potentially be used for early identification and prompt intervention in the pediatric population.

Prevalence and associated factors of depression, anxiety, and stress among Hubei pediatric nurses during COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic is putting healthcare workers across the world in an unprecedented situation. The purpose of this study was to evaluate the levels of depression, anxiety, and stress among Hubei pediatric nurses during the COVID-19 pandemic and to analyze the potential factors associated with them.

MATERIALS AND METHODS

A self-designed online questionnaire survey, which consisted of the demographic and selected features, the occupational protection knowledge, attitudes, and practices of COVID-19, and the Chinese version of Depression, Anxiety, and Stress Scale, were used to assess the levels of depression, anxiety, and stress among Hubei pediatric nurses during COVID-19 pandemic. The logistic regression analyses were performed to analyze the potential factors associated with depression, anxiety, and stress.

RESULTS

A total of 617 pediatric nurses were included in the survey. A considerable proportion of pediatric nurses reported symptoms of depression (95 [15.4%]), anxiety (201 [32.6%]), and stress (111 [18.0%]). Results of multivariable logistic regression analyses indicated that the good occupational protection practices (for depression: OR = 0.455, 95%CI: 0.281 to 0.739; for anxiety: OR = 0.597, 95%CI: 0.419 to 0.851; for stress: OR = 0.269, 95%CI: 0.166 to 0.438) and the personal protective equipment (PPE) meeting work requirements (for depression: OR = 0.438, 95%CI: 0.246 to 0.778; for anxiety: OR = 0.581, 95%CI: 0.352 to 0.959; for stress: OR = 0.504, 95%CI: 0.283 to 0.898) were independent protective factors against depression, anxiety, and stress, respectively. Yet, working in an isolation ward or fever clinic was an independent risk factor associated with depression, anxiety, and stress, respectively (for depression: OR = 1.809, 95%CI: 1.103 to 2.966; for anxiety: OR = 1.864, 95%CI: 1.221 to 2.846; for stress: OR = 2.974, 95%CI: 1.866 to 4.741). Having suspected or confirmed COVID-19 patients in the departments (OR = 1.554, 95%CI: 1.053 to 2.294) and coming in contact with the patient's bodily fluids or blood (OR = 1.469, 95%CI: 1.031 to 2.095) were independent risk factors for anxiety, while >3 times of training for COVID-19 related information was an independent protective factor for depression (OR = 0.592, 95%CI: 0.360 to 0.974). Moreover, >10 years of working was an independent risk factor for stress (OR = 1.678, 95%CI: 1.075 to 2.618).

CONCLUSION

During the COVID-19 outbreak, a considerable proportion of Hubei pediatric nurses had psychological problems. The pediatric nurses endorsing the higher number of risk factors should be given special attention and necessary psychological intervention. Improving the levels of PPE so as to meet the work requirements and intensifying occupational protection practices might help safeguard pediatric nurses from depression, anxiety, and stress.

COVID-19 in Children: A Narrative Review

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic is caused by the third known zoonotic coronavirus. It is a disease that does not spare any age group. The scientific community has been inundated with information since January. This review aims to summarise pertinent information related to COVID-19 in children.

METHODS

A literature search was conducted in 2020 on the PubMed, MEDLINE, and Embase databases, with the keyword "COVID 19" and "children". A bibliographic search of articles included was also undertaken. The abstracts were scanned to assess their appropriateness to be included in this narrative review. This was updated on the 11th April, 2020.

RESULTS

The aetiology, transmission, incubation, pathophysiology, clinical features and complications, and management are discussed.

CONCLUSION

Our understanding of COVID-19 is evolving as more reports are published. The growth of SARS-CoV2 is limited in children and they are often asymptomatic. The disease course is also milder. Continued research to understand its effect on children is important to help us manage the disease in these vulnerable populations in a timely fashion.

Respiratory Therapeutic Strategies in Children and Adolescents with COVID-19: A Critical Review

Evidence on the treatment strategies for the child population with critical conditions due to COVID-19 is scarce and lacks consensus. Thus, this study aimed to critically review non-pharmacological respiratory strategies for this population. Original studies were searched in six databases considering predefined inclusion criteria. Other studies and recommendations were also included after a manual search. Oxygen therapy, invasive (IMV) and non-invasive (NIV) ventilation were the most frequently addressed interventions. In general, the original studies have cited these strategies, but detailed information on the parameters used was not provided. The recommendations provided more detailed data, mainly based on experiences with other acute respiratory syndromes in childhood. In the context of oxygen therapy, the nasal catheter was the most recommended strategy for hypoxemia, followed by the high-flow nasal cannula (HFNC). However, the risks of contamination due to the dispersion of aerosols in the case of the HFNC were pointed out. Lung protective IMV with the use of bacteriological or viral filters was recommended in most documents, and there was great variation in PEEP titration. Alveolar recruitment maneuvers were mentioned in a few recommendations. NIV was not consensual among studies, and when selected, several precautions must be taken to avoid contamination. Airway suctioning with a closed-circuit was recommended to reduce aerosol spread. Information on prone positioning and physiotherapy was even more scarce. In conclusion, oxygen therapy seems to be essential in the treatment of hypoxemia. If necessary, IMV should not be delayed, and protective strategies are encouraged for adequate pulmonary ventilation. Information about techniques that are adjuvant to ventilatory support is superficial and requires further investigation.

A spatial-temporal description of the SARS-CoV-2 infections in Indonesia during the first six months of outbreak

BACKGROUND

Since the first cases reported in Wuhan, China, in December 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide. In Indonesia, the first case was reported in early March 2020, and the numbers of confirmed infections have been increasing until now. Efforts to contain the virus globally and in Indonesia are ongoing. This is the very first manuscript using a spatial-temporal model to describe the SARS-CoV-2 transmission in Indonesia, as well as providing a patient profile for all confirmed COVID-19 cases.

METHOD

Data was collected from the official website of the Indonesia National Task Force for the Acceleration of COVID-19, from the period of 02 March 2020-02 August 2020. The data from RT-PCR confirmed, SARS-CoV-2 positive patients was categorized according to demographics, symptoms and comorbidities based on case categorization (confirmed, recovered, dead). The data collected provides granular and thorough information on time and geographical location for all 34 Provinces across Indonesia.

RESULTS

A cumulative total of 111,450 confirmed cases of were reported in Indonesia during the study period. Of those confirmed cases 67.79% (75,551/111,450) were shown as recovered and 4.83% (5,382/111,450) of them as died. Patients were mostly male (50.52%; 56,300/111,450) and adults aged 31 to 45 years old (29.73%; 33,132/111,450). Overall patient presentation symptoms of cough and fever, as well as chronic disease comorbidities were in line with previously published data from elsewhere in South-East Asia. The data reported here, shows that from the detection of the first confirmed case and within a short time period of 40 days, all the provinces of Indonesia were affected by COVID-19.

CONCLUSIONS

This study is the first to provide detailed characteristics of the confirmed SARS-CoV-2 patients in Indonesia, including their demographic profile and COVID-19 presentation history. It used a spatial-temporal analysis to present the epidemic spread from the very beginning of the outbreak throughout all provinces in the country. The increase of new confirmed cases has been consistent during this time period for all provinces, with some demonstrating a sharp increase, in part due to the surge in national diagnostic capacity. This information delivers a ready resource that can be used for prediction modelling, and is utilized continuously by the current Indonesian Task Force in order to advise on potential implementation or removal of public distancing measures, and on potential availability of healthcare capacity in their efforts to ultimately manage the outbreak.

What could explain the late emergence of COVID-19 in Africa?

At the end of November 2019, a novel coronavirus responsible for respiratory tract infections emerged in China. Despite drastic containment measures, this virus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread in Asia and Europe. The pandemic is ongoing with a particular hotspot in southern Europe and America in spring 2020. Many studies predicted an epidemic in Africa similar to that currently seen in Europe and the USA. However, reported data do not confirm these predictions. Several hypotheses that could explain the later emergence and spread of the coronavirus disease 2019 (COVID-19) pandemic in African countries are being discussed, including the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs.

COVID-19 PICU guidelines: for high- and limited-resource settings

BACKGROUND

Fewer children than adults have been affected by the COVID-19 pandemic, and the clinical manifestations are distinct from those of adults. Some children particularly those with acute or chronic co-morbidities are likely to develop critical illness. Recently, a multisystem inflammatory syndrome (MIS-C) has been described in children with some of these patients requiring care in the pediatric ICU.

METHODS

An international collaboration was formed to review the available evidence and develop evidence-based guidelines for the care of critically ill children with SARS-CoV-2 infection. Where the evidence was lacking, those gaps were replaced with consensus-based guidelines.

RESULTS

This process has generated 44 recommendations related to pediatric COVID-19 patients presenting with respiratory distress or failure, sepsis or septic shock, cardiopulmonary arrest, MIS-C, those requiring adjuvant therapies, or ECMO. Evidence to explain the milder disease patterns in children and the potential to use repurposed anti-viral drugs, anti-inflammatory or anti-thrombotic therapies are also described.

CONCLUSION

Brief summaries of pediatric SARS-CoV-2 infection in different regions of the world are included since few registries are capturing this data globally. These guidelines seek to harmonize the standards and strategies for intensive care that critically ill children with COVID-19 receive across the world.

IMPACT

At the time of publication, this is the latest evidence for managing critically ill children infected with SARS-CoV-2. Referring to these guidelines can decrease the morbidity and potentially the mortality of children effected by COVID-19 and its sequalae. These guidelines can be adapted to both high- and limited-resource settings.

SARS-CoV-2 Infection in Children: Special Considerations

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appeared in December 2019 in Wuhan, Hubei province, China. Soon after, it was discovered to be a novel human virus and it subsequently spread throughout the world, leading to a global pandemic. From the experience we have so far with this virus, it appears that compared to most other respiratory viral illnesses to which they are typically highly susceptible, children are affected less by SARS-CoV-2 than adults. It will continue to be important to collect data and study different populations to learn more about how children are affected by the disease, particularly as we head back to school in different forms this fall. We also must pay close attention to whether or not children are significant transmitters of the disease, as this is largely unknown and will have an affect on those who are providing care for children at school, daycare, and at home. [Pediatr Ann. 2020;49(10):e407-e412.].

Children were less frequently infected with SARS-CoV-2 than adults during 2020 COVID-19 pandemic in Warsaw, Poland

Clinical data suggest that during the current COVID-19 pandemic, children are less prone than adults to SARS-CoV-2 infection. Our purpose was to determine the frequency of SARS-CoV-2 in children vs. adults during the 2020 pandemic in Warsaw, Poland, and to investigate whether RSV and/or influenza A/B infections were associated with SARS-CoV-2 infections. We present results of RT-PCR tests for SARS-CoV-2 performed in Warsaw, Poland. Some of the pediatric subjects were also PCR-tested for RSV, and A and B influenza. We compared the test results from the four groups of symptomatic and asymptomatic subjects: 459 symptomatic pediatric patients (children 0–18 years old), 1774 symptomatic adults, 445 asymptomatic children, and 239 asymptomatic adults. 3.26% (15/459) of symptomatic pediatric patients were positive for SARS-CoV-2 in contrast to 5.58% (99/1774) of symptomatic adults (p = 0.0448). There were no SARS-CoV-2 positive cases in the group of asymptomatic children (0/445) and two positive cases in the group of asymptomatic adults (2/239), i.e., 0.83%. In the group of symptomatic pediatric patients, 17.14% (6/35) (p = 0.0002) were positive for RSV, 8.16% (4/49) were positive for influenza A, and 2.04% (1/49), thus 10.20% (5/49) (p = 0.0176) for influenza A/B. Children were less prone to SARS-CoV-2 infection than the adults during the COVID-19 pandemic in Warsaw. Higher percentage of symptomatic children was infected with RSV or influenza A/B than with SARS-CoV-2. This suggests a necessity for the testing for all these viruses for an early identification and isolation of SARS-CoV-2-positive patients for an ensuing 2020 autumn return of COVID-19.

Atypical case of COVID-19 in a critically unwell 5-week old infant

The effect of COVID-19 by SARS-CoV-2 on the paediatric population remains an evolving mystery. Early reports from China stated that children seem to be unharmed by its dangerous effects, yet more recently there has been evidence of a systemic inflammatory response in a small number of children who are affected. We discuss a 5-week-old male infant who presented atypically with severe COVID-19 infection. To our knowledge, he is the youngest reported case in the UK to require mechanical ventilation and intensive care treatment as a direct result of COVID-19 following horizontal transmission. This case has generated several learning points with regard to atypical presentations of COVID-19 and identifying a potential cohort of 'at risk' infants. We also highlight a number of new challenges that have arisen for paediatricians and anaesthetists providing airway management for infants with SARS-CoV-2.

CLINICAL-EPIDEMIOLOGICAL RELATION BETWEEN SARS-COV-2 AND KAWASAKI DISEASE: AN INTEGRATIVE LITERATURE

Objective:

To analyze the current scientific literature to document, in an integrative review, the main findings that correlate Kawasaki disease (KD) to COVID-19.

Data sources:

The search was carried out in June 2020 in the following databases: Biblioteca Virtual em Saúde (BVS), periódico da CAPES and U.S National Library of Medicine (PubMed). The combination of descriptors used was [(COVID-19 OR SARS-CoV-2) AND (Kawasaki disease)], and the inclusion criteria stipulated were studies published from January 2019 to June 2020, without restriction of language or location, and available online in full. News, editorials, comments, and letters, as well as duplicates and articles that did not answer the guiding question were excluded.

Data synthesis:

A total of 97 articles were identified, of which seven comprised this review. The association of KD to the new coronavirus appears to trigger a severe clinical condition of vasculitis. Different from the usual, in this inflammatory syndrome, patients are older, and prevalence is higher in children from African or Caribbean ancestry; clinical and laboratory manifestations are also atypical, with a predominance of abdominal complaints and exaggerated elevation of inflammatory markers. In addition, there was a greater report of rare complications and greater resistance to the recommended treatment for KD.

Conclusions:

Pediatric COVID-19 and its potential association to severe KD, still unfamiliar to health professionals, reinforces the importance of testing patients with vasculitis for the new coronavirus and the need to wage high surveillance and preparation of the health system during the current pandemic.

COVID-19-associated apnea and circumoral cyanosis in a 3-week-old

BACKGROUND

Data regarding coronavirus disease 2019 (COVID-19) cases and outcomes in infants are sparse compared to older pediatric and adult populations.

CASE PRESENTATION

We present a three-week-old full-term male with a history of mild hypoxic ischemic encephalopathy (HIE) who was admitted as an inpatient twice for episodes of apnea and perioral cyanosis. The patient tested positive for COVID-19 and negative for other common respiratory viruses at both admissions.

CONCLUSIONS

To our knowledge, this is the first report of apnea and perioral cyanosis associated with COVID-19 in an infant. This case highlights a previously undocumented COVID-19 presentation and suggests that even mildly symptomatic infants warrant viral diagnostic testing in an effort to prevent further spread of the disease.

The Resilient Child: Sex-Steroid Hormones and COVID-19 Incidence in Pediatric Patients

Coronavirus disease–2019 (COVID-19), a disease caused by Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has become an unprecedented global health emergency, with fatal outcomes among adults of all ages in the United States, and the highest incidence and mortality in adult men. As the pandemic evolves there is limited understanding of a potential association between symptomatic viral infection and age. To date, there is no knowledge of the role children (prepubescent, ages 9-13 years) play as “silent” vectors of the virus, with themselves being asymptomatic. Throughout different time frames and geographic locations, the current evidence on COVID-19 suggests that children are becoming infected at a significantly lower rate than other age groups—as low as 1%. Androgens upregulate the protease TMPRSS2 (type II transmembrane serine protease-2), which facilitates efficient virus-host cell fusion with the epithelium of the lungs, thus increasing susceptibility to SARS-CoV-2 infection and development of severe COVID-19. Owing to low levels of steroid hormones, prepubertal children may have low expression of TMPRSS2, thereby limiting the viral entry into host cells. As the world anticipates a vaccine against SARS-CoV-2, the role of prepubescent children as vectors transmitting the virus must be interrogated to prepare for a potential resurgence of COVID-19. This review discusses the current evidence on the low incidence of COVID-19 in children and the effect of sex-steroid hormones on SARS-CoV-2 viral infection and clinical outcomes of pediatric patients. On reopening society at large, schools will need to implement heightened health protocols with the knowledge that children as the “silent” viral transmitters can significantly affect the adult populations.

COVID-19 in Neonates and Infants: Progression and Recovery

Between March 10, 2020 and April 17, 2020, of 8/70 (11.4%) SARS-CoV-2 positive infants that presented, 5/8 (63%) developed fever, 4/8 (50%) had lower respiratory tract involvement, 2/8 (25%) had neutropenia and thrombocytosis, and 4/8 infants (50%) were treated for suspected sepsis with broad-spectrum antibiotics. Only 1/8 (13%) required pediatric intensive care. All patients were eventually discharged home well.

Pediatric COVID-19 Disease: A Review of the Recent Literature

The first pediatric coronavirus disease 2019 (COVID-19) case was confirmed in Shenzhen, China on January 20, 2020. At the beginning of the outbreak, COVID-19 pneumonia was more common in adults than in children and adolescents, and the rate of confirmed pediatric cases was relatively lower. However, as screening tests and pathogen detection campaigns were initiated in more regions as the outbreak spread, the number of pediatric infection cases increased significantly. Currently, studies on pediatric COVID-19 are limited in the literature to case reports and case series, and a few epidemiological studies. COVID-19 has distinct characteristics in the pediatric population compared to adults; therefore, we need to better understand the characteristics of this disease in children. Discovering the characteristics of the pediatric COVID-19 disease is important for contributing to the diagnosis and treatment of the disease in this population. In this review, clinical characteristics, epidemiology, diagnosis, and management of pediatric COVID-19 pneumonia based on the recent literature are discussed. [Pediatr Ann. 2020;49(7):e319-e325.].

COVID-19: Specific and Non-Specific Clinical Manifestations and Symptoms: The Current State of Knowledge

Coronavirus disease 2019 (COVID-19), due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become an epidemiological threat and a worldwide concern. SARS-CoV-2 has spread to 210 countries worldwide and more than 6,500,000 confirmed cases and 384,643 deaths have been reported, while the number of both confirmed and fatal cases is continually increasing. COVID-19 is a viral disease that can affect every age group—from infants to the elderly—resulting in a wide spectrum of various clinical manifestations. COVID-19 might present different degrees of severity—from mild or even asymptomatic carriers, even to fatal cases. The most common complications include pneumonia and acute respiratory distress syndrome. Fever, dry cough, muscle weakness, and chest pain are the most prevalent and typical symptoms of COVID-19. However, patients might also present atypical symptoms that can occur alone, which might indicate the possible SARS-CoV-2 infection. The aim of this paper is to review and summarize all of the findings regarding clinical manifestations of COVID-19 patients, which include respiratory, neurological, olfactory and gustatory, gastrointestinal, ophthalmic, dermatological, cardiac, and rheumatologic manifestations, as well as specific symptoms in pediatric patients.

Lessons Learned so Far from the Pandemic: A Review on Pregnants and Neonates with COVID-19

There are concerns regarding the risk and the course of COVID-19 in pregnancy and in the neonates. In this review, we aimed to present the current understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and neonatal periods considering diagnosis, treatment, prognosis, and prevention. Few studies on pregnant women with COVID-19 have been conducted between December 2019 and April 2020. The majority of patients applied in the third trimester and presented with fever and cough. Ground-glass opacities and consolidation on computed tomography were reported to be common. COVID-19 was proposed to have a milder course than SARS and the Middle East respiratory syndrome coronavirus in pregnant women. Hydroxychloroquine and antiproteases (lopinavir/ritonavir) were reported to be safe; however, therapeutic efficacy and safety of remdesivir still lack evidence. As ribavirin and favipiravir have teratogenic effects, there are some debates on the use of ribavirin in severe cases. There is still no clear evidence of vertical transmission of SARS-CoV-2 during delivery. Occupational safety issues of pregnant healthcare workers on the frontline should be considered as their risk to develop severe pneumonia is higher because of altered maternal immune response. Knowledge about neonatal outcomes of COVID-19 was based on studies of the last trimester of pregnancy. There is much to be learnt about COVID-19 in pregnant women and in the neonates, especially concerning prognosis- and treatment-related issues.

Providing a paediatric trauma and orthopaedics service during the peak of the COVID-19 pandemic: The Royal National Orthopaedic Hospital experience

INTRODUCTION

In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated.

METHODS

All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge.

RESULTS

Overall, 100 children underwent surgery or interventional radiological procedures under GA between 20 March and 8 May 2020. There were 35 trauma cases, 20 urgent elective orthopaedic cases, two spinal emergency cases, 25 admissions for interventional radiology procedures, and 18 tumour cases. 78% of trauma cases were performed within 24 hours of referral. In the 97% who responded at two weeks following discharge, there were no cases of symptomatic COVID-19 in any patient or member of their households.

CONCLUSION

Despite the extensive restructuring of services and the widespread concerns over the surgical and anaesthetic management of paediatric patients during this period, we treated 100 asymptomatic patients across different orthopaedic subspecialties without apparent COVID-19 or unexpected respiratory complications in the early postoperative period. The data provides assurance for health care professionals and families and informs the consenting process.Cite this article: Bone Joint Open 2020;1-6:287-292.

Providing a paediatric trauma and orthopaedics service during the peak of the COVID-19 pandemic

Introduction

In response to the COVID-19 pandemic, there was a rapidly implemented restructuring of UK healthcare services. The The Royal National Orthopaedic Hospital, Stanmore, became a central hub for the provision of trauma services for North Central/East London (NCEL) while providing a musculoskeletal tumour service for the south of England, the Midlands, and Wales and an urgent spinal service for London. This study reviews our paediatric practice over this period in order to share our experience and lessons learned. Our hospital admission pathways are described and the safety of surgical and interventional radiological procedures performed under general anaesthesia (GA) with regards to COVID-19 in a paediatric population are evaluated.

Methods

All paediatric patients (≤ 16 years) treated in our institution during the six-week peak period of the pandemic were included. Prospective data for all paediatric trauma and urgent elective admissions and retrospective data for all sarcoma admissions were collected. Telephone interviews were conducted with all patients and families to assess COVID-19 related morbidity at 14 days post-discharge.

Results

Overall, 100 children underwent surgery or interventional radiological procedures under GA between 20 March and 8 May 2020. There were 35 trauma cases, 20 urgent elective orthopaedic cases, two spinal emergency cases, 25 admissions for interventional radiology procedures, and 18 tumour cases. 78% of trauma cases were performed within 24 hours of referral. In the 97% who responded at two weeks following discharge, there were no cases of symptomatic COVID-19 in any patient or member of their households.

Conclusion

Despite the extensive restructuring of services and the widespread concerns over the surgical and anaesthetic management of paediatric patients during this period, we treated 100 asymptomatic patients across different orthopaedic subspecialties without apparent COVID-19 or unexpected respiratory complications in the early postoperative period. The data provides assurance for health care professionals and families and informs the consenting process. Cite this article: Bone Joint Open 2020;1-6:287–292.

Novel coronavirus infection and children

BACKGROUND AND AIM

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Its outbreak in many states of the world, forced the World Health Organization (WHO) to declare a pandemic. Currently, COVID-19 has infected 1 991 562 patients causing 130 885 deaths globally as of 16 April 2020. The aim of this review is to underline the epidemiological, clinical and management characteristics in children affected by COVID-19.

METHODS

We searched Pubmed, from January to April 2020, for the following search terms: "COVID-19", "children", "SARS-COV2", "complications", "epidemiology", "clinical features", focusing our attention mostly on epidemiology and symptoms of COVID-19 in children.

RESULTS

Usually, infants and children present milder symptoms of the disease with a better outcome than adults. Consequently, children may be considered an infection reservoir that may play a role as spreader of the infection in community.

COVID19: potential cardiovascular issues in pediatric patients

The novel severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) has rapidly spread worldwide with increasing hospitalization and mortality rate. Ongoing studies and accumulated data are de- tailing the features and the effects of the new coronavirus disease 19 (COVID 19) in the adult population, and cardiovascular involvement is emerging as the most significant and life-threatening complication, with an in- creased risk of morbidity and mortality in patients with underlying cardiovascular disease. At present, though the limited data on the effects of COVID 19 in pediatric patients, children seem to count for a little proportion of SARS-COV 2 infection, and present with less severe disease and effects However infants and toddlers are at risk of developing critical course. The disease has a range of clinical presentations in children, for which the potential need for further investigation of myocardial injury and cardiovascular issues should be kept in mind to avoid misdiagnosing severe clinical entities. Overlapping with Kawasaki disease is a concern, particularly the incomplete and atypical form. We aim to summarize the initial considerations and potential cardiovascular implications of COVID-19 for children and patients with congenital heart disease.

BEST PRACTICES IN NEWBORN CARE IN COVID-19 TIMES: AN INTEGRATIVE REVIEW

ABSTRACT Objective: to identify scientific evidence on best practices in newborn care, from the delivery room to the home, in COVID-19 times. Method: an integrative review conducted in April 2020 at National Library of Medicine National Institutes of Health (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus, through combinations between the controlled terms “newborn”, “coronavirus infections”, and “COVID-19”. Results: nineteen studies made up the final sample, from which five analytical categories emerged on best practices in newborn care: Pregnant women and puerperal women suspected of having COVID-19; Pregnant and puerperal women with confirmation for COVID-19; Newborns suspected of having COVID-19; Newborns with confirmation for COVID-19; and Horizontal transmission prevention of COVID-19 to newborns. Conclusion: several recommendations were divergent, due to the contemporary pandemic of COVID-19. Therefore, the role of nurses is essential for adherence to best practices, which are proven and recommended nationally and internationally, taking into account the local reality and the constant updating of the theme. Therefore, further research is needed, especially with a strong level of evidence, for formulation of assistance guidelines for this population group that contribute to reducing neonatal morbidity and mortality and healthy and harmonious child development during and post-pandemic.

The clinical course of SARS-CoV-2 positive neonates

The COVID-19 pneumonia was firstly reported in Wuhan, China, in December 2019. The disease had a rapid spread all over the word becoming an international public health emergency. Limited data were available on COVID-19 positive neonates. We reviewed relevant literature to understand the clinical course of disease and transmission routes in affected neonates. The aim of the study was evaluating the clinical course and prognosis of SARS-CoV-2 positive neonates. Based on current literature, the hypothesis of vertical transmission of SARS-CoV-2, though conceivable, remains unproven. A research conducted on PubMed database from December 2019 to April 27, 2020 revealed that were reported 25 neonates affected by SARS-CoV-2. Main symptoms were fever, cough, or shortness of breath but often these neonates did not show other symptoms during length stay in hospital. No deaths occurred.