COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication This represents the final version as of 30 April, 2021. COVID-19; 30-Apr-20 Challenges to Global Commentary The authors describe the overall situation of the COVID-19 pandemic in This article highlights Iwamoto A, Tung R, Ota T, et Cambodia; neonatal care in Health and Cambodia as of April 2020, as well as implications for neonatal care. They the overall situation in al. Challenges to neonatal family; Cambodia amid the Medicine outline infection and prevention measures taken in the neonatal care center Cambodia as relates to care in Cambodia amid the neonatal care; COVID-19 pandemic located in the national hospital for obstetrics, gynecology, and neonatology. the COVID-19 COVID-19 pandemic. Glob task sharing; The measures include disinfection, social distancing, symptom screening, pandemic and Health Med. 2020;2(2):142- workforce and hygiene practices. Family caregivers were engaging in task sharing in the preventative measures 144. neonatal care center prior to the pandemic due to staff shortages, which taken by one hospital doi:10.35772/ghm.2020.0103 presents challenges for infection control during the COVID-19 pandemic. The with obstetrics, 0 authors call for increased screening measures in the facility along with gynecology, and strengthening the professional healthcare workforce so task sharing with neonatology units. To family members is no longer needed. prevent future infections in the neonatal care unit, the authors call for increased screening measures and strengthening the professional healthcare workforce so task sharing with family members is no longer needed. Health inequity, 30-Apr-20 Zooming Toward a Obesity Perspective Health inequities exist throughout the life course, resulting in racial/ethnic The COVID-19 Woo Baidal JA, Chang J, Hulse obesity, Telehealth Solution and socioeconomic disparities in obesity and obesity‐related health pandemic has E, Turetsky R, Parkinson K, telehealth, USA for Vulnerable complications. Obesity and its co-morbidities appear to be linked to COVID- highlighted the long- Rausch JC. Zooming Toward a Children With 19 mortality. Approaches to reduce obesity in the time of COVID‐19 are standing structural Telehealth Solution for Obesity During urgently needed and should start early in life. In New York City, a telehealth inequities that have Vulnerable Children with Coronavirus Disease pediatric weight‐management collaborative between three prominent perpetuated inter- Obesity During Coronavirus 2019 health systems was developed during COVID‐19 with show rates from 76%- generational health Disease 2019. [published 89%. To avoid the impending exacerbation of health disparities related to disparities, including online, 2020 April 30]. obesity risk factors in the aftermath of the pandemic, effective remote obesity. Telehealth Obesity (Silver Spring). interventions are urgently needed among vulnerable children with obesity. has the potential to doi:10.1002/oby.22860 Challenges such as digital technology access, social and linguistic differences, play a crucial role in privacy security, and reimbursement must be overcome to realize the full the effort to address potential of telehealth for pediatric weight management among low‐income childhood obesity in and racial/ethnic‐minority children. vulnerable populations. Corticosteroid 30-Apr-20 Antenatal Acta Letter to Editor The usefulness and safety of corticosteroids as an adjuvant therapy for The use of Sichitiu J, Fakhouri F, therapy, Corticosteroid Obstetricia COVID‐19 pneumonia remains controversial. Corticosteroids may diminish corticosteroids to Desseauve D. Antenatal pregnancy, Therapy and et Gynecolo- the inflammatory response, a major factor for lung damage and acute promote fetal lung corticosteroid therapy and fetal lung COVID-19: gica respiratory distress syndrome in viral respiratory tract infection. Some maturation is COVID-19: pathophysiological maturation Pathophysiological Scandinavica patients with COVID‐19 exhibit biphasic disease evolution with a mild complicated by the considerations [published Considerations presentation followed by a secondary respiratory deterioration due to a potentially adverse online, 2020 Apr 30]. Acta cytokine storm, despite decreasing viral load. Therefore, early effects of Obstet Gynecol Scand. 2020. administration of corticosteroid therapy might be particularly consequential. corticosteroid therapy doi:10.1111/aogs.13887

1 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication However, previous studies on corticosteroid therapy in SARS-CoV and MERS- on pregnant women CoV illustrated delayed viral clearance, with no survival benefit and perhaps with COVID-19. even adverse outcomes. In particular, potentiation of angiotensin II, which plays a key role in SARS-CoV-2 pathophysiology, by corticosteroids might have a detrimental effect. These considerations should be weighed when recommending corticosteroid administration for fetal lung maturation when preterm delivery is anticipated in pregnant women. Children, 30-Apr-20 The Imperative of Indian Correspondence There are limited data on risk factors for severe SARS-CoV-2 infection in Authors argue for the Elenga N. The Imperative of treatment, Early Treatment for Pediatrics children, and the long-term effects on the lungs of COVID-19 in children early treatment of Early Treatment for Children hydroxy- Children With remain unknown, even for those with moderate symptoms. Authors of this children with with COVID-19 Infection chloroquine, COVID-19 Infection correspondence argue that pediatricians should consider employing moderate to severe [published online ahead of azithromycin available COVID-19 treatments (e.g. hydroxychloroquine, azithromycin), respiratory symptoms, print, 2020 Apr 30]. Indian which are already widely used for other indications in children. Side effects using available drugs Pediatr. can be effectively monitored in a hospital environment. that have been 2020;S097475591600169. proposed to treat COVID-19. Pregnancy, 30-Apr-20 Coronavirus Disease The Journal Short Report This report summarizes currently available evidence on maternal, fetal, and The clinical Yang Z, Wang M, Zhu Z, Liu Y. cesarean 2019 (COVID-19) of Maternal- neonatal outcomes of pregnant women infected with COVID-19, published characteristics of Coronavirus disease 2019 delivery, and Pregnancy: A Fetal & between January 1 and March 26, 2020. In total, 18 studies, describing 114 pregnant women with (COVID-19) and pregnancy: a neonatal Systematic Review Neonatal pregnant women, were included in the review. Fever (87.5%) and cough COVID-19 are similar systematic review [published outcomes, Medicine (53.8%) were the most commonly reported symptoms, followed by fatigue to those of non- online, 2020 Apr 30]. J preterm birth, (22.5%), diarrhea (8.8%), dyspnea (11.3%), sore throat (7.5%), and myalgia pregnant adults. Fetal Matern Fetal Neonatal Med. fetal distress, (16.3%). The majority of patients (91%) had cesarean delivery due to various and neonatal 2020;1‐4. vertical indications. In terms of fetal and neonatal outcomes, stillbirth (1.2%), outcomes appear doi:10.1080/14767058.2020. transmission neonatal death (1.2%), preterm birth (21.3%), low birth weight (<2500 g, favorable in most 1759541 5.3%), fetal distress (10.7%), and neonatal asphyxia (1.2%) were reported. Of cases, but available 84 live births with available data, there are reports of RT-PCR positive data only include neonatal throat swabs (n=2), elevated neonatal blood IgG but normal IgM pregnant women (n=3), and elevated neonatal blood IgG and IgM (n=2). No direct evidence of infected in their third intrauterine vertical transmission has been found. trimesters. Pregnancy, 30-Apr-20 Second-Trimester JAMA Research Letter This case report describes a 28-year-old, primigravida pregnant woman with This case report Baud D, Greub G, Favre G, et second Miscarriage in a RT-PCR confirmed COVID-19. The patient presented at 19 weeks' gestation contributes to a gap in al. Second-Trimester trimester, Pregnant Woman with fever, myalgia, fatigue, mild pain with swallowing, diarrhea, and dry data on maternal Miscarriage in a Pregnant miscarriage, With SARS-CoV-2 cough for 2 days. She was given oral acetaminophen and discharged but SARS-CoV-2 infection Woman With SARS-CoV-2 placental Infection returned two days later with severe uterine contractions and no during the second Infection. JAMA. Published pathology, improvement of symptoms. Amniotic fluid and vaginal swabs, sampled trimester of pregnancy online April 30, 2020. Switzerland during labor, tested negative for SARS-CoV-2. A stillborn infant was delivered and provides evidence doi:10.1001/jama.2020.7233 after 10 hours of labor. Swabs from the axillae, mouth, meconium, and fetal for placental blood, obtained within minutes of birth, tested negative for SARS-CoV-2. pathology based on Fetal autopsy showed no malformations, and fetal lung, liver, and thymus RT-PCR and biopsies were negative for SARS-CoV-2. Placental swabs and biopsies were histological findings. positive for SARS-CoV-2, and placental histology demonstrated mixed Whether SARS-CoV-2 inflammatory infiltrates of neutrophils and monocytes. These findings crosses the placental support placental infection with SARS-CoV-2. No other cause of fetal demise barrier warrants was identified. There was no evidence of vertical transmission, but absence further investigation. of the virus is not surprising given the stage of fetal development and short

2 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication period of maternal infection. It is important to note that infection of the maternal side of the placenta, inducing placental insufficiency and resulting in miscarriage of fetal growth restriction, was observed in 40% of maternal infections with MERS-CoV. Pregnancy, 30-Apr-20 COVID-19 in Journal of Letter to the Authors reply to the study by Siyu Chen et al. and draw attention to a Preterm delivery is an Mehan A, Venkatesh A, Girish preterm Pregnancy: Risk of Medical Editor growing body of evidence pointing toward an under-addressed association under-addressed issue M. COVID-19 in pregnancy: delivery, Adverse Neonatal Virology between preterm maternal SARS-CoV-2 infection, preterm delivery and in current cohorts of risk of adverse neonatal neonatal Outcomes adverse neonatal outcomes, which is not reflected in Chen et al.'s small pregnant women with outcomes [published online, outcomes cohort. In addition, vertical transmission, which was not tested by Chen et SARS-CoV-2 infection. 2020 Apr 30]. J Med Virol. al., should not be excluded as a potential mechanism for viral spread. 2020. doi:10.1002/jmv.25959 COVID-19; 29-Apr-20 Homebirth and European Letter to the During the COVID-19 pandemic, pregnant women may be hesitant to give Due to the COVID-19 Ziogou R, Zografou K. midwifery; homecare during Journal of Editor birth at a hospital due to fear of contracting SARS-CoV-2. Hence, the authors pandemic, perinatal Homebirth and homecare pregnancy; COVID-19 Midwifery propose tailoring perinatal care to provide women with the best and safest care has to be tailored during COVID-19. Eur J antenatal care care, suggesting that midwives offer alternatives that sustain and protect to provide women Midwifery. 2020;4:14. the mother and neonate. They recommend providing remote care using with the best and Published 2020 Apr 29. telemedicine, remote monitoring of fetal heart rate, weight, and blood safest care. The doi:10.18332/ejm/120972 pressure, and provision of informational and educational resources. They authors recommend suggest a planned home birth with a registered midwife as an alternative for providing remote low-risk pregnant women, wherein transportation to the nearest hospital perinatal care using must be pre-arranged as a part of the birth plan. The authors indicate the telemedicine and continuity of care at home, the comfort of home, the right of choice, and suggest a planned their partner's presence as important reasons women choose to deliver at home birth with a home. Additionally, they find that women incur less costs with home births registered midwife as compared to hospital births, and a midwife can perform virtual/in-person an alternative for low- visits to check on the mother and neonate's health. Hence, they recommend risk pregnant women, establishing a midwife-led model of maternity care to minimize costs and wherein provide pregnant women with high-quality perinatal care. transportation to the nearest hospital must be pre-arranged as a part of the birth plan. Oxygen 29-Apr-20 Early Acute Obstetrics & Original article The initial intervention for hypoxemic pregnant patients with COVID-19 This article Pacheco LD, Saad AF, Saade therapy, fluid Respiratory Support Gynecology infection is the administration of oxygen therapy. The authors suggest summarizes the basic G. Early Acute Respiratory therapy, high- for Pregnant starting oxygen therapy in pregnant patients when SpO2 values fall below initial respiratory Support for Pregnant Patients flow nasal Patients With 94%. During pregnancy, the risk of pulmonary edema in the setting of lung support interventions With Coronavirus Disease cannula, Coronavirus Disease inflammation may be increased secondary to increased blood volume and recommended for 2019 (COVID-19) Infection. noninvasive 2019 (COVID-19) lower oncotic pressure, so the authors recommend that maintenance fluids pregnant patients with Obstet Gynecol. positive Infection be avoided in pregnant patients with acute COVID-19 infection and oxygen infection with SARS- 2020;136(1):42-45. pressure desaturation (SpO2 < 94%). The high-flow nasal cannula has emerged as an CoV-2, including doi:10.1097/AOG.000000000 ventilation, attractive alternative to treat patients with acute hypoxemic respiratory oxygen therapy, fluid 0003929 fetal failure whose respiratory status is not improving despite conventional therapy, high-flow monitoring, oxygen therapy and who do not have an immediate indication for nasal cannula, pregnancy, endotracheal intubation. Noninvasive positive pressure ventilation is noninvasive positive initial support another modality commonly used in patients for whom conventional oxygen pressure ventilation, therapy fails. The use of unnecessary nebulized treatments and sputum- and fetal monitoring. inducing agents should be minimized in patients with COVID-19 infection. Before 23–24 weeks of gestation, the authors do not recommend electronic

3 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication fetal monitoring for pregnant patients with COVID-19–related respiratory failure. Community 29-Apr-20 A single centre Journal of Research Article Community acquired pneumonia (CAP) is an important cause of morbidity SARS-CoV-2 was not Mancino E, Cristiani L, acquired study of viral Clinical and mortality in children, with multifactorial viral and bacterial etiologies. detected in a cohort of Pierangeli A, et al. A single pneumonia, community- Virology The present study examines viral etiologies in children less than 14 years old, 42 hospitalized centre study of viral children, acquired with clinical and radiological diagnoses of pneumonia at a pediatric children with community-acquired human pneumonia in emergency department in Rome, from October 1 to March 31, 2020. Within pneumonia in Rome, pneumonia in children: No rhinovirus, Italy children: No 24 hours of admission, every patient underwent a nasal wash for detection Italy. The most evidence of SARS-CoV-2 from evidence of SARS- of respiratory viruses, including SARS-CoV-2 since the study period partially commonly detected October 2019 to March 2020 CoV-2 from October overlapped with peak COVID-19 incidence in Italy. 42 children (median age viral agent was human [published online 2020 Apr 2019 to March 29.5 months, range 1.7-184) were enrolled. Two children (2/42, 5%) were rhinovirus. 29]. J Clin Virol. 2020. admitted to the PICU. 31/42 (74 %) had at least one virus detected; of these, doi:10.1016/j.jcv.2020.10438 7/42 (17 %) had a coinfection. The only human Coronavirus detected was 5 HUK1 in 2/42 children (5%); none of children tested positive for SARS-CoV-2. Analyzing all detected pathogens, human rhinovirus was the most frequently detected agent (17/42, 40.5 %), followed by respiratory syncytial virus (12/42, 28.5 %) and influenza A and B (6/42 14.3 %). Children, 29-Apr-20 The Curious Case of Journal of Letter to Editor The CDC (USA) considers children, especially those under 5 years of age, as a Epidemiological Gupta S, Malhotra N, Gupta epidemiology, COVID-19 in Pediatrics high-risk category for influenza-related disease. The age distribution of differences between N, Agrawal S, Ish P. The SARS, MERS, Children patients in the COVID-19 pandemic is incongruent with that of the H1N1 SARS, MERS, COVID- curious case of COVID-19 in H1N1 influenza pandemic of 2009. At the authors' tertiary care center, 215 individuals have 19, and the H1N1- children [published online, been evaluated for COVID-19 through April 10, 2020. Of those tested, all 22 influenza pandemic 2020 Apr 29]. J Pediatr. 2020. individuals under the age of 18 years were negative for SARS-CoV-2. This (2009) are outlined in doi:10.1016/j.jpeds.2020.04. report presents epidemiological differences among 3 coronaviruses (SARS, this letter. 062 MERS, COVID-19) and H1N1-2009 influenza in children. Children, age- 29-Apr-20 Changes in contact Science Report As transmission intensifies in other countries, the interplay between age, This transmission Zhang J, Litvinova M, Liang Y, related patterns shape the contact patterns, social distancing, susceptibility to infection, and COVID-19 model for COVID-19 et al. Changes in contact susceptibility, dynamics of the dynamics remains unclear. In this report, authors analyze contact survey shows that children (0- patterns shape the dynamics epidemiology, COVID-19 outbreak data from Wuhan and Shanghai before and during the outbreak, as well as 14 years) are less of the COVID-19 outbreak in transmission in China contact tracing information from Hunan Province. Daily contacts were susceptible to SARS- China [published online, 2020 model, social reduced 7-8-fold during the COVID-19 social distancing period, with most CoV-2 infection than Apr 29]. Science. 2020. distancing interactions restricted to the household. Children 0-14 years are less adults (15-64 years). doi:10.1126/science.abb8001 interventions, susceptible to SARS-CoV-2 infection than adults 15-64 years of age (OR 0.34, The authors advocate China 95% CI 0.24-0.49). In contrast, individuals over 65 years are more susceptible for the design of long- to infection (OR 1.47, 95% CI: 1.12-1.92). Building a transmission model, the term targeted authors conclude that social distancing alone, as implemented in China strategies to control during the outbreak, is sufficient to control COVID-19. While proactive COVID-19, along with school closures cannot interrupt transmission on their own, they can reduce large scale testing and peak incidence by 40-60% and delay the epidemic. contact tracing. Neonates, 29-Apr-20 Novel Coronavirus Italian Review Few cases of COVID-19 have been observed in children, and adolescents This review discusses De Rose DU, Piersigilli F, infants, clinical Disease (COVID-19) Journal of who seem to have a more favorable clinical course than other age groups. clinical features and Ronchetti MP, et al. Novel characteristics, in Newborns and Pediatrics Even fewer cases have been observed in newborns. This review provides an management of Coronavirus disease (COVID- epidemiology, Infants: What We overview of existing knowledge on SARS-CoV-2 epidemiology, transmission, COVID-19 in newborns 19) in newborns and infants: Italy Know So Far the associated clinical presentation and outcomes in newborns and infants and infants up to 6 what we know so far. Ital J up to 6 months of life. months of life. Pediatr. 2020;46(1):56, doi:10.1186/s13052-020- 0820-x 4 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Pregnancy, 29-Apr-20 Analysis of Vaginal International Clinical Article This retrospective study compared vaginal delivery outcomes between 10 Findings from this Liao J, He X, Gong Q, Yang L, vaginal Delivery Outcomes Journal of pregnant women with clinical diagnosis of COVID‐19 and 53 pregnant study support safe Zhou C, Li J. Analysis of delivery, Among Pregnant Gynecology women without COVID‐19, admitted between January 20 and March 2, vaginal delivery in vaginal delivery outcomes neonates, Women in Wuhan, & Obstetrics 2020. There were no significant differences in gestational age, postpartum pregnant women with among pregnant women in China China During the hemorrhage, and perineal resection rates between the two groups. There COVID-19, without Wuhan, China during the COVID-19 Pandemic were no significant differences in birth weight of neonates and neonatal exacerbating COVID-19 pandemic asphyxia rates between the two groups. Neonates delivered by pregnant symptoms and [published online, 2020 Apr women with clinical diagnosis of COVID‐19 tested negative for SARS‐CoV‐2 without increasing risk 29]. Int J Gynaecol Obstet. infection. of SARS-CoV-2 2020. doi:10.1002/ijgo.13188 infection in neonates. Pregnancy, low- 29-Apr-20 Should We Stop Ultrasound Letter to the COVID-19 can progress to critical illness with acute respiratory distress and Authors recommend Mathilde G, Rolnik DL, dose aspirin Aspirin Prophylaxis in Obstetrics Editor disseminated intravascular coagulation (DIC). Biomarkers of DIC (elevated D- cessation of low-dose Hoffman MK, Panchaud A, therapy, in Pregnant Women & dimer and thrombocytopenia) are detectable early in the course of disease aspirin therapy for Baud D. Should we stop preeclampsia Diagnosed With Gynecology and correlate with poor prognosis. Multiple phenomena underpin the SARS- preeclampsia aspirin prophylaxis in prophylaxis, COVID-19? CoV-2 associated thrombocytopenia: decreased production in infected prophylaxis in pregnant women diagnosed thrombo- hematopoietic marrow as well as increased consumption by DIC and in pregnant women upon with COVID-19? [published cytopenia, DIC damaged lung tissue and capillaries. Aspirin belongs to the group of diagnosis of COVID-19, online, 2020 Apr 29]. nonsteroidal anti-inflammatory drugs (NSAIDs), which are controversial in often associated with Ultrasound Obstet Gynecol. COVID-19 patients. Currently, prophylactic administration of low-dose thrombocytopenia. 2020. doi:10.1002/uog.22063 aspirin to pregnant women is common and indicated in those at risk for preeclampsia (10-15% of all pregnancies). The risk/benefit ratio of aspirin therapy in pregnant women with COVID-19 should be carefully evaluated, taking into account the indication, gestational age, and platelet count. Hunger, 29-Apr-20 COVID-19 in The Lancet Spotlight With a population of over 200 million people, Nigeria is one of the most COVID-19 lockdown Kalu B. COVID-19 in Nigeria: a poverty, Nigeria: a disease of Respiratory populous black nations worldwide. On Feb 27, 2020, the first official case of measures imposed disease of hunger [published lockdown hunger Medicine COVID-19 in the state of Lagos was announced. As of April 22, there were across several Nigerian online, 2020 Apr 29]. Lancet measures, 873 confirmed cases, 197 recoveries, and 28 deaths. A large proportion of states may exacerbate Resp Med. 2020. Nigeria the population, especially in the commercial hub of Lagos, live on daily poverty and doi:10.1016/S2213- income. Thus, lockdown orders announced on March 30 for 3/36 states widespread hunger. 2600(20)30220-4 could lead to widespread hunger. The author advocates that the Nigerian government must protect its citizens by providing them with the necessary commodities to help mitigate the consequences of this pandemic. Labor and 29-Apr-20 Infection Control Neonatology Commentary Two fundamental principles have been repeatedly emphasized concerning This commentary Ng PC. Infection Control delivery, Measures for maternal COVID-19 during pregnancy. First, limited available evidence highlights Measures for COVID-19 in the infection COVID-19 in the suggests that SARS-CoV-2 is unlikely to be transmitted vertically (even in recommended Labor Suite and Neonatal control, Hong Labor Suite and preterm infants), though recent reports indicated that newborns could infection control Unit [published online, 2020 Kong Neonatal Unit acquire SARS-CoV-2 infection postnatally within days after birth. Secondly, measures for Apr 29]. Neonatology. maternal SARS or COVID-19 infection per se should not be an indication for maternal/neonatal 2020;1‐3. early delivery. The timing and mode of delivery should solely be determined units in hospitals. doi:10.1159/000508002 by the maternal respiratory status and obstetric indications. Guided by these principles, this commentary emphasizes effective triaging and protection of healthcare workers in maternal/neonatal units as key infection control measures, while noting that different clinical and physical setups, as well as admission criteria, should inform recommendations.

5 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication COVID-19; 28-Apr-20 The latest update European Editorial The author gives an update, as of April 2020, on the effects of SARS-CoV-2 The author gives an Antonakou A. The latest pregnancy; on the effects of Journal of infection in pregnancy and guidelines for pregnancy management by several update, as of April update on the effects of labor; delivery; COVID-19 infection Midwifery international scientific societies. Pregnant women do not appear to be more 2020, on the effects of COVID-19 infection in vertical in pregnancy likely to contract the infection than the general population. However, once SARS-CoV-2 infection pregnancy. Eur J Midwifery. transmission; contracted, symptoms may be more severe, since pregnancy alters the in pregnancy and 2020;4:12. morbidity immune system and its response to viral infections. There is some evidence guidelines for doi:10.18332/ejm/120973. to suggest that vertical transmission is possible. There had been no pregnancy evidence, at the time of the article, of increased perinatal transmission management by during vaginal delivery. Women should be informed about the risks and several international benefits of mode of delivery (vaginal vs. C-section) and should be fully scientific societies. supported in their final decision. The author also states that women should During these difficult be permitted and encouraged to have a single, asymptomatic birth partner times, midwives and present during labor and birth. During these difficult times, midwives and health professionals health professionals need to support women in their choices and provide need to support them with safe clinical care, guidance, and increased support throughout women in their pregnancy and labor. choices and provide them with safe clinical care, guidance, and increased support throughout pregnancy and labor. China, 28-Apr-20 Safe Delivery for BJOG: Commentary The authors discuss their recommendations regarding delivery timing during The authors of this Qi H, Luo X, Zheng Y, et al. pregnancy, Pregnancies International pregnancy, indications for cesarean section, delivery room and infection article discuss their Safe delivery for pregnancies SARS-CoV-2, Affected by COVID- Journal of protection, anesthesia, and neonatal management in pregnant women with recommendations affected by COVID-19. BJOG. neonatal, 19 Obstetrics & SARS-CoV-2 infections. They recommend that the timing of delivery be regarding delivery and 2020;127(8):927-929. delivery, Gynecology determined by maternal disease status. In severe or critical disease, they neonatal management doi:10.1111/1471- positive, recommend early delivery to ensure maternal safety regardless of in pregnant women 0528.16231 negative, gestational age. In cases of mild SARS-CoV-2 infections, the timing of with SARS-CoV-2 quarantine delivery remains to be determined. Timing and mode of delivery should infections. depend on obstetric indications; however, they recommend that the threshold for cesarean delivery be lowered in women with SARS-CoV-2 infections, especially if there is a delay in the first stage of labor. The authors recommend delivery in a negative-pressure room or infection isolation operating room if a negative-pressure room is unavailable to deliver pregnant women with SARS-CoV-2 infections. They recommend epidural anesthesia over general anesthesia unless the patient is already intubated to prevent exacerbation in pregnant women with SARS-CoV-2 related pneumonia. The authors advise isolation of the newborns in the neonatal isolation ward until maternal SARS-CoV-2 nucleic acid testing results are obtained. If the test is negative, the newborn can be transferred out of isolation, but if positive, the newborn is to be quarantined for at least 14 days. Children, risks, 28-Apr-20 Risks to children British Editorial The author discusses a "secondary pandemic" of child neglect and abuse The author discusses a Green P. Risks to children and domestic and young people Medical being brought on from measures taken to control the spread of COVID-19 "secondary pandemic" young people during covid-19 abuse, neglect, during covid-19 Journal such as lockdown. Since the start of the pandemic, there is an urgent need of child neglect and pandemic. BMJ. United pandemic (BMJ) by the UK government to reduce the clinical effect on adults while child well- abuse in the UK, 2020;369:m1669. doi: Kingdom being is largely ignored. For some families, staying at home together brought on from 10.1136/bmj.m1669. 6 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication increases the chances of child abuse and neglect. Without regular access to measures taken to professionals such as teachers, general practitioners, health visitors, and control the spread of social and youth workers, routine opportunities to spot signs are lost. Some COVID-19 such as social work staff have had to self-isolate, stretching safeguarding teams and lockdown. They straining service delivery. There is also a nationwide decline in attendance at recommend a changed emergency departments (25%) and general practice and a consequent national approach and reduction of face-to-face consultations. Moreover, a 22% increase in investment towards supermarket alcohol sales were observed in March 2020 indicating a rise in child well-being. domestic consumption and potential risk to children. Increased calls to child support lines and increased police attendance at domestic abuse incidents have also been observed. A wholesale change in the national approach and investment towards child well-being involving the top governmental voices is necessary. Pediatric 28-Apr-20 Summary of Pediatric Article In this article, the International Society of Pediatric and Adolescent Diabetes This article from the International Society of diabetes, recommendations Diabetes (ISPAD) responds to anecdotal reports from one doctor in Wuhan, China and International Society Pediatric and Adolescent diabetic regarding COVID-19 two doctors in Italy during peak COVID-19 activity that children with of Pediatric and Diabetes (ISPAD). Summary ketoacidosis, in children with diabetes did not show a different disease pattern compared to children Adolescent Diabetes of recommendations DKA, delayed diabetes: Keep without diabetes in their respective hospitals. However, all three doctors summarizes anecdotal regarding COVID-19 in care, Italy, Calm and Mind expressed significant strain on the local healthcare systems due to COVID- reports from doctors children with diabetes: Keep China your Diabetes Care 19, and two doctors reported cases of delayed care for children with new in China and Italy that Calm and Mind your Diabetes and Public Health onset diabetes or diabetic keto-acidosis. In response, the ISPAD emphasizes children with diabetes Care and Public Health Advice the importance of continued attentiveness to standard diabetes care to do not appear to be at Advice. Pediatr Diabetes. avoid the need for hospitalization and emergency or urgent care visits. increased risk of 2020 May;21(3):413-414. doi: Methods to facilitate communication between patients, families, and COVID-19 10.1111/pedi.13013. PMID: healthcare teams such as telehealth should be implemented to reduce the complications. 32346988; PMCID: need for hospitalization. However, there have PMC7267149. been cases of severe diabetic keto-acidosis in children resulting from delayed care due to restricted access to healthcare services. China, 28-Apr-20 Evidence of British Letter to the Cases of COVID-19 infections in newborns have been noted, though vertical Based on the Sun M, Xu G, Yang Y, et al. Caesarean mother-to-newborn Journal of Editor and perinatal mother-to-newborn transmission of COVID-19 has not been outcomes of three Evidence of mother-to- delivery, infection with Anesthesia confirmed. The authors report three mothers with COVID-19 and the cases with mothers newborn infection with mother-to- COVID-19 outcomes of their newborns in Henan Province, China after undergoing a with COVID-19 giving COVID-19. Br J Anaesth. newborn Caesarean delivery due to confirmed or suspected maternal diagnosis of birth by Caesarean 2020;125(2):e245-e247. transmission COVID-19. The three women infected with COVID-19 in the peripartum delivery, the authors doi:10.1016/j.bja.2020.04.06 period had three different maternal and neonatal outcomes, and the report report the risk of 6 highlights the risk of mother-to-newborn transmission of SARS-CoV-2. From mother-to-newborn the outcomes of the cases, the authors note that the number of visitors transmission and should be minimized, and sufficient PPE is important to prevent caregivers recommend isolating from infection. Though the route of transmission is not clear in these newborns from SARS- newborns, it is important to maintain practices that minimize droplet and CoV-2-positive contact spread, through procedures such as isolating newborns from SARS- mothers after birth CoV-2-positive mothers immediately after birth and use of PPE by visitors. and the use of PPE by

7 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication visitors to minimize transmission. Breastfeeding, 28-Apr-20 Distance, Diffusion, Maternal & Letter to the Since December 2019, a team of health and social scientists have captured An analysis of Twitter Moukarzel S, del Fresno M, social media, and the Role of Child Editor Twitter data and employed social network analyses to examine the diffusion data revealed that the Bode L, Daly AJ. Distance, Twitter data, Social Media in a Nutrition of pseudoscience and misinformation related to breastfeeding. Our findings majority of tweets Diffusion, and the Role of scientific Time of COVID indicate a “breastfeeding and COVID-19” social network totaling 756 unique related to COVID-19 Social Media in a Time of guidance Contagion users, 880 tweets and 28 distinct communities. The WHO and other and breastfeeding COVID Contagion [published professional users act as key diffusers of information. While the vast reflects scientific online 2020 April 28]. majority of tweets reflected current scientific guidance, updates from guidance. Vigilance is doi:10.1111/mcn.13025 researchers about ongoing COVID-19 studies, as well as community still necessary to engagement and breastfeeding advocacy, 6% of tweets contained counter the diffusion scientifically unfounded recommendations and commercial promotions. misinformation. Pregnancy, lung 28-Apr-20 The Diagnosis of American Clinical Opinion Lung ultrasound examination has been demonstrated to be an accurate In this case report, Inchingolo R, Smargiassi A, ultrasound, Pneumonia in a Journal of imaging method to detect pulmonary and pleural conditions. During point-of-care lung Moro F, et al. The Diagnosis pleural Pregnant Woman Obstetrics & pregnancy, there is a need for rapid assessment of the maternal lung in ultrasound indicated of Pneumonia in a Pregnant effusion, Italy With COVID-19 Gynecology patients with suspected COVID-19. Typical ultrasound features of this COVID-19 diagnosis, in Woman with COVID-19 Using Using Maternal pulmonary pathology, including diffuse hyperechoic vertical artifacts with the presence of Maternal Lung Ultrasound Lung Ultrasound thickened pleural line and "white lung" with patchy distribution, were normal chest X-ray [published online, 2020 Apr observed in a pregnant patient with COVID-19 in this case study. Chest X-ray, findings, in a pregnant 28]. Am J Obstet Gynecol. performed on the same day, was not suggestive for viral pneumonia, but woman who was later 2020. throat swabs for SARS-CoV-2 by RT-PCR confirmed the COVID-19 diagnosis. confirmed to have doi:10.1016/j.ajog.2020.04.0 SARS-CoV-2 infection 20 by RT-PCR. Pregnancy, 28-Apr-20 Maternal Death American Original Research Given the disproportionate burden of severe and fatal respiratory disease This report describes 7 Hantoushzadeh S, maternal Due to COVID-19 Journal of previously documented among pregnant women following other related cases of maternal Shamshirsaz AA, Aleyasin A, mortality, Disease Obstetrics & coronavirus outbreaks (SARS-CoV, MERS-CoV) and influenza pandemics over death in the 2nd or et al. Maternal Death Due to respiratory Gynecology the last century, the absence of reported maternal morbidity and mortality 3rd trimester, due to COVID-19 Disease [published failure with COVID-19 disease is unexpected. This report describes a multi- COVID-19, in Iran. online, 2020 Apr 28]. Am J institution adjudicated case series from Iran, which includes 9 pregnant There is a need for Obstet Gynecol. 2020. women diagnosed with severe COVID-19 during their 2nd or 3rd trimester. more rigorously doi:10.1016/j.ajog.2020.04.0 At the time of reporting, 7 of 9 women died, 1 of 9 remains critically ill and collected surveillance 30 ventilator-dependent, and 1 of 9 recovered after prolonged hospitalization. data and recognition Self-verified familial/household cohort data showed that maternal outcomes of COVID-19 were more severe when compared to other high and low-risk associated maternal familial/household members (n=33 members for comparison). mortality. Children, 28-Apr-20 Clinical and Journal of Review By searching available Chinese and English literature, data from 406 children Based on data from Zhen-Dong Y Prof, Gao-Jun Z transmission Transmission Infection with COVID-19 in China were analyzed and the following findings were 406 children with Prof, Run-Ming J, et al. dynamics, Dynamics obtained. In general, the incidence in children is low. Family cluster COVID-19 in China, Clinical and Transmission clinical Characteristics of incidence is a dynamic transmission feature. Asymptomatic and mild more children have Dynamics Characteristics of characteristics, 406 Children With infections account for 44.8% of reported cases, with only 7 cases of critical asymptomatic 406 Children with anal swab Coronavirus Disease illness. Laboratory examination of lymphocyte count is not reduced, as it is infections, milder Coronavirus Disease 2019 in samples, China 2019 in China: A for adults. Chest CT findings are less severe than those of adults. Only 55 of conditions, faster China: A Review [published Review 406 cases were tested by anal swab for viral nucleic acid, 45 of which were recovery, and better online, 2020 Apr 28]. J Infect. positive (81.8% of stool samples). COVID-19 screening is needed in the prognosis compared 2020. pediatric fever clinic, and respiratory and digestive tract nucleic acid tests with adults. doi:10.1016/j.jinf.2020.04.03 should be performed. The authors state that efforts should be made to 0

8 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication prevent children from becoming a hidden source of transmission in kindergartens, schools and families. Dietary 28-Apr-20 Functional Role of International Hypothesis Given the recent evidence in different hospitals suggesting IL-6 and TNF-α This proposed dietary Messina G, Polito R, Monda intervention, Dietary Journal of inhibitor drugs as a possible therapy for COVID-19, this report argues that a intervention to V, et al. Functional Role of IL-6, Intervention to Molecular dietary intervention could be useful to ameliorate outcomes during therapy improve therapeutic Dietary Intervention to adiponectin, Improve the Sciences for COVID-19. Since COVID-19 infection can generate a mild or highly acute outcomes in patients Improve the Outcome of lung infection, Outcome of COVID- respiratory syndrome with a consequent release of pro-inflammatory with COVID-19 COVID-19: A Hypothesis of cytokine storm 19: A Hypothesis of cytokines, including IL-6 and TNF-α, a dietary regimen modification to considers the anti- Work. Int J Mol Sci. Work increase levels of adiponectin, one of the most abundant circulating inflammatory role of 2020;21(9):E3104. Published adipocytokines, may help regulate cytokine responses. Involvement of adiponectin, a 2020 Apr 28. adiponectin has been demonstrated in several lung diseases and plays a regulator of cytokine doi:10.3390/ijms21093104 crucial anti-inflammatory role in maintaining vascular homeostasis and responses. protecting against dysfunction. Children, 28-Apr-20 Covid-19: Concerns BMJ News Doctors in the UK have been warned over a rising number of children Physicians in the UK Mahase E. Covid-19: multisystem Grow Over presenting with a multisystem inflammatory state, characterized by over- raise warning over concerns grow over inflammatory Inflammatory production of cytokines, and needing intensive care. In an urgent alert cases of children inflammatory syndrome state, intensive Syndrome Emerging shared by North Central London Clinical Commissioning Group and the presenting with a emerging in children. BMJ. care, UK in Children Paediatric Intensive Care Society, doctors were told that while the multisystem 2020;369:m1710. Published unspecified number of cases may be connected to the current pandemic, the inflammatory state. 2020 Apr 28. symptoms have been observed in both children who have tested positive Symptoms are doi:10.1136/bmj.m1710 and negative for COVID-19. It is noted that the cases have in common consistent with severe “overlapping features of toxic shock syndrome and atypical Kawasaki disease COVID-19 but have with blood parameters consistent with severe COVID-19 in children.” been observed in both Abdominal pain and gastrointestinal symptoms were also reported as COVID-19 positive and common features, as well as cardiac inflammation. negative children. Children, 28-Apr-20 Sheltering in Place Pediatrics Perspectives One in four children (more than 18 million) in the U.S. lives in an immigrant The COVID-19 Cholera R, Falusi OO, Linton immigrant in a Xenophobic family, in which the child or at least one parent was born outside the U.S. pandemic exacerbates JM. Sheltering in Place in a families, health Climate: COVID-19 Children in immigrant families (CIF) experience increased health and social health inequities Xenophobic Climate: COVID- insurance and Children in risks compared to peers in non-immigrant families, including lower rates of experienced my 19 and Children in Immigrant coverage, Immigrant Families health insurance coverage and higher poverty levels. The COVID-19 children in immigrant Families [published online, Medicaid pandemic amplifies existing inequities and introduces new ones. One in families, 2020 Apr 28]. Pediatrics. three undocumented children are uninsured, and millions of CIF remain disproportionately 2020. ineligible for Medicaid. Parental limited English proficiency remains a risk affected by lower doi:10.1542/peds.2020-1094 factor for poor health outcomes among children, including less diagnostic health insurance testing and higher rates of complications and adverse events. coverage. Pregnancy, 28-Apr-20 Clinical Science Short In this retrospective study, five pregnant women were admitted between Five neonates, born to Xu L, Yang Q, Shi H, et al. neonates, Presentations and Bulletin Communication January 21 and February 9, 2020 to Wuhan Union Hospital. All patients were mothers with Clinical presentations and cesarean Outcomes of SARS- >34 weeks' gestation and presented with fever or respiratory symptoms. All confirmed COVID-19 in outcomes of SARS-CoV-2 section, China CoV-2 Infected were SARS-CoV-2 positive, confirmed by real-time RT-PCR and developed Wuhan, China, tested infected pneumonia in Pneumonia in mild pneumonia during the course of hospitalization. Four patients delivered negative for SARS- pregnant women and health Pregnant Women by cesarean section, and one delivered vaginally. Neonates were separated CoV-2 infection in status of their neonates and Health Status from their mothers at birth, without breastfeeding. There were no throat swab samples. [published online, 2020 Apr of Their Neonates respiratory symptoms observed in neonates, and all tested negative on 28]. Sci Bull (Beijing). 2020. SARS-CoV-2 RT-PCR, using throat swab specimens collected at zero (1/5), doi:10.1016/j.scib.2020.04.04 one (2/5), or eight (2/5) days after birth. 0

9 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Pregnancy, 28-Apr-20 General Guidelines American Clinical Opinion Data regarding COVID-19 in pregnancy are limited to case reports and small This commentary Stephens AJ, Barton JR, labor and in the Management Journal of cohort studies. Clinical protocols and practice on labor and delivery units outlines Bentum NA, et al. General delivery, of an Obstetrical Perinatology must adapt to optimize the safety of patients and health care workers and to recommendations for Guidelines in the intrapartum Patient on the better conserve resources. In this commentary, authors provide suggestions adapting labor and Management of an management Labor and Delivery to meet these goals without impacting maternal or neonatal outcomes. They delivery units to the Obstetrical Patient on the Unit During the consider delivery planning, intrapartum management, use of medications COVID-19 context. Labor and Delivery Unit COVID-19 Pandemic like corticosteroids, magnesium sulfate, and NSAIDs. during the COVID-19 Pandemic [published online, 2020 Apr 28]. Am J Perinatol. 2020. doi:10.1055/s-0040- 1710308 Breast feeding, 27-Apr-20 To breastfeed or Revista Review Article These authors performed a rapid systematic review to evaluate the These authors Martins-Filho PR, Santos VS, pneumonia, not to breastfeed? Panamerican evidence, as of 21 April 2020, on the presence of SARS-CoV-2 in breast milk performed a rapid Santos HP Jr. To breastfeed viral, virus Lack of evidence on a de Salud from women with COVID-19. They found 8 studies analyzing the presence of systematic review to or not to breastfeed? Lack of diseases the presence of Publica (Pan SARS-CoV-2 RNA in the breast milk of 24 women with COVID-19 during the evaluate the evidence, evidence on the presence of SARS-CoV-2 in American third trimester of pregnancy. All patients had fever and/or acute respiratory as of 21 April 2020, on SARS-CoV-2 in breastmilk of breastmilk of Journal of symptoms and chest CT images indicative of COVID-19 pneumonia. Most the presence of SARS- pregnant women with pregnant women Public pregnant women had C-sections (n = 22, 91.7%) and 2 neonates (8.3%) had CoV-2 in breast milk COVID-19. Rev Panam Salud with COVID-19 Health) low birthweight (< 2500 g). Biological samples collected immediately after from women with Publica. 2020 Apr 27;44:e59. birth from the upper respiratory tract of neonates and placental tissues COVID-19. From 8 doi: 10.26633/RPSP.2020.59. were negative for SARS-CoV-2 by RT-PCR testing. No breast milk samples studies including 24 PMID: 32454808; PMCID: were positive for SARS-CoV-2. The authors share recommendations from the COVID-19 positive PMC7241574. CDC and WHO at the time of their writing; recommendations include women, no breast milk avoiding viral transmission to infants by wearing a mask and washing hands samples were positive and breasts with soap and water before breastfeeding. for SARS-CoV-2. Neonate, 27-Apr-20 COVID-19 and Pan Review Article This article aimed to describe perinatal and neonatal outcomes in newborns The authors describe Duran P, Berman S, clinical newborn health: American exposed to SARS-CoV-2. A systematic review was conducted by searching the perinatal and Niermeyer S, et al. COVID-19 presentation, systematic review Journal of PubMed Central, LILACS, and Google Scholar using the keywords 'covid ' neonatal outcomes in and newborn health: breastmilk, Public Health AND 'newborn' OR 'child' OR 'infant,' on March 18 2020, and again on April newborns exposed to systematic review. Rev vertical 17 2020. 20 articles met the inclusion criteria comprised of data on 222 SARS-CoV-2, Panam Salud Publica. 2020 transmission newborns with mothers who were either suspected or confirmed to be highlighting that the Apr 27;44:e54. doi: SARS-CoV-2 positive perinatally (17 studies) or newborns referred to hospital majority of cases are 10.26633/RPSP.2020.54. with infection/pneumonia (3 studies). Of the 222 newborns (>17 days old), mild with little to no 13 were reported as positive for SARS-CoV-2. Most of the studies reported symptoms. mild to no symptoms and no adverse perinatal outcomes. However, there Additionally, they were some instances where positive newborns had moderate to severe state negative SARS- clinical characteristics, and radiographic imaging reported pneumonia, CoV-2 results for increased lung marking, thickened texture, or high-density nodular shadow. breastmilk and advise Studies that tested breastmilk reported negative SARS-CoV-2 results. The that abstaining from authors state that the vertical transmission could not be confirmed or breastfeeding is not denied at the study time. Additionally, they state that the current literature supported by the does not support abstaining from breastfeeding nor separating mothers and literature. newborns. Pregnancy, 27-Apr-20 Coronavirus Disease International Research Article This study aims to compare clinical course and outcomes between pregnant Pregnant women have Qiancheng X, Jian S, Lingling reproductive- 2019 in Pregnancy Journal of and reproductive-aged non-pregnant women with COVID-19, hospitalized comparable clinical P, et al. Coronavirus disease age women, Infectious from January 15 to March 15, 2020. Eighty-two patients (28 pregnant course and outcomes 2019 in pregnancy [published neonates, Diseases women, 54 reproductive-aged non-pregnant women) with laboratory compared with online, 2020 Apr 27]. Int J 10 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication vertical confirmed COVID-19 were enrolled. Univariate regression indicated no reproductive-aged Infect Dis. 2020. transmission, association between pregnancy and the severity of disease (OR 0.73, 95% CI non-pregnant women doi:10.1016/j.ijid.2020.04.06 delivery 0.08-5.15; p=0.76), virus clearance time (HR 1.16, 95% CI 0.65-2.01; p=0.62), when infected with 5 methods, China and length of hospital stay (HR 1.10, 95% CI 0.66-1.84; p=0.71). There were SARS-CoV-2. No 22 pregnant women who delivered 23 live births either by cesarean section evidence supported (17, 60.7%) or vaginal delivery (5, 17.9%), and no neonate was infected with vertical transmission SARS-CoV-2. of COVID-19 in the late stage of pregnancy in this study. Nutritional 27-Apr-20 Nutritional Status Clinical Rapid Report Mortality appears to be highest among older people and those with Treatment for Mehta S. Nutritional status status, and COVID-19: An Medicine comorbidities, who are also often the most at risk of undernutrition in undernutrition may be and COVID-19: an undernutrition, Opportunity for Journal society. Despite international efforts to identify a specific treatment, therapy a cost-effective opportunity for lasting general Lasting Change? remains supportive and is principally focused on optimizing respiratory method of improving change? [published online, population, function. However, the timely identification and correction of undernutrition outcomes of COVID-19 2020 Apr 27]. Clin Med hospitalized also have the potential to improve outcomes cost effectively and should not patients. (Lond). 2020. patients be forgotten. This report outlines why nutritional status may be particularly doi:10.7861/clinmed.2020- compromised during this crisis, among both the population and hospital 0187 inpatients. Practical steps to improve nutritional status at a time when hospital services are overwhelmed are also considered. Infant, fever, 27-Apr-20 COVID-19: Fever Anales de Case Report This case report describes a 26-day-old male who was brought to the A COVID-19 positive Chacón-Aguilar R, Osorio- neurologic Syndrome and Pediatría emergency department (ED) after experiencing 2 paroxysmal episodes. The infant initially Cámara JM, Sanjurjo-Jimenez manifestations, Neurological first episode manifested with upward eye rolling and generalized hypertonia presented with fever I, González-González C, hypertonia, Symptoms in a lasting several minutes and associated with a feeding. The second episode and neurologic López-Carnero J, Pérez- Spain Neonate manifested with generalized hypertonia and facial cyanosis lasting several manifestations. The Moneo-Agapito B. COVID-19: minutes during sleep. On presentation to the ED, the infant had fever, nasal neurotropic properties Fever syndrome and discharge, and vomiting. The infant was exclusively breastfed and had of SARS-CoV-2 virus neurological symptoms in a adequate weight. Given the presence of fever with neurologic warrant further neonate [published online, manifestations, empirical antibiotic therapy was initiated until cultures attention and 2020 Apr 27]. An Pediatr yielded negative results. Blood, urine, cerebrospinal fluid and stool cultures research. (Engl Ed). 2020. were negative, and the stool was negative for RSV and influenza A and B doi:10.1016/j.anpede.2020.0 viruses. The PCR test for SARS-CoV-2 detection was positive. The infant was 4.001 discharged after 6 days, without evidence of convulsive seizures. Previous studies have demonstrated the neurotropic properties of coronaviruses, including in children <6 years old. However, the pathogenesis of febrile seizures is not directly related to the neuro-invasiveness of coronaviruses, so further research is required to understand their role in seizure etiology. Age-related 27-Apr-20 Additional Acta Letter Authors present additional hypotheses in order to address lower incidence This letter discusses Ruggiero A, Attinà G, susceptibility, Hypotheses About Paediatrica and milder clinical manifestation of COVID-19 in children. Aging is associated progressive reduction Chiaretti A. Additional adaptive Why COVID-19 Is with a progressive decline in normal immune functioning, associated with in thymic output as a hypotheses about why immunity, Milder in Children natural involution of the thymus leading to decline in naive T cell output. possible explanation COVID-19 is milder in lymphocyte Than Adults Lower adaptive immunity is considered to be the leading cause of morbidity for age-related children than adults count, CD8 T and mortality in the elderly. In particular, CD8 T cells appear to be more susceptibility to [published online, 2020 Apr cells susceptible to age-related reduction. Low T lymphocyte count in patients COVID-19. 27]. Acta Paediatr. 2020. with COVID-19, based on emerging data, suggest the role of immune doi:10.1111/apa.15328 dysregulation in the pathogenesis of disease.

11 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Pregnancy, 27-Apr-20 Infections in Archives of Review This report analyzes the effect of infection with respiratory RNA viruses on Intrauterine Schwartz DA, Dhaliwal A. vertical Pregnancy with Pathology & pregnancy and examines the frequency of maternal-fetal transmission with transmission of SARS- Infections in Pregnancy with transmission, COVID-19 and Laboratory SARS-CoV-2, SARS, MERS, influenza, respiratory syncytial virus (RSV), CoV-2 has not been COVID-19 and Other respiratory RNA Other Respiratory Medicine parainfluenza (HPIV) and metapneumovirus (hMPV). There have been no confirmed thus far. Respiratory RNA Virus viruses, RNA Virus Diseases confirmed cases of intrauterine transmission reported with COVID-19 or any Similar to other Diseases Are Rarely, If Ever, coronaviruses Are Rarely, If Ever, other coronavirus infections. Influenza virus, despite causing approximately respiratory RNA Transmitted to the Fetus: Transmitted to the one billion annual infections globally, has only a few cases of confirmed or viruses, including Experiences with Fetus: Experiences suspected intrauterine fetal infections reported. RSV is in an unusual cause coronaviruses like Coronaviruses, HPIV, hMPV with Coronaviruses, of illness among pregnant women, and with the exception of one premature SARS and MERS, RSV, and Influenza [published HPIV, hMPV RSV, infant with congenital pneumonia, no other cases of maternal-fetal infection maternal-fetal online, 2020 Apr 27]. Arch and Influenza are described. HPIV and hMPV can produce symptomatic maternal transmission would be Pathol Lab Med. 2020. infections but do not cause intrauterine fetal infection. In summary, it a rare event. doi:10.5858/arpa.2020-0211- appears that the absence of maternal-fetal transmission of SARS-CoV-2, as SA reported thus far, is similar to other coronaviruses, and is also consistent with the extreme rarity of suggested or confirmed cases of intrauterine transmission of other respiratory RNA viruses. Pregnancy, 27-Apr-20 Vaginal Delivery in BJOG: An Main Research This retrospective study enrolled 42 pregnant women with COVID-19, who Findings from this Ferrazzi E, Frigerio L, Savasi V, vaginal SARS-CoV-2 International Article were admitted to 12 participating centers in northern Italy and delivered study suggest that et al. Vaginal delivery in delivery, Infected Pregnant Journal of between March 1-20, 2020. Twenty-four (57.1%, 95% CI: 41.0-72.3) women vaginal delivery is SARS-CoV-2 infected neonatal Women in Northern Obstetrics & delivered vaginally. An elective cesarean section was performed in 18/42 associated with low pregnant women in Northern infection, Italy: A Gynecology (42.9%, 95% CI: 27.7-59.0) cases––in 8 cases the indication was unrelated to risk of intra-partum Italy: a retrospective analysis vertical Retrospective COVID-19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI: SARS-CoV-2 [published online, 2020 Apr transmission, Analysis 29.8-61.3) cases. Of these, 7/19 (36.8%, 95% CI: 16.3-61.6) required oxygen transmission. Two 27]. BJOG. 2020. breastfeeding, support and 4/19 (21.1%, 95% CI: 6.1-45.6) were admitted to a critical care neonates, born to doi:10.1111/1471- Italy unit. In 10 cases, breastfeeding was permitted. Two women breastfed mothers who were 0528.16278 without a mask because COVID-19 was diagnosed in the post-partum period; diagnosed with their newborns tested positive for SARS-CoV-2 infection. In another case, a COVID-19 postpartum newborn was vaginally delivered and immediately separated from his and did not wear mother, who developed severe postpartum hemorrhage. Within a few masks while hours, the newborn developed gastrointestinal symptoms, and after three breastfeeding, tested days he developed respiratory symptoms and was transferred to the NICU positive for SARS-CoV- where he recovered after one day of mechanical ventilation. The first 2. Other breastfed newborn test for SARS-CoV-2 was equivocal a few hours after delivery, but infants, whose positive three days later. The mother did not breastfeed. No associated mothers wore a mask, health care providers had a confirmed diagnosis of COVID-19 infection. No tested negative. other positive SARS-CoV-2 test was found among the newborns. Pediatrics, 27-Apr-20 Challenges for the The Pediatric Letter to the Apart from the management of febrile children, pediatricians will also have This letter raises Gkentzi D, Karatza A, neonates, fetal Pediatricians During Infectious Editor to face challenges of SARS-CoV-2 infection during the neonatal period. The important areas of Dimitriou G. Challenges for development, the Coronavirus Disease first priority is identifying the timing of infection (antenatally, perinatally or uncertainty, related to the Pediatricians During the breastfeeding Disease 2019 Journal postnatally) and confirming its presence. In the potential case of a neonate fetal and neonatal Coronavirus Disease 2019 (COVID-19 infected in utero, the timing of infection may impact fetal development and SARS-CoV-2 infection. (COVID-19 Coronavirus Coronavirus Disease possibly longer-term outcomes. It is unknown whether acquisition of COVID- Disease 2019) Pandemic Start 2019) Pandemic 19 during the first trimester of pregnancy is associated with birth defects, or From the Neonatal Period Start From the whether fetal infection is more likely in advanced pregnancy stages, similar [published online, 2020 Apr Neonatal Period to other congenital infections. It is also uncertain whether two tests are 27]. Pediatr Infect Dis J. 2020. enough to rule out neonatal infection, given that serology is not always doi:10.1097/INF.0000000000 002713 12 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication reliable. Guidelines on separation of infected mother and neonate and feeding options are mixed. Nosocomial 27-Apr-20 First Reported Clinical Major Article Authors report a nosocomial outbreak of SARS-CoV-2 infections in the A nosocomial Schwierzeck V, König JC, infection, Nosocomial Infectious pediatric dialysis unit of the University Hospital of Münster (UHM) in outbreak of COVID-19 Kühn J, et al. First reported healthcare Outbreak of Severe Diseases Germany. Forty-eight cases (28 healthcare workers (HCWs), 13 patients with at a pediatric dialysis nosocomial outbreak of workers, Acute Respiratory chronic kidney disease, and 7 accompanying persons (ACP)) were involved in in Germany was severe acute respiratory exposure- Syndrome this outbreak. After contact with the index case, 9 contact cases (7 HCWs, 1 largely due to syndrome coronavirus 2 based risk Coronavirus 2 patient, 1 ACP) developed real-time RT-PCR confirmed COVID-19 infections. transmission between (SARS-CoV-2) in a pediatric classification, (SARS-CoV-2) in a Two SARS-CoV-2 positive cases remained clinically asymptomatic. Eleven patients and dialysis unit [published infection Pediatric Dialysis cases reported flu-like symptoms without positive results. Threshold cycle healthcare workers online, 2020 Apr 27]. Clin control Unit values were significantly lower in cases presenting typical COVID-19 (HCWs). Strategies Infect Dis. 2020. measures, symptoms, compared to asymptomatic cases, suggesting high viral shedding must be developed to doi:10.1093/cid/ciaa491 pediatric (p =0.007). Person-to-person transmission was at the heart of a hospital trace and monitor dialysis, outbreak of SARS-CoV-2 between HCWs and patients in the pediatric dialysis SARS-CoV-2 infected Germany unit at the UHM. RT-PCR results suggest that individuals with high viral load HCWs, in order to pose a risk to spread SARS-CoV-2 in the hospital setting. prevent COVID-19 outbreaks in the hospital setting. Pregnancy, lung 26-Apr-20 Clinical Role of Lung Ultrasound Case Series Although chest CT is the current gold standard to assess lung involvement, Lung ultrasound is a Buonsenso D, Raffaelli F, ultrasound, Ultrasound for the Obstetrics & with a specificity superior to the nasopharyngeal swab for diagnosis, lung useful tool to assess Tamburrini E, et al. Clinical point-of-care Diagnosis and Gynecology ultrasound (LUS) can be a valid alternative, with some particular advantages and monitor lung role of lung ultrasound for ultrasound, Monitoring of for pregnant women. Indeed, LUS can be performed directly at bedside by a involvement in the diagnosis and monitoring neonates, Italy COVID-19 single operator, reducing the risk of person-to-person transmission among pregnant patients with of COVID-19 pneumonia in Pneumonia in health professionals, and is a radiation-free exam, which is favored for serial COVID-19. pregnant women [published Pregnant Women exams. In the present study, authors report four cases of pregnant women, online, 2020 Apr 26]. with COVID-19 infection, who have been monitored via LUS. Patients Ultrasound Obstet Gynecol. showed LUS features indicative of COVID-19 pneumonia at admission: 2020. doi:10.1002/uog.22055 irregular pleural lines and vertical artifacts (B-lines) were observed in all four cases, whereas patchy areas of white lung were observed in two cases. LUS was more sensitive than chest X-ray in detecting COVID-19. Three patients had resolution of lung pathology on LUS, 96 hours after admission. Two pregnancies are ongoing, and two patients had cesarean delivery with no fetal complications. PCR testing of cord blood and newborn nasopharyngeal swabs were negative in both cases. Children, 26-Apr-20 Coronavirus Disease Indian Correspondence Authors highlight possible explanations for the lower prevalence of COVID- Exposure to various Unni JC. Coronavirus Disease immunization, (COVID-19) With Pediatrics 19 in India. In particular, the protective effect of BCG vaccination must be pathogens and early (COVID-19) With Relevance BCG vaccine, Relevance to considered in countries where almost universal BCG vaccination is practiced immunizations in India to Pediatrics [published seroconversion, Pediatrics and fewer COVID-19 cases have been reported. It is well-known that may contribute to online, 2020 Apr 26]. Indian India seroconversion to oral polio vaccine (OPV) and rotavirus vaccine has been greater immune Pediatr. poor in India, compared to the developed world. Frequent viral infections defense in Indian 2020;S097475591600164. that likely prevent a new virus from getting a "foothold," early children, possibly immunizations, and exposure to both atypical and typical bacterial and explaining lower rates fungal infections may expose children in India to various antigens, of SARS-CoV-2 contributing to effective immune defense. infection.

13 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Children, 26-Apr-20 Do Not Neglect the Indian Correspondence This brief correspondence provides an overview of various issues concerning This correspondence Naseri A, Hosseini MS. Do neonates, Children: Pediatrics children during the COVID-19 pandemic. These include clinical course of from Indian authors Not Neglect the Children: breastfeeding, Considerations for disease, reasons behind lower prevalence of COVID-19 among children promotes indirect Considerations for COVID-19 India COVID-19 Pandemic compared to adults, asymptomatic transmission, breast feeding, and the breastfeeding for Pandemic [published online, effects of lockdown on children's mental and physical health. COVID-19 positive 2020 Apr 26]. Indian Pediatr. mothers. 2020;S097475591600165. Child, infant, 26-Apr-20 Does a Crying Child Indian Correspondence Aerosol is defined as suspension of fine solid particles or liquid droplets in air Screaming and crying Sivabalan S, Srinath MV. Does neonate, Enhance the Risk Pediatrics or another gas. Aerosols of varying severity are generated by sneezing, in young infants with a Crying Child Enhance the crying, for COVID-19 coughing, talking, and during normal breathing. Crying or screaming in COVID-19 may Risk for COVID-19 screaming, Transmission? children is another potential aerosol generating procedure. Related points to increase the risk of Transmission? [published aerosol consider: infants and toddlers who arrive for routine vaccinations can be aerosol load and online, 2020 Apr 26]. Indian generating asymptomatic or pre-symptomatic; implementing source control measures transmission. Pediatr. procedure, are difficult in this age group; crying may increase the risk of aerosol 2020;S097475591600166. transmission generation; and young children are often in close proximity to caregivers. Children, 26-Apr-20 Coronavirus Disease Indian Correspondence From the point of epidemiology, there is under-sampling and under- Authors comment on Senthilkumaran S, epidemiology, (COVID-19) in Pediatrics reporting of COVID-19 in children due to under-testing. From a physiological the epidemiology and Meenakshisundaram R, Shah physiology, Children: Indian perspective, a higher frequency of beating lung cilia in children hinders viral clinical course of S, Thirumalaikolundus- judiciary Perspectives entry into lung pneumocytes and may explain an uneventful clinical course COVID-19 in children, ubramanian P. Coronavirus system, India of COVID-19 in children. Decreased thrombin and fibrin formation, less as well as recent Disease in Children: Indian comorbidities, and increased ACE2 expression in pediatric lungs may further contributions of the Perspectives [published explain low risk for COVID-19 associated ARDS. Recently, the Indian judiciary Indian judiciary to the online, 2020 Apr 26]. Indian has shifted attention towards the care of marginalized children, including health of children Pediatr. those in foster and kinship care, during the pandemic. during the pandemic. 2020;S097475591600167. Maternal 25-Apr-20 Forecasting the American Original Research Pregnancy and delivery pose unique challenges during the COVID-19 The authors used a Putra M, Kesavan M, mortality, impact of Journal of pandemic, given the altered maternal immune system and the fact that phenomenological Brackney K, et al. Forecasting forecasting, coronavirus disease Obstetrics & most American women choose to deliver in the hospital setting. This study model to forecast the the impact of coronavirus prediction during delivery Gynecology used a phenomenological model to forecast the first pandemic wave of first pandemic wave of disease during delivery model, USA hospitalization: an MFM COVID-19 (March - September 2020) in the US population and the incidence COVID-19 (March - hospitalization: an aid for aid for resource of severe, critical, and fatal COVID-19 cases during delivery hospitalization. September 2020) in resource utilization utilization The model forecasted a total of 860,475 cases of COVID-19 in the US by mid- the general population [published online, 2020 Apr September 2020, with a cumulative incidence of COVID-19 during delivery and the incidence of 25]. Am J Obstet Gynecol hospitalization of 16,601 (95% CI, 9711–23,491) cases, 3308 (95% CI, 1755– severe, critical, and MFM. 2020;2(3):100127. 4861) cases of which are expected to be severe, 681 (95% CI, 1324–1038) fatal COVID-19 cases doi:10.1016/j.ajogmf.2020.10 critical, and 52 (95% CI, 23–81) fatal. Assuming similar baseline maternal during delivery 0127 mortality rate as the year 2018, the authors projected an increase in hospitalization in the maternal mortality rate in the US to at least 18.7 (95% CI, 18.0-19.5) deaths US. The authors per 100,000 live births as a direct result of COVID-19. The model used to anticipated an produce these results may be useful in informing resource allocation for any increased maternal potential second wave. mortality rate of 18.7 deaths per 100,00 live births as a result of COVID-19. The model used to produce these results may be useful in informing resource allocation for any

14 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication potential second wave. Complement, 25-Apr-20 Analysis of Annals of Original Research SARS-CoV-2 may represent a systemic thrombotic and microvascular injury This study suggests Mulvey JJ, Magro CM, Ma LX, thrombosis, complement Diagnostic syndrome arising from immune complement activation. The authors that the thrombosis in Nuovo GJ, Baergen RN. pregnancy, deposition and viral Pathology examined the histology and complement deposition in five placentas from COVID-19 infections Analysis of complement placenta, USA RNA in placentas of full-term births to COVID-19 patients at New York Presbyterian Hospital, may be due to deposition and viral RNA in COVID-19 patients New York, USA. Of the five cases, two mothers had documented fevers and systemic effects rather placentas of COVID-19 one mother had a sore throat and mild cough. All the cases resulted in than aberrant patients. Ann Diagn Pathol. healthy deliveries. These were compared to five control placentas collected activation of the 2020;46:151530. prior to 2019. Histological evaluation of the five case placentas showed complement system. doi:10.1016/j.anndiagpath.20 evidence of fetal vascular malperfusion and thrombosis within the vessels of However, additional 20.151530 the chorionic plate and stem villi. There was no evidence of complement research is needed to staining (C3d, C4d, and C5b-9) within the larger thrombosed vessels of the understand how COVID-19 exposed placentas, and the distribution of complement staining COVID-19 may impact was similar between the case and control placentas. Additionally, there was women with a only rare staining for the viral spike protein and viral RNA within the COVID- predisposing 19 placentas. These findings suggest that there was no direct viral infection thrombotic or of the placentas. Therefore, the effects of thrombosis could be systemic complement rather than due to the localized effects of the virus. regulation mutation during pregnancy. asymptomatic 24-Apr-20 Asymptomatic Journal of Case Report In this case report from early in the COVID-19 pandemic, the authors In this case report Lu D, Sang L, Du S, Li T, COVID-19 COVID-19 infection Medical investigate the clinical characteristics and outcomes of asymptomatic from early in the Chang Y, Yang XA. infection; in late pregnancy Virology COVID-19 in late pregnancy, and discuss the possibility of vertical SARS-CoV- COVID-19 pandemic, Asymptomatic COVID-19 intrauterine indicated no 2 transmission. In February 2020, a 22-year-old nulliparous pregnant woman the authors infection in late pregnancy vertical in China was tested for SARS-CoV-2 at 38 weeks' gestation, due to having investigate the clinical infection; late indicated no vertical transmission family members with COVID-19 pneumonia. Her test was positive, so the characteristics and pregnancy; transmission. J Med Virol. patient was admitted to the hospital. The patient had no COVID-19 outcomes of vertical symptoms, and vital signs and fetal ultrasound were normal. Lab tests asymptomatic COVID- 2020 Apr transmission; demonstrated hypoproteinemia, but no other abnormalities. Chest CT 19 in late pregnancy. 24:10.1002/jmv.25927. doi: China showed a small amount of bilateral pleural effusion. The patient had This case showed no 10.1002/jmv.25927. Epub irregular contractions on hospital day 3, and a C-section was performed indication of vertical ahead of print. PMID: under spinal-epidural anesthesia, in an isolation operating room. [No viral transmission. 32330313; PMCID: obstetric indications for this C-section are mentioned]. A female infant was PMC7264617. delivered uneventfully. Nasopharyngeal swabs, oropharyngeal swabs, and blood samples from the infant were all negative for SARS-CoV-2. Amniotic fluid, umbilical cord, and placenta were not tested. The infant was isolated from her mother for 14 days, and was not breastfed. The infant never had COVID-19 symptoms. On postpartum day 8, repeat chest CT on the mother again showed mild bilateral pleural effusion. The patient received umifenovir and recombinant human interferon, followed by 2 negative SARS-CoV-2 tests. The mother and infant were discharged to home on postpartum day 14. In this case of asymptomatic COVID-19 in late pregnancy, there was no indication of vertical viral transmission. COVID-19; 24-Apr-20 Consensus Pediatric Guidelines Children with kidney failure are at significant risk for COVID-19. In turn, this This article provides a Shen Q, Wang M, Che R, et al; Children; recommendations Nephrology article provides recommendations for the prevention and control of SARS- set of Chinese Society of Pediatric Dialysis; SARS- for the care of CoV-2 and COVID-19 in pediatric hemodialysis (HD) centers and in-home recommendations for Nephrology and Chinese CoV-2 children receiving peritoneal dialysis settings. Recommendations are based on the the prevention and Medical Doctor Association 15 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication chronic dialysis in epidemiological features of SARS-CoV-2 and COVID-19, susceptibility factors, control of SARS-CoV-2 of Pediatric Nephrology. association with the and preventive and control strategies. The factors associated with an and COVID-19 in Consensus recommendations COVID-19 epidemic increased risk of SARS-CoV-2 infection among pediatric chronic dialysis pediatric hemodialysis for the care of children patients include: (a) compromised immune system; (b) close proximity to centers and in-home receiving chronic dialysis in other patients in a confined HD unit; (c) frequent contact with healthcare peritoneal dialysis association with the COVID- workers caring for a variety of other patients; (d) increased risk of cluster settings. The 19 epidemic. Pediatr Nephrol. infection due to presence of parents or caregivers during treatment; and (e) recommendations are 2020 Jul;35(7):1351-1357. non-adherence to infection prevention practices. In the context of HD based on the doi: 10.1007/s00467-020- treatment, the authors recommend healthcare staff training, epidemic epidemiological 04555-x. Epub 2020 Apr 24. history surveillance, body temperature monitoring, hand hygiene, adequate features of SARS-CoV- PMID: 32333285; PMCID: rest, and adequate PPE use during HD treatment (2nd level for medical 2 and COVID-19, PMC7181108. observation cases, 3rd level for suspected or confirmed COVID-19 cases). susceptibility factors, Recommendations are also made regarding patient education, remote and preventive and medical care, surveillance, body temperature monitoring, and PPE use in the control strategies. context of in-home care. Disinfection protocols and infection control strategies for HD facility management are also discussed. These recommendations will be updated as new information regarding SARS-CoV-2 and COVID-19 becomes available. Mental health, 24-Apr-20 Mental Health JAMA Research Letter This study investigated depressive and anxiety symptoms among students in This study investigated Xie X, Xue Q, Zhou Y, et al. psychological Status Among Pediatrics Hubei province, China under the policy of school closure in order to help 1784 primary students Mental Health Status Among impacts, Children in Home optimize interventions on the mental health of children. A total of 2330 in Wuhan and Children in Home primary school, Confinement students in grade 2 through 6 in 2 primary schools in Hubei province, of Huangshi from Hubei Confinement During the children, school During the whom 845 were from Wuhan and 1485 were from Huangshi, were enrolled province, China, who Coronavirus Disease 2019 closure, policy, Coronavirus Disease between February 28th and March 5th, 2020. Their optimism about the were experiencing the Outbreak in Hubei Province, China 2019 Outbreak in epidemic, whether they worried about being infected by COVID-19, and school closure policy China. JAMA Pediatr. 2020 Hubei Province, depressive and anxiety symptoms were investigated. Among 2330 students, due to the COVID-19 Apr 24:e201619. doi: China 1784 participants (56.7% boys; 62.2% residing in Huangshi) completed the outbreak. This study 10.1001/jamapediatrics.2020 survey, Students had been restricted to home for a mean (SD) of 33.7 (2.1) showed 22.6% and .1619. days when they completed this survey. A total of 403 students (22.6%) and 18.9% of students 337 students (18.9%) reported depressive and anxiety symptoms, reported depressive respectively. Students in Wuhan had a greater risk of depressive symptoms and anxiety (OR= 1.426 [95% CI, 1.138-1.786]). The authors concluded that the symptoms, prevalence of depressive and anxiety symptoms was higher than that in respectively which some other surveys. They pointed out that this study cannot evaluate were higher than in whether the outcomes will be long-lasting after the COVID-19 outbreak and some other surveys. they would continue to follow up with these participants. Children, 24-Apr-20 Encephalitis Pediatric Letter to the Neurological complications associated with COVID-19 infection are not well How SARS-CoV-2 McAbee GN, Brosgol Y, encephalitis, Associated with Neurology Editor understood in children or adults. In preliminary data from US cases, affects the brain is not Pavlakis S, Agha R, Gaffoor M. neurological COVID-19 Infection headache was the only neurological symptom. This case report describes an known, and there is Encephalitis Associated with effects in an 11-Year-Old 11-year-old who presented with encephalitis. The EEG revealed frontal the possibility for COVID-19 Infection in an 11- Child intermittent delta activity and he tested positive for COVID-19 by multitude of Year-Old Child. Pediatr nasopharyngeal swab. He had a two-day history of generalized weakness neurological Neurol. 2020;109:94. without respiratory symptoms or fever at home. This is believed to be the complications. This doi:10.1016/j.pediatrneurol.2 first child reported with COVID-19 viral encephalitis, and the condition was case report studied an 020.04.013 reversible as the patient recovered without treatment in six days. The 11-year-old who findings suggest that a possible brain infection might be possible when SARS- initially presented CoV-2 affects the brain. An auto-immune process or a vascular process with with encephalitis and 16 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication clotting and infarction may also be possible. Although these findings may be was subsequently preliminary, the authors recommend screening children presenting with diagnosed with encephalitis for COVID-19 as infected patients require special precautions to COVID-19. prevent further spread. Children, 24-Apr-20 Clinical Features of Journal of Original Article This retrospective analysis included 16 children (11 months-14 years) Children with Song W, Li J, Zou N, Guan W, clinical Pediatric Patients Clinical diagnosed with COVID-19 between January 1, 2020 and March 17, 2020 at confirmed COVID-19 in Pan J, Xu W. Clinical features characteristics, With Coronavirus Virology Xiangyang Central Hospital, Hubei province, China. All children had positive Xiangyang city, China of pediatric patients with chest CT Disease (COVID-19) epidemiologic histories, 12 (12/16, 75%) involving family units. The illnesses often acquired coronavirus disease (COVID- abnormalities, were either mild (5/16, 31.3%) or ordinary (11/16, 68.8%), presenting as infection from family 19) [published online, 2020 China follows: asymptomatic (8/16, 50%), fever and/or cough (8/16, 50%). members and Apr 24]. J Clin Virol. 2020. Leukocyte counts were normal in 14 cases (88%), but 2 patients (12.5%) had experienced mild doi:10.1016/j.jcv.2020.10437 leukopenia, and 1 (6.3%) was lymphopenic. Four asymptomatic patients in disease with good 7 ordinary cases had chest CT abnormalities. In asymptomatic children, the prognosis. Chest CT median time to SARS-CoV-2 nucleic acid test (NAT) positivity, once exposed abnormalities were to a family member with confirmed infection, was 15.5 days (range, 10-26 noted in 4/8 days). The median time to first NAT-negative conversion was 5.5 days (range asymptomatic 1-23 days). children. Children, acral 24-Apr-20 Acral Cutaneous Journal of Letter to Editor Authors report on peculiar (perniosis-like) skin lesions observed in young In Italy, perniotic skin Recalcati S, Barbagallo T, lesions, Lesions in the Time the outpatients who visited the Dermatologic Unit of an Italian hospital, in the lesions were observed Frasin LA, et al. Acral cutaneous of COVID-19 European last 4 weeks of the COVID-19 pandemic (March-April 2020). Fourteen cases, in a series of young cutaneous lesions in the Time manifestations, Academy of including 11 children (average: 14.4 years, range: 13-18) and 3 young adults outpatients, during of COVID-19 [published Italy Dermatology (average: 29 years, range: 23-39) were observed in this case series. The the COVID-19 online, 2020 Apr 24]. J Eur and cutaneous manifestations consisted of an acral eruption of erythemato- pandemic between Acad Dermatol Venereol. Venereology violaceous papules and macules, with possible bullous evolution, or digital March-April 2020. 2020. doi:10.1111/jdv.16533 swelling. Lesions were localized on the feet in 8 cases, on the hands in 4 These lesions may cases, on both sites in 2. No systemic symptoms were reported, except mild represent late itch in 3 cases. Lesions resolved after 2-4 weeks without treatment. Both manifestations of nasopharyngeal (3 patients) and rectal swabs (2 patients) for COVID-19 COVID-19 in yielded negative results. Nevertheless, authors argue that the clustering of asymptomatic unusual lesions and their temporal relationship with the COVID-19 pandemic individuals. strongly support the hypothesis that skin involvement may be a late manifestation of COVID-19. Children, young 24-Apr-20 Chilblain-like International Commentary A series of dermatological findings associated with SARS-CoV-2 infection Dermatologists in Landa N, Mendieta-Eckert M, adults, Lesions on Feet and Journal of have emerged in Spain. Most patients are children (median: 13 years) and Spain have noted an Fonda-Pascual P, Aguirre T. cutaneous Hands During the Dermatology young adults (median: 31, range: 18-91 years). The lesions are initially emergence of Chilblain-like lesions on feet lesions, COVID-19 Pandemic erythematous and popular, resembling chilblains. Subsequently, in the span chilblain-like lesions, and hands during the COVID- chilblain, Spain of 1 week, they become purpuric and flattened. Finally, they appear to primarily in children 19 Pandemic [published resolve on their own, without requiring treatment. Patients do not show and young adults; online, 2020 Apr 24]. Int J signs of Raynaud's disease or ischemia. Although there is some referred their association with Dermatol. 2020. discomfort or pain when palpated, the skin lesions are not very SARS-CoV-2 infection doi:10.1111/ijd.14937 symptomatic. The majority of patients do not present with COVID-19 remains to be symptoms or significant respiratory conditions. In a case series of 6 patients confirmed. with cutaneous lesions reported in this commentary, 2 tested positive for SARS-CoV-2 infection by RT-PCR. In 3 patients, COVID-19 testing was not performed, and 1 patient tested negative. Confirmatory testing is required to corroborate the association of these chilblain-like lesions with COVID-19.

17 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Children, 24-Apr-20 Chilblain‐like Journal of Letter to Editor Authors noticed an outbreak of chilblain‐like lesions in Italy contemporarily A pattern of chilblain- Piccolo V, Neri I, Filippeschi C, adolescents, lesions during the to COVID‐19 epidemic. A Google form was created to rapidly collect like, cutaneous lesions et al. Chilblain-like lesions cutaneous COVID‐19 epidemic: European information about patients presenting with these singular clinical findings. in otherwise healthy during COVID-19 epidemic: a lesions, a preliminary study Academy of Preliminary results from 63 patients are presented in this report. The adolescents were preliminary study on 63 chilblain, Italy on 63 patients Dermatology median age was 14 years (IQR: 12-16 years). Feet alone were mostly observed in the midst patients [published online, and affected (85.7%) followed by feet/hands together (7%) and hands alone of the COVID-19 2020 Apr 24]. J Eur Acad Venereology (6%). 31/54 presented with erythematous-edematous lesions and 23/54 pandemic in Italy. Dermatol Venereol. 2020. with blistering lesions. Pain and itch were equally observed. Median time doi:10.1111/jdv.16526 from the onset to clinical diagnosis was 10 days (IQR: 6-15 days). Information about COVID-19 status was available in a minority of cases: 2/63 patients had positive swabs and serology. While primary chilblains are notoriously due to exposure to low temperature, secondary chilblains could be associated with several diseases, such as autoimmune disorders (chilblain lupus), hematologic disorders, and rarely viral infections. Pregnancy, 24-Apr-20 Protection by Obstetrics & Commentary Governmental institutions and pharmaceutical companies are racing to find Without clear Costantine MM, Landon MB, exclusion Exclusion: Another Gynecology therapeutics and vaccines that target COVID-19. However, pregnant and justification for Saade GR. Protection by criteria, clinical Missed Opportunity breastfeeding women are excluded from participating in clinical trials during exclusion, clinical trials Exclusion: Another Missed trial, to Include Pregnant this pandemic. This "protection by exclusion" of pregnant women from drug to develop Opportunity to Include therapeutics, Women in Research development and clinical therapeutic trials, even during pandemics, is not therapeutics and Pregnant Women in Research vaccine During the unprecedented. Moreover, it is both misguided and not justifiable and may vaccines against During the Coronavirus development Coronavirus Disease have excluded them from potentially beneficial interventions. This is another COVID-19 should Disease 2019 (COVID-19) 2019 (COVID-19) missed opportunity to obtain pregnancy-specific safety and efficacy data, include pregnant Pandemic [published online, Pandemic because therapeutics developed for men and nonpregnant women may not women. 2020 Apr 24]. Obstet be generalizable to pregnant women. Therefore, authors recommend and Gynecol. 2020. urge the scientific community and professional societies that, without clear doi:10.1097/AOG.000000000 justification for exclusion, pregnant women should be given the opportunity 0003924 to be included in clinical trials for COVID-19 based on the concepts of justice, equity, autonomy, and informed consent. Pregnancy, 24-Apr-20 Neonatal Neonatology Review Controversy exists whether COVID-19 can be transmitted in utero and lead This report presents a Trevisanuto D, Moschino L, perinatal Resuscitation to disease in the newborn. As this chance cannot be ruled out, strict checklist on Doglioni N, et al. Neonatal period, Where the Mother instructions for the management of mothers and newborn infants are management of Resuscitation Where the neonatal Has a Suspected or mandatory. This perspective aims to be a practical support tool for the mothers with Mother Has a Suspected or resuscitation Confirmed Novel planning of delivery and neonatal resuscitation of infants born by mothers suspected or Confirmed Novel Coronavirus Coronavirus (SARS- with suspected or confirmed COVID-19 infection. confirmed COVID-19 (SARS-CoV-2) Infection CoV-2) Infection: and their infants [published online, 2020 Apr Suggestion for a before, during, and 24]. Neonatology. 2020;1–8. Pragmatic Action after delivery. doi:10.1159/000507935 Plan Pregnancy, 24-Apr-20 Severe Acute Obstetrics & Research Letter Authors report seven cases of confirmed COVID-19 during late pregnancy 1 out of 7 neonates, Hu X, Gao J, Luo X, et al. neonate, Respiratory Gynecology and neonatal outcomes, observed from January 20 to February 20, 2020. born to mothers with Severe Acute Respiratory vertical Syndrome Prior to COVID-19 diagnosis, six of the pregnancies had been uneventful, and confirmed COVID-19 in Syndrome Coronavirus 2 transmission, Coronavirus 2 one had presented with liver dysfunction. No mother experienced clinical late pregnancy, tested (SARS-CoV-2) Vertical amniotic fluid (SARS-CoV-2) deterioration, and there were no delivery-related complications. Amniotic positive for SARS-CoV- Transmission in Neonates samples, China Vertical fluid samples were obtained at delivery and were negative by PCR testing. 2 infection in throat Born to Mothers With Transmission in Cesarean delivery was performed for all but one woman, who delivered swabs, suggesting the Coronavirus Disease 2019 Neonates Born to vaginally. All neonates were tested within the first 24-36 hours of life, and potential for vertical (COVID-19) Pneumonia Mothers With [published online, 2020 Apr 18 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Coronavirus Disease one (14.3%) was positive for SARS-CoV-2 infection in throat swabs. The transmission, although 24]. Obstet Gynecol. 2020. 2019 Pneumonia neonates were isolated for 14 days and exclusively formula-fed. infrequent. doi:10.1097/AOG.000000000 0003926 Child, 24-Apr-20 A Child Confirmed Graefe's Letter to the Conjunctivitis symptoms have been found in a minority of adult patients, SARS-CoV-2 infection Wu P, Liang L, Chen C, Nie S. conjunctivitis, COVID-19 With Archive for Editor with positive results of SARS-CoV-2 nucleic acid in conjunctival swab of ocular tissues has A child confirmed COVID-19 dermatitis, Only Symptoms of Clinical and samples. This letter describes the first report of conjunctivitis and eyelid been linked to with only symptoms of conjunctival Conjunctivitis and Experimental dermatitis in a 2-year-old child, 7 days after confirming COVID-19 infection conjunctivitis conjunctivitis and eyelid samples, ACE2 Eyelid Dermatitis Ophthal- through community screening with SARS-CoV-2 detected in nasopharyngeal symptoms in adults dermatitis [published online, receptor, China mology swabs. It is not specified whether conjunctival samples from the child were with COVID-19. This 2020 Apr 24]. Graefes Arch tested. Studies have shown that ACE2 receptors are expressed in cornea and study describes ocular Clin Exp Ophthalmol. 2020. conjunctiva, thus the ocular symptoms in this child could have been caused symptoms in a child doi:10.1007/s00417-020- by SARS-CoV-2 viral infection or by secondary bacterial infection. with COVID-19, but 04708-6 conjunctival samples were not tested. Children, 24-Apr-20 Updated diagnosis, World Review Article In the early February 2020, an experts' committee with more than 30 This is the second Shen KL, Yang YH, Jiang RM, diagnosis, treatment and Journal of Chinese experts from 11 national medical academic organizations was edition of a consensus et al. Updated diagnosis, treatment, prevention of Pediatrics convened to formulate the first edition of consensus statement on statement on the treatment and prevention of prevention, COVID-19 in diagnosis, treatment and prevention of COVID-19 in children. With diagnosis, treatment COVID-19 in children: China children: experts' accumulated experiences in the diagnosis and treatment of COVID-19 in and prevention of experts' consensus statement consensus children, authors have updated the consensus statement and released the COVID-19 in children, (condensed version of the statement second edition (the current version in English is a condensed version). from over 30 Chinese second edition) [published (condensed version Diagnosis and treatment criteria have been optimized, and early experts. online, 2020 Apr 24]. World J of the second identification of severe and critical cases is highlighted. The early warning Pediatr. 2020. edition). indicators for severe pediatric cases have also been summarized. doi:10.1007/s12519-020- 00362-4 Febrile illness, 24-Apr-20 Diagnosing malaria The Lancet Comment While the Asia-Pacific region has made substantial progress against malaria, The COVID-19 Dittrich S, Lamy M, Acharya S, malaria, and other febrile Global with a 42% reduction in confirmed cases between 2010 and 2018, the pandemic jeopardizes Thu HK, Datta R, Blacksell SD. dengue fever, illnesses during the Health emergence of COVID-19 could undermine elimination efforts. Diagnosis of recent progress made Diagnosing malaria and other community COVID-19 pandemic fever in the Asia-Pacific region has always been a challenge due to the toward malaria febrile illnesses during the health workers, prevalence of many febrile diseases, including malaria and dengue fever, elimination in the COVID-19 pandemic Asia-Pacific now further complicated by the addition of COVID-19. Initial diagnosis of Asia-Pacific region. [published online, 2020 Apr region febrile disease in this region is commonly done by frontline community Frontline community 24]. Lancet Glob Health. health-care workers, but physical distancing measures are making it difficult health workers must doi:10.1016/S2214- to access patients with fever. WHO has clearly stated that ongoing malaria be supported to make 109X(20)30210-2 interventions must continue to ensure that elimination gains are not discriminative jeopardized. Adapted health-care packages that include pragmatic advice on diagnoses between PPE options, training on the use of triage tests such as respiratory rate COVID-19 and other measurements, and digital tools to support data collection and contact febrile illnesses that tracing could support health-care workers in their short-term tasks, as well are prevalent in the as build the foundation for more integrated fever management in the future. region. Existing clinical decision algorithms could also be adapted to consider local epidemiology, seasonal prevalence and severity of various febrile diseases, and relative accuracy of the available diagnostic tools. BCG 24-Apr-20 Is BCG Vaccination Allergy Letter to the The influence of infectious stimuli on the development of allergic disorders This speculative report Ozdemir C, Kucuksezer UC, vaccination, Effecting the Editor has been well investigated. In many countries, Bacillus Calmette Guerin considers the Tamay ZU. Is BCG vaccination innate Spread and Severity (BCG), a live attenuated vaccine, is administered routinely in the newborn relationship between effecting the spread and immunity, of COVID-19? period. Mycobacteria are previously reported to be potent Th1 stimulants, BCG vaccination, severity of COVID-19? 19 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication country-level, skewing an immune response toward a Th1 cytokine pattern. It is claimed shown to have a non- [published online, 2020 Apr hemisphere that BCG vaccination plays a non-specific protective role, through innate specific immune 24]. Allergy. 2020. immune cells, against non-related pathogens like viruses. This report found protective role, and doi:10.1111/all.14344 that mean COVID-19 cases per population ratio, mean COVID-19 deaths per COVID-19 cases and population ratio, and COVID-19 deaths per cases ratio were statistically deaths, on a country significantly lower in BCG-vaccinated countries (n=138) compared with BCG- level. non-vaccinated countries (n=37). Analyses were also performed between BCG-vaccinated and non-BCG-vaccinated countries, within hemispheres and within European countries only. Children, 24-Apr-20 SARS-CoV-2 Pediatric Review Article As the number of children with COVID-19 gradually increases, the disease This review describes Lu X, Xiang Y, Du H, Wing-Kin infants, Infection in Allergy and has been documented in premature babies, infants, children and clinical features, Wong G. SARS-CoV-2 immune Children - Immunology adolescents. Severe and fatal cases in children are relatively rare. The epidemiology, and infection in children - response, Understanding the burden of disease in children has been relatively low, but the high immune responses of Understanding the immune epidemiology Immune Responses proportions of asymptomatic or mildly symptomatic infections in children children with SARS- responses and controlling the and Controlling the deserve careful attention. This review outlines current understanding of the CoV-2 infection. pandemic [published online, Pandemic pathogenicity of SARS-CoV-2 infection and immune responses in children. 2020 Apr 24]. Pediatr Allergy Immunol. 2020. doi:10.1111/pai.13267 Medical 24-Apr-20 Short Report - European Short Report Medical nutrition therapy is one of the core contents of comprehensive This report presents Romano L, Bilotta F, Dauri M, nutrition Medical Nutrition Review for treatment measures for patients with COVID-19. This report presents a set guidelines for et al. Short Report - Medical therapy, Therapy for Medical and of guidelines for nutritional medical therapy for critically ill COVID-19 nutritional medical nutrition therapy for critically micronutrient Critically Ill Patients Pharmacolog patients, based on international guidelines. Recommendations for therapy for critically ill ill patients with COVID-19. intake, With COVID-19 ical Sciences micronutrient intake, immuno-nutrients, probiotics and polyphenol COVID-19 patients. Eur Rev Med Pharmacol Sci. immuno- supplementation are included. 2020;24(7):4035–4039. nutrients doi:10.26355/eurrev_202004 _20874 Pregnancy, 24-Apr-20 A Systematic International Review Article This systematic search of electronic databases identified 33 studies reporting This systematic review Elshafeey F, Magdi R, Hindi N, childbirth, Scoping Review of Journal of 385 pregnant women with COVID‐19 infection: 368 (95.6%) mild; 14 (3.6%) of COVID‐19 infection et al. A systematic scoping maternal and COVID-19 During Gynecology severe; and 3 (0.8%) critical. Seventeen women were admitted to intensive during pregnancy and review of COVID-19 during neonatal Pregnancy and & Obstetrics care, including six who were mechanically ventilated and one maternal childbirth found little pregnancy and childbirth outcomes Childbirth mortality. A total of 252 women gave birth, comprising 175 (69.4%) cesarean evidence for poor [published online, 2020 Apr and 77 (30.6%) vaginal births. Outcomes for 256 newborns included four RT‐ maternal or neonatal 24]. Int J Gynaecol Obstet. PCR positive neonates, two stillbirths, and one neonatal death. Authors outcomes. 2020. doi:10.1002/ijgo.13182 conclude that SARS-CoV-2 infection during pregnancy has a clinical presentation and severity resembling that in non‐pregnant adults. Based on findings, COVID-19 is probably not associated with poor maternal or perinatal outcomes. COVID-19; 23-Apr-20 Novel coronavirus International Review The authors present a summary of emerging data in the obstetric population The authors present Bampoe S, Odor PM, Lucas pregnancy; SARS-CoV-2 and Journal of and evidence-driven, practice-based recommendations for the anesthetic emerging data and DN. Novel coronavirus SARS- anesthetic COVID-19. Practice Obstetric management of pregnant women with suspected or confirmed COVID-19. recommendations for CoV-2 and COVID-19. Practice management recommendations Anesthesia Although pregnant women do not appear to exhibit greater susceptibility to the anesthetic recommendations for for obstetric COVID-19 than the general population, the direct and indirect risks of management of obstetric anaesthesia: what anaesthesia: what managing infected maternity patients mandate a change in approach to pregnant women with we have learned thus far. Int we have learned teamwork, anesthesia practice, information dissemination, and decision- suspected or J Obstet Anesth. 2020;43:1-8. thus far making on the labor ward. Risk of antenatal vertical transmission of SARS- confirmed COVID-19. doi:10.1016/j.ijoa.2020.04.00 CoV-2 is low. Epidural analgesia should be considered, provided platelet Although pregnant 6. counts are not low. Droplet precautions are indicated for all women with women do not exhibit 20 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication suspected COVID-19. Airborne precautions are recommended for general greater susceptibility anesthesia or higher risk thereof. Both staff and patients alike may require to COVID-19 than the additional support during this period of severe working conditions caused by general population, COVID-19. Women and staff alike should receive timely evaluation of the risks of managing anxiety, depression and sleep. Mental health teams should be consulted for infected maternity psychological intervention. patients mandate a change in approach to teamwork, anesthesia practice, information dissemination, and decision-making on the labor ward. antiviral 23-Apr-20 Analysis of the European Review This review analyzes pregnant women's susceptibility to SARS-CoV-2 and the This review analyzes Zhao X, Jiang Y, Zhao Y, et al. treatment; susceptibility to Journal of safety of existing drugs used to treat COVID-19. ACE2 is highly increased pregnant women's Analysis of the susceptibility Fetal safety; COVID-19 in Clinical during pregnancy, which may increase susceptibility to SARS-CoV-2. Changes susceptibility to SARS- to COVID-19 in pregnancy New pregnancy and Microbiology to the anatomical structure of the respiratory system during pregnancy CoV-2 infection and and recommendations on coronavirus recommendations & Infectious results in easier transmission via aerosols and droplets in pregnant women. severe COVID-19 potential drug screening. Eur disease; on potential drug Diseases The effects of progesterone and relaxants in the 1st trimester lead to resulting from J Clin Microbiol Infect Dis. Pregnancy; screening relaxation of ligaments in the ribs and upward movement of the diaphragm anatomical, 2020;39(7):1209-1220. Virus as the uterus grows. The subcostal angle and transverse diameter of the reproductive, doi:10.1007/s10096-020- susceptibility thoracic cavity increase further in the 3rd trimester. These changes together endocrine, and 03897-6 with the decreased compliance of chest wall eventually lead to a 20-30% immune changes reduction in functional residual capacity, making the mother prone to during pregnancy. The hypoxia. Cardiovascular changes, increased metabolic rate and oxygen authors also review consumption, and the mismatch between basic ventilation and perfusion the safety of existing also lead to hypoxic respiratory failure in pregnant women infected with drugs used to treat SARS-CoV-2. Changes in reproductive hormones and in the immune system COVID-19 with regard also make pregnant women generally more susceptible to infections. to their impact on Specific drugs for COVID-19 do not exist at the time of this article; therefore, maternal and fetal management of COVID-19 has largely been done by adapting use of existing health and provide treatments. Drugs with proven maternal and fetal safety are worthy of treatment consideration for pregnant women with COVID-19, such as chloroquine, recommendations. metformin, statins, lobinavir/ritonavir, glycyrrhizic acid, and nanoparticle- mediated drug delivery. Treatment recomendations are provided for each. Hematopoietic 23-Apr-20 COVID-19 in Frontiers in Letter to the In this letter, the authors presented cases of three children with cancer and In this letter, the Al Yazidi LS, Al Rawas A, Wali stem cell Children With Pediatrics Editor post-hematopoietic stem cell transplants (HSCT) who tested positive for and authors reviewed the Y. COVID-19 in Children With transplant, Cancers and Post- required hospital admission for COVID-19 in Oman. Two of the patients had severity of COVID-19 Cancers and Post- cancers, Oman Hematopoietic leukemia and one was post-HSCT for primary immune deficiency. Case 1 had in pediatric patients Hematopoietic Stem Cell Stem Cell been admitted for non-COVID-19-related outcomes and had a mild course who had cancers and Transplantation (HSCT) in Transplantation and chemotherapy was stopped with no additional management. Case 2 had had undergone Oman, Journal of Pediatric (HSCT) in Oman chemotherapy for acute lymphoid leukemia and was admitted for hematopoietic stem Hematology/Oncology: pneumonia. He was treated with oral azithromycin and IV ceftriaxone and cell transplant. They October 21, 2020 - Volume discharged after a week. Case 3 was admitted for non-COVID-19-related determined that akin Publish Ahead of Print - Issue issues and discharged after a short period. The authors suggest that despite to healthy children, - doi: initial theories indicating greater susceptibility of the SARS-CoV-2 infection in SARS-CoV-2 infection 10.1097/MPH.000000000000 immunocompromised children, there are indications that COVID-19 in has milder 1978 children is milder and self-limiting. The authors conclude by summarizing manifestations in 21 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication similar results found in studies done in Italy, France, and the USA. The children, even those authors also reported a small cohort in Spain of 8 children with post-HSCT who are relatively with COVID-19, which had more severe outcomes, possibly due to immunocompromised. lymphopenia and low CD4/CD8 ratios. Pediatric, ACE2, 23-Apr-20 COVID-19 Infection Frontiers in Opinion In this article, the authors discuss the protective role of ACE2 receptors in The authors present Ciaglia E, Vecchione C, Puca protective and Circulating Pediatrics women and children. Previous studies suggested the usage of genetic ACE2 the putative link AA. COVID-19 Infection and ACE2 Levels: variants in potentially impacting ACE2 levels in the body. Findings also between circulating Circulating ACE2 Levels: Protective Role in indicate that sex-specific predisposition to COVID-19 may be reflective of a ACE2 and COVID-19 Protective Role in Women Women and peculiar ACE2 plasma profile. This effect is not seen in children, possibly due severity, which may and Children. Front Pediatr. Children to the influence of sexual maturity. ACE2 is modulated by estradiol and is form a rapidly 2020 Apr 23;8:206. doi: also connected to male reproduction. The unique ACE2 plasma profile can emerging field of 10.3389/fped.2020.00206. help children combat the infection effectively but also contribute to their study for therapeutic PMID: 32391299; PMCID: carrier status. The transfer of ACE2 can confer neonatal immunity and intervention. ACE2 PMC7192005. protective factors. Answering questions about the less severe manifestations plasma profiles can of COVID-19 in children can help shed light on why some populations are impact the severity of more at-risk than others, as well as contribute to the development of disease, that may be therapeutics. The authors propose the determination of ACE2 levels in reflective of the milder blood, milk, tears, and urine as a first rapid-test screening, with tests in age- symptomology in matched healthy volunteers for comparison. children as compared to adults. Neonate, 23-Apr-20 COVID-19 and Neonatology Editorial Note The editors comment on two articles with suggestions for neonatal The authors describe Halliday HL, Speer CP. COVID- management, Neonatal resuscitation when the mother is suspected of having COVID-19 infection. two articles, one from 19 and Neonatal resuscitation, Resuscitation They describe the different contexts from which the articles are written Italy and one from Resuscitation. Neonatology. Italy, Hong (Italy and Hong Kong), as well as provide context regarding the uncertainty Hong Kong, that 2020;117(2):132. Kong of vertical transmission. provide doi:10.1159/000508003 recommendations for neonatal resuscitation for infants with mothers with suspected COVID-19 infection. Micronutrient 23-Apr-20 Optimal Nutritional Nutrients Review A wealth of mechanistic and clinical data show that vitamins, including This review states that Calder PC, Carr AC, Gombart supplementatio Status for a Well- vitamins A, B6, B12, C, D, E, and folate; trace elements, including zinc, iron, based on well- AF, Eggersdorfer M. Optimal n, vitamins, Functioning selenium, magnesium, and copper; and the omega-3 fatty acids, established evidence Nutritional Status for a Well- minerals, Immune System Is eicosapentaenoic acid and docosahexaenoic acid, play important and of the immune- Functioning Immune System omega-3 fatty an Important Factor complementary roles in supporting the immune system. Inadequate intake supportive role that Is an Important Factor to acids, viral to Protect Against of these nutrients is widespread, leading to decreased resistance to nutrition plays, Protect against Viral infection, Viral Infections infections and increased disease burden. Supplementation with the above supplementation with Infections. Nutrients. immune system micronutrients and omega-3 fatty acids is a safe, effective, and low-cost micronutrients is a 2020;12(4):E1181. Published strategy to help support optimal immune function; public health officials are safe and cost-effective 2020 Apr 23. encouraged to include nutritional strategies in their recommendations to public health strategy doi:10.3390/nu12041181 improve public health. to protect against viral infection. Pregnancy, 23-Apr-20 Coronavirus Disease American Case Series Clinical records were retrospectively reviewed for 116 pregnant women with Based on this report of Yan J, Guo J, Fan C, et al. neonates, 2019 (COVID-19) in Journal of COVID-19 pneumonia from 25 hospitals in China between January 20 and 116 cases of pregnant Coronavirus disease 2019 clinical Pregnant Women: Obstetrics March 24, 2020. The median gestational age on admission was 38+0 (IQR: women with COVID-19 (COVID-19) in pregnant characteristics, 36+0 -- 39+1) weeks. The most common symptoms were fever (50.9%, in China, SARS-CoV-2 women: A report based on 22 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication preterm birth, A Report Based on and 59/116) and cough (28.4%, 33/116); 23.3% (27/116) patients presented infection during 116 cases [published online, vertical 116 Cases Gynecology without symptoms. Abnormal radiologic findings were found in 96.3% pregnancy was not 2020 Apr 23]. Am J Obstet transmission, (104/108) of cases. There were eight cases (6.9%, 8/116) of severe associated with Gynecol. 2020. amniotic fluid, pneumonia but no maternal deaths. One of eight patients (1/8) that increased risk of doi:10.1016/j.ajog.2020.04.0 cord blood presented in the first- and early-second trimester had a missed spontaneous spontaneous abortion 14 samples, China abortion. 85.9% (85/99) underwent Cesarean delivery and 14.1% (14/99) and preterm birth. had a vaginal delivery. For 38.8% (33/85) of those who underwent Cesarean There was no evidence delivery, the indication was COVID-19 pneumonia. Twenty-one of 99 of vertical patients (21.2%, 21/99) that had delivered had preterm birth, including six transmission of SARS- with preterm premature ruptured of membranes. The rate of spontaneous CoV-2 infection during preterm birth before 37 weeks was 6.1% (6/99). There was one case of late pregnancy. severe neonatal asphyxia that resulted in neonatal death. Eighty-six of the 100 neonates were tested for SARS-CoV-2; all had negative results. Of these, ten neonates had paired amniotic fluid and cord blood samples that were tested negative for SARS-CoV-2. Six mothers had their vaginal secretion samples tested and were negative. Twelve mothers had their breast milk samples tested and were negative. Children, family 23-Apr-20 Clinical and Journal of Case Series In Beijing, family clusters are the main mode of human-human transmission, SARS-CoV-2 was Song R, Han B, Song M, et al. clusters, viral Epidemiological Infection accounting for 57.6% of the total confirmed cases. This series presents transmitted quickly in Clinical and epidemiological shedding Features of COVID- clusters of one small and three large families, in which a total of 22/24 four reported family features of COVID-19 family period, China 19 Family Clusters infections were observed, through contact with an index case. Among those clusters from Beijing. clusters in Beijing, China in Beijing, China infected, 20/22 had mild symptoms and only two had moderate to severe While the infection [published online, 2020 Apr clinical manifestations. Eight children were included in this study (range: 9 rate was high, the viral 23]. J Infect. 2020. months - 10 years old), and all but one tested positive for SARS-CoV-2 on RT- shedding period varied doi:10.1016/j.jinf.2020.04.01 PCR. Children with positive RT-PCR results generally showed milder between infected 8 symptoms and became negative after 5-17 days, whereas RT-PCR results for adults and children adults remained positive much longer. within family clusters. Children, 23-Apr-20 How Is Journal of Review A systematic review of literature identified 16 relevant articles, with 110 Immunosuppressed Minotti C, Tirelli F, Barbieri E, adults, Immunosuppressive Infection immunosuppressed adults and children with COVID-19. Of 98 patients adult and pediatric Giaquinto C, Donà D. How is immuno- Status Affecting receiving cancer treatment, one child had leukemia. In addition, three patients with COVID- immunosuppressive status suppression, Children and Adults children who underwent liver transplantation are included. Cancer was more 19 seem to experience affecting children and adults cancer, liver in SARS-CoV-2 often associated with a more severe course, but not necessarily with a bad favorable outcomes, in SARS-CoV-2 infection? A transplantation, Infection? A prognosis. Data show that both children and adults with compared to other systematic review [published immune Systematic Review immunosuppression seem to have a favorable disease course, as compared comorbidities, possibly online, 2020 Apr 23]. J Infect. response to the general population. explained by a 2020. protective, weaker doi:10.1016/j.jinf.2020.04.02 immune response. 6 Pregnancy, 23-Apr-20 Clinical Analysis of International Original Research The clinical features and outcomes of 10 pregnant women, with confirmed Of 11 neonates born Cao D, Yin H, Chen J, et al. neonates, Ten Pregnant Journal of COVID-19 at Maternal and Child Health Hospital of Hubei Province, from to 10 pregnant women Clinical analysis of ten cesarean Women With Infectious January 23 to February 23, 2020 were retrospectively analyzed. All 10 with confirmed pregnant women with delivery, COVID-19 in Diseases pregnant women, including 9 singletons and 1 set of twins, were residents of COVID-19 in Wuhan, COVID-19 in Wuhan, China: A vertical Wuhan, China: A Wuhan. None developed severe COVID-19 or died. Two patients underwent China, 5 were tested retrospective study transmission, Retrospective Study vaginal delivery, two patients underwent intrapartum cesarean section, and for SARS-CoV-2 nucleic [published online, 2020 Apr China the remaining six patients underwent elective cesarean section. After acid in throat swabs. 23]. Int J Infect Dis. 2020. delivery, all women showed lung abnormalities by pulmonary CT imaging. Of All tested negative. doi:10.1016/j.ijid.2020.04.04 11 neonates, 5 underwent SARS-CoV-2 testing of throat swabs, which were This study does not 7 support the possibility 23 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication found to be negative. Among all neonates, no neonatal death or asphyxia of vertical was observed. transmission. Neurologic 23-Apr-20 Neurologic Neurology Clinical/Scientific This case report describes a 6-week-old (born at 39 weeks via uncomplicated This case report Dugue R, Cay-Martínez KC, event, infant, Manifestations in Notes spontaneous vaginal delivery), who presented with fever, cough, and two introduces the Thakur K, et al. Neurologic co-infection, an Infant With brief 10-15 second episodes of upward gaze and bilateral leg stiffening. On possibility of rare manifestations in an infant rhinovirus COVID-19 exam after arrival at the emergency room, the anterior fontanel was soft neurologic with COVID-19 [published and non-bulging, and the neurologic exam was unremarkable. Respiratory manifestations of online, 2020 Apr 23]. pathogen PCR panel was positive for rhinovirus/enterovirus. SARS-CoV-2 COVID-19 (and co- Neurology. 2020. rRT-PCR was also positive on nasopharyngeal swab, but viral RNA was not infection with doi:10.1212/WNL.000000000 detected in CSF, serum, or plasma. EEG results did not confirm initial rhinovirus) in children. 0009653 suspicion for seizures. The patient was discharged home one day after admission without further fevers or events. Pregnancy, 23-Apr-20 Management of the International Brief Data are emerging on the consequences of the infection on mothers and An OB/GYN Sharma KA, Kumari R, neonate, First Patient With Journal of Communication infants. Many guidelines on pregnancy management during the pandemic department in India Kachhawa G, et al. obstetric unit, Confirmed COVID- Gynecology have been released, but the actual journey to establishing an obstetric describes the process Management of the first breastfeeding, 19 in Pregnancy in & Obstetrics isolation unit can be challenging. The present article describes the stepwise of establishing an patient with confirmed India India: From informed approach that was taken to rapidly establish a unit for suspected obstetric isolation COVID-19 in pregnancy in Guidelines to COVID‐19 patients within existing resources, and the experience of unit, where an India: From guidelines to Frontlines delivering the first pregnant patient with asymptomatic, confirmed COVID‐ asymptomatic frontlines [published online, 19 in India. A healthy male neonate was delivered by cesarean section, was pregnant woman with 2020 Apr 23]. Int J Gynaecol breastfed, and tested negative for COVID-19 on day seven. COVID-19 delivered a Obstet. 2020. healthy neonate, who doi:10.1002/ijgo.13179 was breastfed and tested negative for COVID-19. Human milk 23-Apr-20 Use of Disinfectant Journal of Original Article This paper reports experience from the Human Milk Bank (HMB) of a A human milk bank Rose DU, Reposi MP, Amadio bank, Wipes to Sanitize Human children's hospital in Rome, Italy. Donors express milk via mechanical pumps from Rome, Italy P, et al. Use of Disinfectant breastfeeding, Milk's Containers of Lactation and store milk in sterile single-use plastic containers supplied by the HMB. reports experiences Wipes to Sanitize Milk's sanitization, Human Milk Bank While milk donation was practically suspended in other Italian cities, drivers adapting to the Containers of Human Milk Rome, Italy During COVID-19 at this HMB continue to collect expressed human milk (EHM) directly from COVID-19 era, through Bank During COVID-19 Pandemic donors, once a week. Milk is frozen, then defrosted and pasteurized before less frequent donated Pandemic [published online, use. Breastfeeding information is provided to the mothers via telephone milk collection and 2020 Apr 23]. J Hum Lact. consultation available 8 hours a day. It is recommended that donor mothers sanitization of 2020. suspend donation and be promptly tested if any SARS-CoV-2 symptoms containers. doi:10.1177/0890334420924 occur; however, SARS-CoV-2 could contaminate the outside of the container, 639 since this virus can be detected for up to 72 hours on plastic and various surfaces. Therefore, the HMB has begun to sanitize EHM containers using disinfectant wipes and gloved hands, which is both feasible and sustainable. Children, 23-Apr-20 Covid-19 and Pediatric Correspondence Children with cancer receiving immunosuppressive chemotherapy have There is a paucity in Ruggiero A, Romano A, Attinà cancer, Children With Research typically significant quantitative and qualitative abnormalities in T-cell literature on the G. Covid-19 and children with immuno- Cancer: Are They at function and immunoglobulin levels. Even after completion of clinical and cancer: are they at increased suppressive Increased Risk of chemotherapy, immune dysfunction may persist for several months. Authors epidemiological risk of infection? [published chemotherapy, Infection? performed a literature search on COVID-19 infection in children with cancer characteristics of online, 2020 Apr 23]. Pediatr immune and found only one manuscript that could not be obtained through the COVID-19 infection in Res. 2020. dysfunction PubMed platform. children with cancer. doi:10.1038/s41390-020- 0919-1

24 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication pediatric, lung 22-Apr-20 How to Perform Journal of Letter to the Lung ultrasound (LUS) has been increasingly used for the diagnosis of The authors of this De Rose, C., Inchingolo, R., ultrasound, Pediatric Lung Ultrasound Editor respiratory diseases, including COVID-19, in both adult and pediatric letter discuss their Smargiassi, A., Zampino, G., Italy, Ultrasound in Medicine patients. The authors of this letter discuss their technique for pediatric LUS technique for pediatric Valentini, P. and Buonsenso, technology, Examinations in the during the COVID-19 pandemic in Italy. Their method aims to reduce health LUS during the COVID- D. (2020), How to Perform Time of COVID‐19 care worker and medical device exposure to COVID-19, and also conserve 19 pandemic in Italy. Pediatric Lung Ultrasound PPE PPE. After written informed consent is obtained, a pediatrician prepares the Their method aims to Examinations in the Time of a wireless ultrasound transducer and a tablet, on which the LUS images are reduce health care COVID‐19. J Ultrasound Med, displayed. The transducer is placed in a single-use plastic cover. Pediatrician worker and medical 39: 2081- 1, wearing appropriate PPE, enters the patient room with the wireless device exposure to 2082. https://doi.org/10.100 transducer and performs the LUS examination. Pediatrician 2 remains COVID-19, and also 2/jum.15306 outside the room with the tablet and can then freeze and store conserve PPE. images/videos without entering the room. At the end of the procedure, the transducer is sterilized in a dedicated area and put into a new sterile plastic bag. The article includes videos of this technique in use. At the date of the authors' letter, 21 children with suspected COVID-19 had been evaluated with this procedure. Of these children, 1 tested positive for COVID-19; 5 had viral respiratory tract infections; and 1 had bacterial pneumonia. All cases were managed with LUS, and no chest radiographic or CT scans were performed. Infectious 22-Apr-20 The implications of South Editorial The COVID-19 pandemic is an emerging problem that can potentially put The authors discuss Mustafa F, Green R. The disease, COVID-19 for the African intolerable strain on a health system that is fragile and likely to collapse, how many common implications of COVID-19 for children, Africa, children of Africa Medical such as those that exist in Africa. The authors discuss how many common infectious diseases in the children of Africa. S Afr low resource, Journal infectious diseases present with similar symptoms to COVID-19 (malaria, Africa present with Med J. 2020;110(6):448-449. case definitions viral respiratory tract infections, pneumonia, etc.). The authors argue that similar symptoms to Published 2020 Apr 22. the focus on diagnosing cases of COVID-19 in Africa may ultimately lead to COVID-19 (malaria, doi:10.7196/SAMJ.2020v110i not identifying other illnesses. Additionally, the overwhelmed hospitals and viral respiratory tract 6.14824 clinics, lack of treatment facilities, and limited testing impact the health infections, outcomes of the African population for not only COVID-19 but also malaria, pneumonia, etc.) and viral respiratory tract infections, influenza, and asthma. The authors describe some of the conclude that whether or not COVID-19 ultimately affects the children of challenges that impact Africa directly, it will leave them scarred, worse off, and still facing a burden the health outcomes of infectious diseases not seen anywhere else in the world. of children in Africa. Severe acute 22-Apr-20 COVID-19 and Cadernos de Brief Surveillance of hospitalized cases and deaths due to severe acute respiratory Thus far, in 2020, the Bastos LS, Niquini RP, Lana respiratory Hospitalizations for Saúde Communication illness (SARI) in Brazil has expanded to include COVID-19. Between the 9th number of severe RM, et al. COVID-19 and illness, children, SARI in Brazil: A Pública and 12th epidemiological weeks of 2020, hospitalizations for SARI exceeded acute respiratory hospitalizations for SARI in hospitalization, Comparison Up to the numbers observed during the same period in each of the previous 10 illness hospitalizations Brazil: a comparison up to the epidemiology, the 12th years. In 2019, more than half of SARI cases occurred in children under two in adults over the age 12th epidemiological week of Brazil Epidemiological years of age, and the most frequently detected virus was RSV (23.3%). In of 60 has exceeded 2020 [published online 2020 Week of 2020 contrast, the number of cases of children affected by SARI has decreased in those in children Apr 22]. Cad Saude Publica. 2020, while the age bracket over 60 years has been the most heavily under 2 years old, in 2020. doi:10.1590/0102- affected. The inclusion of SARS-CoV-2 testing in the SARI surveillance Brazil. 311X00070120 protocol is important for monitoring severe COVID-19 cases in Brazil.

25 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Infant, 22-Apr-20 Neurosurgery in an The Lancet Correspondence Administering general anesthesia to infants with respiratory infections is a This case report from Carrabba G, Tariciotti L, Guez neurosurgery, Infant With COVID- challenge because anesthetic drugs suppress immunity. Authors report a Milan, Italy describes a S, Calderini E, Locatelli M. general 19 case from Milan, Italy, of an 8-month-old male with complex hydrocephalus, COVID-19 positive Neurosurgery in an infant anesthesia, who presented with a mild temperature, dry cough, and occipital infant who underwent with COVID-19 [published immuno- cerebrospinal fluid collection, suggestive for shunt malfunctioning. A chest major neurosurgical online, 2020 Apr 22]. Lancet. suppression, X-ray was negative for overt interstitial pneumonia, but the nasopharyngeal operation, under 2020. doi:10.1016/S0140- Milan, Italy swab tested positive for SARS-CoV-2. Neurosurgical intervention for the immunosuppressive 6736(20)30927-2 shunt malfunction was arranged, following available protocols for patients general anesthesia, with COVID-19. Four days later, a second neurosurgical revision of the shunt and did not suffer any was performed. The infant did not experience any respiratory complications respiratory while under general anesthesia, and the major surgical operation was not complications. associated with additional morbidity. Children, 22-Apr-20 Presenting JAMA Original This case series of patients with COVID-19 admitted to 12 hospitals in the Reports from 12 Richardson S, Hirsch JS, hospitalization, Characteristics, Investigation New York City area, between March 1 and April 4, 2020, reports a total of hospitals in the New Narasimhan M, et al. mortality rate, Comorbidities, and 5700 COVID-19 positive patients, confirmed by RT-PCR testing of York City area show a Presenting Characteristics, New York City Outcomes Among nasopharyngeal samples. In the 0-9 age group, 13 males and 13 females mortality rate of 0% Comorbidities, and Outcomes 5700 Patients were discharged alive, with a median length of stay of 2.0 days (IQR: 1.7- among children Among 5700 Patients Hospitalized With 2.7). Seven remained hospitalized at the study end point. In the 10-19 age admitted with COVID- Hospitalized With COVID-19 COVID-19 in the group, 1 male and 7 females were discharged alive, with a median length of 19 (<18 years old). in the New York City Area New York City Area stay of 1.8 days (IQR: 1.0-3.1). Nine remained hospitalized at the study end [published online, 2020 Apr point. Of patients <18 years old, 2 required ICU care, 1 discharged patient 22]. JAMA. was readmitted, and no deaths were reported. doi:10.1001/jama.2020.6775 Children, 22-Apr-20 Severe Acute JAMA Systematic This review aims to evaluate currently reported pediatric cases of SARS-CoV- To authors' Castagnoli R, Votto M, Licari adolescents, Respiratory Pediatrics Review 2 infection. An extensive search strategy was designed to retrieve all articles knowledge, this is the A, et al. Severe Acute clinical Syndrome published from December 1, 2019, to March 3, 2020, in several electronic first systematic review Respiratory Syndrome characteristics, Coronavirus 2 databases (PubMed, Cochrane Library, and CINAHL). A total of 815 articles that assesses and Coronavirus 2 (SARS-CoV-2) pediatric (SARS-CoV-2) were identified. Eighteen studies with 1065 participants (444 patients were summarizes clinical Infection in Children and management Infection in younger than 10 years, and 553 were aged 10 to 19 years) with confirmed features and Adolescents: A Systematic Children and SARS-CoV-2 infection were included in the final analysis. All articles reflected management of Review [published online, Adolescents: A research performed in China, except for 1 clinical case in Singapore. Children children with SARS- 2020 Apr 22]. JAMA Pediatr. Systematic Review at any age were mostly reported to have mild respiratory symptoms, namely CoV-2 infection. 2020. fever, dry cough, and fatigue, or were asymptomatic. Bronchial thickening doi:10.1001/jamapediatrics.2 and ground-glass opacities were the main radiologic features, and these 020.1467 findings were also reported in asymptomatic patients. Among the included articles, there was only 1 case of severe COVID-19 infection, which occurred in a 13-month-old infant. No deaths were reported in children aged 0 to 9 years. Available data about therapies were limited. Neonatal 22-Apr-20 Late-Onset New England Correspondence A 3-week-old boy presented with a 2-day history of nasal congestion, This case illustrates a Coronado Munoz A, infection, Neonatal Sepsis in a Journal of tachypnea, and reduced feeding. He was born at 36 weeks of gestation to a severe case of Nawaratne U, McMann D, sepsis, Patient With Covid- Medicine 21-year-old woman (gravida 3, para 1). On transfer from the emergency neonatal COVID-19 in Ellsworth M, Meliones J, mechanical 19 department to a pediatric hospital, the patient had hypotension, a 3-week-old boy, who Boukas K. Late-Onset ventilation, tachycardia, hypothermia, and tachypnea. Chest radiography performed was managed with Neonatal Sepsis in a Patient pneumothorax, after intubation showed bilateral infiltrates and partial collapse of the right standard PICU with Covid-19 [published hydroxy- upper lobe. Transthoracic echocardiography showed normal cardiac protocols. online, 2020 Apr 22]. N Engl J chloroquine, anatomy and function. The white-cell count was 4000 per cubic millimeter Med. 2020. azithromycin with 55% lymphocytes; levels of inflammatory markers were elevated. doi:10.1056/NEJMc2010614 Mechanical ventilation was initiated, and hydroxychloroquine and 26 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication azithromycin were initiated for presumed COVID-19. On day 2 after admission, the hypotension resolved. A pneumothorax that developed on the right side and was successfully treated by tube thoracostomy. The results of RT-PCR testing to detect SARS-CoV-2 on admission, from nasal swabs, were positive on day 7; he completed the 5-day course of hydroxychloroquine and azithromycin. The patient was discharged on day 9 without supplemental oxygen. Pregnancy, 22-Apr-20 No SARS-CoV-2 The Lancet Correspondence This report presents two cases of SARS-CoV-2 negativity in amniotic fluid SARS-CoV-2 viral RNA Yu N, Li W, Kang Q, Zeng W, early gestation, detected in Infectious from pregnant women, who were diagnosed with COVID-19 in early was not detected by Feng L, Wu J. No SARS-CoV-2 amniotic fluid, amniotic fluid in Diseases pregnancy. The first patient was a 34-year-old primiparous woman, RT-PCR in amniotic detected in amniotic fluid in amniocentesis, mid-pregnancy admitted on January 30 after developing cough on January 26 (8 weeks + 5 fluid collected from mid-pregnancy [published serology, days of gestation). The second patient was a 27-year-old multiparous two pregnant women online, 2020 Apr 22]. Lancet vertical woman who attended an outpatient clinic on February 12 (10 weeks + 1 day in early pregnancy in Infect Dis. transmission, of gestation) after developing fever, weakness, diarrhea, and dyspnea on China; however, due doi:10.1016/S1473- China February 1 (8 weeks + 4 days of gestation). On March 23, both patients—in to small sample size 3099(20)30320-0 the second trimester of pregnancy—tested positive for SARS-CoV-2 total and other limitations, antibodies in serum and were negative for viral RNA in throat swabs. On the possibility of March 26, amniotic fluid samples were collected from the patients via vertical transmission percutaneous, ultrasound-monitored amniocentesis. The RT-PCR results for cannot be ruled out. amniotic fluid were negative, and tests for SARS-CoV-2 IgM and IgG in amniotic fluid were also negative. Although SARS-CoV-2 was not detected in the amniotic fluid of these two patients, the possibility of vertical transmission in early and middle pregnancy could not be ruled out because RNA is much less stable in amniotic fluid than DNA, and the virus might have been undetectable in amniotic fluid due to insufficient gestational age (optimal time for amniocentesis is 18-21 weeks' gestation). Pregnancy, 22-Apr-20 A call for action for The Lancet Comment Pregnant women are currently not recognized as a population at increased Pregnant women Buekens P. Alger J. Bréart G. surveillance, COVID-19 Global risk for COVID-19; however, they might still be vulnerable for not only warrant more Cafferata ML. Harville E. prenatal and surveillance and Health medical but also social risks. Additionally, prenatal and delivery care attention as a Tomasso G. A call for action delivery care research during provides opportunities to answer key questions about COVID-19, including population at for COVID-19 surveillance pregnancy the collection of blood samples to generate population-based estimates of increased risk for and research during asymptomatic SARS-CoV-2 infections. Beyond virus-specific risks, illnesses COVID-19. Prenatal pregnancy [published online, with high fevers early in pregnancy are associated with specific birth defects, and delivery care 2020 Apr 22]. Lancet Glob such as neural tube defects. Literature to date suggests that pregnant provide opportunities Health. doi:10.1016/S2214- women with COVID-19 might not be at increased risk for severe to generate 109X(20)30206-0 complications or adverse outcomes. However, studies have lacked sufficient population-based sample sizes to discern infrequent risks attributable to COVID-19 infection. estimates of Multiple strategies need to be deployed to address the knowledge gaps asymptomatic SARS- surrounding COVID-19 in pregnancy, including sentinel surveillance, CoV-2 infection. seroprevalence surveys, and socio-behavioral and psychological research.

27 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Children, 22-Apr-20 Multicenter Initial Journal of Original Article A panel of pediatric infectious diseases physicians and pharmacists from 18 For the small Chiotos K, Hayes M, antiviral Guidance on Use of the Pediatric North American institutions convened through a series of teleconferences proportion of children Kimberlin DW, et al. therapy, Antivirals for Infectious and surveys, developing a set of guidance statements on antiviral therapy who develop severe or Multicenter initial guidance remdesivir, Children With Diseases for pediatric COVID-19. Supportive care is recommended for the majority of critical COVID-19, this on use of antivirals for hydroxy- COVID-19/SARS- Society children with mild COVID-19. For more critical cases, the panel suggests a guidance offers an children with COVID- chloroquine CoV-2 decision-making framework for antiviral therapy that weighs risks and approach for decision- 19/SARS-CoV-2 [published benefits based on disease severity as indicated by respiratory support needs, making around online, 2020 Apr 22]. J with consideration on a case-by-case basis of potential pediatric risk factors antiviral therapy, with Pediatric Infect Dis Soc. 2020. for disease progression. If an antiviral is used, the panel suggests remdesivir remdesivir as the doi:10.1093/jpids/piaa045 as the preferred agent. Hydroxychloroquine could be considered for patients preferred agent. who are not candidates for remdesivir or when remdesivir is not available. Antivirals should preferably be used as part of a clinical trial if available. Viral hepatitis 22-Apr-20 COVID-19 and Viral Liver Letter to the The WHO set a goal for the elimination of viral hepatitis by 2030. This means The COVID-19 Karimi-Sari H, Rezaee- elimination, Hepatitis International Editor that the number of newly infected persons and related mortality should be pandemic has diverted Zavareh MS. COVID-19 and immunization, Elimination decreased by 90% and 65%, respectively. The elimination programs focus on attention and viral hepatitis elimination mother to child Programs: Are We testing, treatment, immunization against hepatitis B virus (HBV), preventing resources away from programs: Are we stepping transmission Stepping mother to child transmission, blood safety, and harm reduction. Now, the WHO goal of backward? [published online, Backward? COVID‐19 is diverting attention and resources away from viral hepatitis eliminating viral 2020 Apr 22]. Liver Int. 2020. elimination. hepatitis globally by doi:10.1111/liv.14486 2030. Pediatric lung 22-Apr-20 How to Perform Journal of Letter to the Although chest radiography is a routine tool to diagnose respiratory diseases In place of chest De Rose C, Inchingolo R, ultrasound, Pediatric Lung Ultrasound Editor including COVID‐19 pneumonia, it lacks sensitivity and has relatively low radiography, this letter Smargiassi A, Zampino G, diagnosis, Ultrasound Medicine accuracy. For this reason, lung ultrasound (LUS) has been increasingly used suggests the use of Valentini P, Buonsenso D. respiratory Examinations in the for the diagnosis of respiratory diseases in both adult and pediatric patients, lung ultrasound to How to Perform Pediatric disease, Time of COVID-19 including COVID‐19. While waiting for the result of the nasopharyngeal swab diagnose COVID-19 in Lung Ultrasound pneumonia for COVID‐19, differential diagnosis of other known viral or bacterial pediatric patients. Examinations in the Time of respiratory infections remains pivotal and can be based on clinical, COVID-19 [published online, laboratory, and LUS findings. Authors introduce a procedure based on LUS 2020 Apr 22]. J Ultrasound use by evaluating clinicians. To date, 21 children with suspected COVID-19 Med. 2020. infection have been evaluated with this procedure. Only one (13-year-old) doi:10.1002/jum.15306 boy tested positive. Five had viral respiratory tract infections, and one had a diagnosis of bacterial pneumonia. All cases were managed with LUS, and no chest radiographic or CT scans were performed. Children, 22-Apr-20 Managing Pediatric Review Patients with chronic diseases warrant special attention and adaptation of Severe asthma, which Brough HA, Kalayci O, Sediva allergy, asthma, Childhood Allergies Allergy and their regular treatment plan in the context of the COVID-19 pandemic. In is common in children, A, et al. Managing childhood biologics, and Immunology children, allergy and asthma are among the most prevalent non- and immunodeficiency allergies and corticosteroids, Immunodeficiencies communicable chronic diseases, and severe asthma and immunodeficiency are risk factors for immunodeficiencies during immuno- During Respiratory are classified as risk factors for COVID-19. Currently, there is no available COVID-19. There is no respiratory virus epidemics - deficiency Virus Epidemics - evidence on the potential risk for severe disease posed by asthma and current evidence on the 2020 COVID-19 pandemic The 2020 COVID-19 allergy treatments, including antihistamines, corticosteroids, the effect of asthma [published online, 2020 Apr Pandemic bronchodilators. This statement of the EAACI Section on Pediatrics puts and allergy treatments 22]. Pediatr Allergy Immunol. forward six recommendations for the management of childhood allergies on clinical severity of 2020. doi:10.1111/pai.13262 and immunodeficiencies based on existing evidence. COVID-19 in children. Pediatric, 22-Apr-20 Chloroquine Dosing Clinical Brief Report As chloroquine (CHQ) becomes part of experimental treatment guidelines This study proposes a Verscheijden LFM, van der chloroquine, Recommendations Pharma- for COVID-19, pediatric dosing guidelines are needed. Recent pediatric data model-informed, age- Zanden TM, van Bussel LPM, age-adjusted for Pediatric COVID- cology & suggest that existing WHO dosing guidelines for children with malaria are adjusted dose et al. Chloroquine dosing dosing, 19 Supported by Therapeutics suboptimal. A previously developed physiologically based pharmacokinetic selection paradigm to recommendations for 28 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication pharmaco- Modeling and (PBPK) model for CHQ was used to simulate exposure in adults and children inform safe pediatric pediatric COVID-19 kinetics Simulation and verified against published pharmacokinetic data. The COVID‐19 dosing of chloroquine supported by modeling and recommended adult dosage regimen of 44mg/kg total was tested in adults for treatment of simulation [published online, and children to evaluate variation in exposure. Based on differences in AUC COVID-19, when 2020 Apr 22]. Clin Pharmacol (0‐70h), the optimal CHQ dose was determined in children of different ages pediatric clinical trial Ther. 2020. compared to adults. Revised doses were re‐introduced into the model to data are absent. doi:10.1002/cpt.1864 verify that overall CHQ exposure in each age band was within 5% of the predicted adult value. Simulations showed differences in drug exposure in children of different ages and adults when the same body weight-based dose is given. The following total cumulative doses are proposed: 35 mg/kg (CHQ base) for children 0‐1 month, 47 mg/kg for 1‐6 months, 55 mg/kg for 6 months‐12 years and 44 mg/kg for adolescents and adults. Infant, fever, 22-Apr-20 Fever Without a Journal of Brief Report A 5-week-old infant was admitted for fever, without a source (but who had This unexpected Kan MJ, Grant LMC, Muña clinical Source in a Young the Pediatric known sick contacts, including her father), at Kaiser Permanente Northern presentation of an MA, Greenhow TL. Fever characteristics, Infant Due to SARS- Infectious California San Francisco Emergency Department. The infant subsequently infant with fever without a source in a young San Francisco CoV-2 Diseases tested positive for SARS-CoV-2 based on a combination of oropharyngeal without a source infant due to SARS-CoV-2 Society and bilateral nasopharyngeal swab sent for qualitative nucleic amplification. changed regional [published online, 2020 Apr The infant was born full-term and had a history of hydronephrosis and hospital screening 22]. J Pediatric Infect Dis Soc. duplex kidney. She had a mild hospital course, without respiratory distress, procedures for COVID- 2020. and fever resolved within 30 hours of hospitalization. She continued to 19. doi:10.1093/jpids/piaa044 breastfeed while the mother wore a mask. COVID-19; 21-Apr-20 Addressing the Journal of Editorial The author discusses the impact of the COVID-19 pandemic on children and The author discusses Wagner KD. Addressing the children; Experience of Clinical adolescents. The experiences of children are varied and non-uniform across the impact of the Experience of Children and adolescents; Children and Psychiatry families, making it essential for clinicians who treat children and adolescents COVID-19 pandemic Adolescents During the families Adolescents During to talk with both the youth and the parent about the pandemic’s impact on on children and COVID-19 Pandemic. J Clin the COVID-19 the life of the family. Symptoms of depression and anxiety or hyperactivity adolescents. The Psychiatry. Pandemic may be situational for the child, and may resolve over time or with a experiences of 2020;81(3):20ed13394. supportive intervention. A singular focus on the child will miss a critical children are varied doi:10.4088/JCP.20ed13394. component in the youth’s outcome—the family. If parents and siblings are and non-uniform overwhelmed by the COVID-19 crisis, their emotional stress may fuel the across families, child’s depression, anxiety, or other psychiatric disorder. A brief inquiry by making it essential for the clinician about the mental health status of each family member would clinicians who treat enable a discussion about the importance for family members to seek children and treatment, if needed. Parents should address issues of uncertainty and adolescents to talk isolation in the child. The child should be reminded that the current situation with both the youth is temporary, and that they will be able to resume the enjoyable parts of and the parent about their life. Efforts should be made to spend more time than usual, if possible, the pandemic’s impact with the child and to encourage thinking about or contacting relatives. on the life of the family. Parents should address issues of uncertainty and isolation in the child, and strengthen family connection.

29 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Pregnancy, 21-Apr-20 Considerations for The Letter to the In the context of the COVID-19 pandemic, institutions performing fetal This letter provides Cardinal MP, Poder TG, Roy- infant , fetal Scaling Down Fetal Canadian Editor echocardiography (FE) are weighing the risks and benefits of reducing the evidence that, if it Lacroix ME, et al. echocardiograp Echocardiography Journal of number of FE to free up resources and limit nonessential visits to hospitals becomes temporarily Considerations for Scaling hy, CHD, During the COVID- Cardiology and clinics. This article presents preliminary results of a population-based necessary, FE could be Down Fetal Echocardiography Canada 19 Pandemic retrospective cohort study to assess the performance of prenatal congenital done rapidly for During the COVID-19 heart disease (CHD) screening in Québec. The cohort included 698,984 patients with a normal Pandemic. Can J Cardiol. pregnancies. Of them, 14,917 (2.1%) were referred for FE owing to fetal or second-trimester scan 2020;36(6):969.e5-969.e6. maternal risk factors despite a normal second-trimester ultrasound. When without increasing the doi:10.1016/j.cjca.2020.04.01 the second-trimester ultrasound was normal, the number needed to screen number of missed 6 was 222 for moderate to severe CHD and 361 for severe CHD. The authors severe CHD estimate that in the presence of a normal second-trimester ultrasound, not significantly. performing FE for maternal diabetes, family history of CHD, maternal medication, and increased nuchal translucency would reduce the number of FE by > 40%. In the cohort, more than 95% of undetected moderate to severe CHD occurred in pregnancies without risk factors and were therefore not referred for a FE. From the perspective of the overall population of Québec, not performing FE when the second-trimester ultrasound is normal would increase the overall number of undetected significant CHD by < 0.8 per 10,000 pregnancies. Niger Delta, 21-Apr-20 Socially Distanced The Editorial Over the past few decades, the Niger Delta has witnessed large-scale mass A weekly nutritional Francis NN, Pegg S. Socially Nigeria, School-Based Extractive peaceful mobilizations and rebellion-like conditions from violent militia program in the Niger distanced school-based children, Nutrition Program Industries groups. Local host communities have suffered greatly from corruption, Delta region of Nigeria nutrition program feeding malnutrition, Feeding Under and Society political instability, violence and the environmental devastation of their provides an example under COVID 19 in the rural school feeding COVID 19 in the farmlands and fishing grounds. Oil companies, implicated in violence of how to prevent Niger Delta [published online, program Rural Niger Delta perpetrated by Nigerian security forces, have turned to corporate social further malnutrition in 2020 Apr 21]. Extr Ind Soc. responsibility (CSR) initiatives to repair relations with oil-producing rural children by 2020. communities. There are also governmental and humanitarian actors adapting the program doi:10.1016/j.exis.2020.04.00 supporting various initiatives in the oil-producing areas. This article to social distancing 7 highlights the challenges that one long running micro-scale development measures of the project has faced due to the COVID-19 disease outbreak and the closure of COVID-19 era. all schools in Rivers State, Nigeria in March 2020. The school closures have halted some initiatives, but weekly nutritional program feedings in the village of Bodo, based on a formula called "Ogi Soy Plus" (mixture of millet, soybeans, crayfish), have continued in new, socially distanced forms to prevent children from becoming more malnourished during the pandemic. At-risk children, 21-Apr-20 Mitigating the Pediatrics Perspective This report highlights strategies that could mitigate the health risks of Strategies to mitigate Wong CA, Ming D, Maslow G, pandemic Impacts of the pandemic response measures for at-risk subpopulations of children are the health risks of Gifford EJ. Mitigating the response, low COVID-19 Pandemic outlined for policymakers, healthcare workers/systems, and communities. pandemic response Impacts of the COVID-19 SES, behavioral Response on At- Specific at-risk subpopulations of children include children with behavioral measures for at-risk Pandemic Response on At- health, foster Risk Children health needs, in foster care or at risk of maltreatment, and those with subpopulations of Risk Children [published care, medical complexity. In particular, children in low socioeconomic status children are outlined. online, 2020 Apr 21]. maltreatment, households are at highest risk for new or worsening issues. Pediatrics. 2020. medical doi:10.1542/peds.2020-0973 complexity Children, point- 21-Apr-20 Lung Ultrasound in Pediatrics Research Brief Even though lung ultrasound (LUS) is recognized as a valid imaging technique Based on findings in a Denina M, Scolfaro C, of-care Children With for the diagnosis and follow-up of pneumonia in children, no data are small cohort of Silvestro E, et al. Lung ultrasound, COVID-19 currently available about LUS use in COVID-19 affected children. Considering children with mild or Ultrasound in Children With 30 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication lung the well-known advantages of point-of-care ultrasound, including the severe COVID-19, lung COVID-19 [published online, abnormalities, possibility of reducing patient movement across the hospital, this ultrasound may be a 2020 Apr 21]. Pediatrics. Italy observational study investigates LUS findings in children (0-17 years) with useful tool in the 2020. SARS-CoV-2 infection, admitted to Regina Margherita Children Hospital in diagnostic and clinical doi:10.1542/peds.2020-1157 Turin, Italy between March 18 and March 26, 2020. Of total eight children management of included, two patients (25%) were classified as severe clinical types, two pediatric COVID-19, as (25%) as moderate, and four (50%) as mild. LUS documented sub-pleural an alternative to consolidations in two children and confluent B-lines (expression of an radiology. interstitial syndrome) in five. In 7/8, these results were in concordance with radiologic findings. This suggests that ultrasound may be a reasonable method to detect lung abnormalities in children with COVID-19, lowering radiation exposure, reducing the number of health care workers exposed to SARS-CoV-2, and allowing simple sterilization procedures for ultrasound equipment. Children, 21-Apr-20 The implications of The Lancet Correspondence Around the world reports are emerging of numerous residential institutions As residential Goldman PS, van Ijzendoorn orphan, COVID-19 for the Child & for children being closed as a result of the COVID-19 pandemic. Children institutions are closed, MH, Sonuga-Barke EJS, on homeless, care of children Adolescent appear to be being sent back to their communities without proper family-based and behalf of the Lancet residential living in residential Health consideration of where they will reside, how their transition will be community-based Institutional Care Reform institutions, institutions supported, and whether their safety will be monitored. There is concern for programs should be Commission Group. Lancet family-based children's physical, emotional, and social vulnerabilities, with supported for children Child Adolesc Health. programs immunodeficiencies that make them susceptible to COVID-19, and those who find themselves doi:10.1016/S2352- returning to households without the knowledge or resources to support orphaned or homeless 4642(20)30130-9 children with disabilities or those susceptible to COVID-19. As a result of as a result of the COVID-19, many children may be abandoned or separated from their pandemic. families due to increased poverty, mortality, poor health, family stress, domestic violence, and other reasons. Sexual and 21-Apr-20 Not a luxury: a call The Lancet Comment About 1.8 billion people live in fragile contexts worldwide, including 168 Experience from past Nguyen TT, Tappis H, reproductive to maintain sexual Global million individuals in need of humanitarian assistance. Approximately a epidemics in these Spilotros N, Krause S, Knaster health, fragile and reproductive Health quarter of those in fragile contexts are women and girls of reproductive age, settings has showed S, for the Inter-Agency settings, health in with countries affected by fragility and crisis accounting for 61% of maternal that discontinuing Working Group on humanitarian humanitarian and deaths worldwide. Experience from past epidemics in these settings has health-care services Reproductive Health in settings, fragile settings showed that discontinuing health-care services deemed unrelated to the deemed unrelated to Crises. Not a luxury: a call to obstetric and during the COVID- epidemic response resulted in more deaths than did the epidemic itself. the epidemic response maintain sexual and newborn care, 19 pandemic Poor health outcomes will surge from the absence or disruption of lifesaving resulted in more reproductive health in breastfeeding services, including emergency obstetric and newborn care. Early and deaths than did the humanitarian and fragile exclusive breastfeeding and skin-to-skin contact for neonates should be epidemic itself. settings during the COVID-19 promoted, and mother and neonate should not be separated unless one or pandemic. Lancet. 2020, both are critically ill in cases of suspected or confirmed COVID-19 infections doi:10.1016/S2214- 109X(20)30190-X Alveolus, 20-Apr-20 Why is Coronavirus Pediatric Editorial Chest tomography findings in SARS-CoV-2-infected children are similar to 83% of cells expressing Im DD. Why is Coronavirus pediatric, age- Disease 2019 not as Pulmonology those of infected adults, yet pediatric cases of COVID-19 are not as severe. ACE2, the receptor Disease 2019 not as severe in related severe in children?- The author suggests that this phenomenon could be due to age-related SARS-CoV-2 utilizes for children?-A look at type 2 differences, A look at type 2 differences within alveolar epithelial type II cells(AECII). SARS-CoV-2 enters cell entry, are AECII. alveolar cells. Pediatr AECII, ACEII alveolar cells cells using the ACE2 receptor. 83% of ACE2-expressing cells are AECII, Previous publications Pulmonol. 2020;55(6):1332- suggesting that AECIIs are reservoirs for viral invasion. The author argues show evidence of age- 1333. that COVID-19 shows evidence of AECII injury and depletion and recalls a related differences in doi:10.1002/ppul.24786 mouse model experiment done for a previous publication showing age- response to AECII 31 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication related differences in response to AECII injury and depletion. Though depletion and injury. younger mice (age=10 days, n not stated) died by day 2 depletion, adult The author suggests mice (age and n not stated) survived beyond 12 days post AECII depletion. that AECIIs may be of Though these results are the opposite of COVID-19 mortality and severity importance in treating trends, the author argues that this experiment provides evidence of age- COVID-19. related AECII differences and suggests that AECIIs could be important in treating COVID-19. Pregnancy, 20-Apr-20 Pulmonary Thrombosis Letter to the On March 29, 2020, a 17-year-old obese pregnant woman (BMI 32kg/m2) at A young obese Martinelli I, Ferrazzi E, obesity, Embolism in a Research Editors-in-Chief 29 weeks' gestation was admitted to a COVID-19 Maternity Hub in Milan pregnant woman with Ciavarella A, et al. Pulmonary pulmonary Young Pregnant with a 3-day history of fever, mild dyspnea and rhinitis. A nasopharyngeal SARS-CoV-2 and embolism in a young embolism, Woman With swab detected SARS-CoV-2 infection. The following day, her respiratory Staphylococcus aureus pregnant woman with respiratory COVID-19 function suddenly worsened, and she began oxygen supplementation. Blood co-infection COVID-19 [published online, failure, cultures demonstrated a Staphylococcus aureus bacteremia. On April 4, the developed pulmonary 2020 Apr 20]. Thromb Res. cesarean patient developed acute respiratory failure and underwent a chest CT scan embolism, which 2020;191:36‐37. delivery, Italy that showed a segmental pulmonary embolus in the right superior lobe, in prompted an urgent doi:10.1016/j.thromres.2020. addition to ground-glass opacities. At 29 weeks and 6 days, the patient cesarean delivery. 04.022 delivered a female newborn by urgent cesarean section due to worsening dyspnea. In the postpartum period, the patient's condition gradually improved on continuous positive airway pressure and was discharged. The newborn was admitted to the NICU and did not suffer from any complications. No information on neonatal SARS-CoV-2 testing was provided. Obese pregnant women with COVID-19 may have a particularly high risk of pulmonary embolism because of coexisting prothrombotic conditions. Children, 20-Apr-20 Ensuring availability Indian Commentary A 21-day lockdown has been imposed by the Government of India, to curtail Lockdown measures Upadhyay MK, Patra S, Khan nutritional of food for child Journal of the spread of COVID-19. This has impacted the availability of food and have the potential to AM. Ensuring availability of status, under- nutrition amidst the Community nutrition related services, like the Mid-Day Meal Scheme, which would affect cause serious impact food for child nutrition nourished, food COVID–19 Health the nutritional status of children throughout India. This report discusses the on the nutritional amidst the COVID – 19 security, pandemic: challenges and way forward for ensuring availability of food for child status of children pandemic: Challenges and lockdown, India Challenges and way nutrition during this health crisis. The government and non-government throughout India. Way forward [published forward partners must coordinate and scale up child nutrition services in the online 2020 Apr 20]. Indian J community through strengthening of the public distribution system and Community Health;32(2):251- home delivery of food parcels, wherever feasible. 254. Pregnancy, 20-Apr-20 Cesarean Section in Acta Médica Case Report Authors report the first cesarean delivery in a woman with COVID-19 at a No adverse maternal Lyra J, Valente R, Rosário M, neonate, a Pregnant Woman Portuguesa level III hospital in Portugal. A healthy 35-year-old woman with a term or neonatal outcomes Guimarães M. Cesarean cesarean With COVID-19: pregnancy tested positive for SARS-CoV-2 infection, on RT-PCR of were observed in this Section in a Pregnant Woman delivery, First Case in nasopharyngeal and oropharyngeal swabs, on the day of labor induction. case report of with COVID-19: First Case in Portugal Portugal Given a Bishop score < 4 and prior history of a cesarean section, the team cesarean delivery of a Portugal [published online, decided to perform a surgical delivery. The newborn was separated from his newborn by a mother 2020 Apr 20]. Acta Med Port. mother immediately after birth. Newborn nasal and oropharyngeal swabs with confirmed 2020. were all negative for SARS-CoV-2. The mother began mechanical breast COVID-19. doi:10.20344/amp.13883 stimulation to begin breastfeeding after recovering from COVID-19. Children, 20-Apr-20 The Profile of Journal of Original Research 56 children with COVID-19 pneumonia (40/56) or with respiratory syncytial CD8+ T cell response Li H, Chen K, Liu M, Xu H, Xu respiratory Peripheral Blood Infection virus (RSV) pneumonia (16/56) were included in the study. Compared with and serum IL-10 levels Q. The profile of peripheral syncytial virus, Lymphocyte children with RSV pneumonia, patients with COVID-19 pneumonia had may influence the blood lymphocyte subsets pneumonia, Subsets and Serum higher counts of CD3+8+ lymphocytes, higher percentages of CD3+ and severity of COVID-19 and serum cytokines in

32 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication lymphocyte Cytokines in CD3+8+ lymphocytes, and a lower percentage of CD19+ lymphocytes. The pneumonia in children with 2019 novel count, serum Children With 2019 serum IL-10 level was significantly higher in children with RSV pneumonia. children. coronavirus pneumonia IL-10, co- Novel Coronavirus One COVID-19 pneumonia child, who had an obvious increase in serum IL-10 [published online, 2020 Apr infection Pneumonia levels, developed severe pneumonia. Based on these results, effective CD8+ 20]. J Infect. 2020. T cell response may modulate the mild to moderate symptoms of COVID-19 doi:10.1016/j.jinf.2020.04.00 pneumonia seen in this study, compared to RSV which can cause more 1 severe lower respiratory tract infection. The adaptable change in IL-10 level might also contribute to the relatively mild pneumonia symptoms in children with COVID-19 pneumonia, and bacterial co-infection might be a risk factor of severe COVID-19 pneumonia. Pregnancy, 20-Apr-20 Clinical Virologica Research Article Pregnancy is a unique physiological condition and is characterized by altered Laboratory Wu C, Yang W, Wu X, et al. clinical Manifestation and Sinica immunity and elevated hormone levels to actively tolerate the semi- characteristics of 8 Clinical Manifestation and characteristics, Laboratory allogeneic fetus. This report retrospectively analyzed the clinical features, SARS-CoV-2 positive Laboratory Characteristics of laboratory Characteristics of laboratory characteristics, and imaging features of eight pregnant cases of pregnant women in SARS-CoV-2 Infection in characteristics SARS-CoV-2 SARS-CoV-2 infection during the pre-partum and post-partum periods. Four this study included Pregnant Women [published Infection in of the eight pregnant women were asymptomatic before delivery but elevated white blood online, 2020 Apr 20]. Virol Pregnant Women became symptomatic post-partum. White blood cell counts increased, and cell count and CRP Sin. 2020. lymphocyte counts decreased. Serum C-reactive protein levels also levels, and decreased doi:10.1007/s12250-020- increased to a higher level than those in general pregnancy. lymphocyte count. 00227-0 Nutrition, 20-Apr-20 Nutrition Amid the European Perspective This commentary presents a framework for action to maintain optimal This framework Naja F, Hamadeh R. Nutrition micronutrient COVID-19 Journal of nutrition using an adapted version of the ecological model of health addresses the impact amid the COVID-19 deficiencies, Pandemic: A Multi- Clinical behavior. At the individual level, nutritional deficiencies of energy, protein, of COVID-19 on pandemic: a multi-level food insecurity Level Framework Nutrition and specific micronutrients are associated with depressed immune function nutrition at multiple framework for action for Action and increased susceptibility to infection. An adequate intake of iron, zinc, levels within society, [published online, 2020 Apr and vitamins A, E, B6, and B12 is predominantly vital for the maintenance of with particular 20]. Eur J Clin Nutr. 2020. immune function. At the community level, food access and availability are attention paid to the doi:10.1038/s41430-020- particularly vulnerable to the implications of the COVID-19 outbreak. At the importance of 0634-3 national level, governments are also battling destabilization in their micronutrient intake economies and a rising threat of food insecurity. At the global level, it is for immune function essential to ensure the smooth flow of global trade and make full use of the and the challenges of international markets as a vital tool to secure food supply across the globe food insecurity. to prevent food insecurity. Maternal-infant 20-Apr-20 Managing COVID- Breast- Correspondence This report describes two cases of maternal-infant dyads, in which all four This report of two Salvatori G, De Rose DU, dyad, 19-Positive feeding individuals tested positive by nasopharyngeal swab for SARS-CoV-2, at a confirmed COVID-19 Concato C, et al. Managing breastfeeding, Maternal-Infant Medicine referral care center in Rome, Italy. Mother 1 and newborn 1 were 36 years maternal-infant dyads COVID-19-Positive Maternal- breast milk Dyads: An Italian old and 18 days old at admission, respectively. Mother 2 and newborn 2 in Rome, Italy did not Infant Dyads: An Italian samples, Italy Experience were 26 years old and 10 days old at admission, respectively. Neither the find evidence of viral Experience [published online, mothers nor the infants required intensive care unit admission. Viral nucleic nucleic acid in breast 2020 Apr 20]. Breastfeed acid was not detected by RT-PCR in expressed breast milk samples of both milk samples. Med. 2020, mothers. To the authors' knowledge, these are the first data on postnatal doi:10.1089/bfm.2020.0095 horizontal COVID-19 infection in newborns and breast milk analysis in Italy. Vitamin D, 20-Apr-20 Editorial: Low Alimentary Invited Editorial When mortality per million is plotted against latitude, it can be seen that all Lower COVID-19 Rhodes JM, Subramanian S, disease Population Pharma- countries that lie below 35 degrees North have relatively low mortality due mortality in the Laird E, Anne Kenny R. severity, Mortality From cology & to COVID-19. This happens to be the latitude above which people do not Southern hemisphere, Editorial: low population population COVID-19 in Therapy receive sufficient sunlight to retain adequate vitamin D levels during the where vitamin D mortality from COVID-19 in mortality, Countries South of winter. Vitamin D deficiency has been shown to correlate with hypertension, deficiency is rare, may countries south of latitude 35 Latitude 35 Degrees diabetes, and obesity––all features associated with increased risk of severe suggest a protective degrees North - supports 33 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Southern North - Supports COVID-19. It is important to note that the hypothesis is not that vitamin D role for vitamin D vitamin D as a factor hemisphere Vitamin D as a would protect against SARS-CoV-2 infection but that it could be very through prevention determining severity Factor Determining important in preventing the cytokine storm and subsequent ARDS that is against the cytokine [published online, 2020 Apr Severity commonly the cause of mortality. storm, not necessarily 20]. Aliment Pharmacol Ther. infection itself. 2020. doi:10.1111/apt.15777 Children, 20-Apr-20 Children May Be Journal of Heads Up The February 2020 World Health Organization‐China Joint Mission on This brief Children may be less affected infants, Less Affected Than Pediatrics Coronavirus Disease found that only 2.4% of cases of COVID-19 were in communication than adults by novel neonates, Adults by Novel and Child those less than 19 years of age. 2.5% of children developed severe disease summarizes data on coronavirus (COVID-19). J epidemiology, Coronavirus Health (compared to 13.8% overall) and 0.2% of children developed critical disease COVID-19 in children Paediatr Child Health. clinical (COVID-19) (compared to 6.1% overall). Severe disease was defined as dyspnea, from the February 2020;56(4):657. characteristics, tachypnea, hypoxia or infiltrates affecting >50% of the lung fields within 2020 WHO-China Joint doi:10.1111/jpc.14876 WHO, China 48 hours; critical disease was defined as respiratory failure, septic shock Mission on and/or multi‐organ failure. Although reported case numbers are quite small, Coronavirus Disease, young infants seem to have relatively low rates of being severely affected; as well as case reports one study of nine infected infants found none required intensive care or had on infant and neonatal significant complications. Despite this, certain pediatric populations, such as infection. extremely prematurely born babies, are likely to be particularly vulnerable, with one death confirmed in this subgroup. Pediatric 19-Apr-20 Paediatric Pediatric Educational Pediatric anaesthetists, who perform aerosol generating procedures Key recommendations Lee-Archer P, von Ungern- anesthesia, Anaesthetic Anaesthesia Review involving the airway, are at high risk of exposure to the SARS-CoV-2 virus and for pediatric Sternberg BS. Paediatric intubation, Implications of must be well-prepared to manage such cases. This article reviews the anesthesia during the Anaesthetic implications of aerosol COVID-19 - A relevant pediatric literature surrounding COVID-19 and summarizes the key COVID-19 pandemic COVID-19 - A Review of generation Review of Current recommendations for anaesthetists involved in the care of children during are outlined. Current Literature [published Literature this pandemic. online, 2020 Apr 19]. Paediatr Anaesth. 2020. doi:10.1111/pan.13889 Pregnancy, 18-Apr-20 Coronavirus Disease American Systematic This is a systematic review of the management of pregnancies complicated The authors highlight Della Gatta AN, Rizzo R, Pilu management, 2019 During Journal of Review by COVID-19 conducted through searches of PubMed, CINAHL, and Scopus in this review the high G, Simonazzi G. Coronavirus Cesarean rate, Pregnancy: A Obstetrics databases. 6 studies were included for analysis with a total of 51 cases of rate of C-sections disease 2019 during preterm birth Systematic Review and pregnancies with COVID-19. Symptoms at onset of COVID-19 infection were among women with pregnancy: a systematic of Reported Cases Gynecology reported for 35 pregnant women (69%) and most commonly included fever pregnancy review of reported cases. Am (48%), dry cough (46%), and fever only in the postpartum period (23%). complicated by J Obstet Gynecol. There was 1 case of gestational hypertension at 27 weeks’ gestation and 1 COVID-19. They also 2020;223(1):36-41. doi: case of pre-eclampsia at 31 weeks’ gestation; in both cases, symptoms provide further 10.1016/j.ajog.2020.04.013 appeared after the diagnosis of COVID-19. Of the 48 women who delivered, evidence of the 2 had a vaginal delivery and 46 underwent Cesarean delivery. Preterm labor association between was reported in 6 of 48 cases, and premature rupture of the membranes COVID-19 and was reported in 9 of 34 cases. Out of 48 neonates that were delivered, there spontaneous preterm was 1 stillbirth in a severely compromised mother, and 1 neonatal death birth. with a negative a throat swab for COVID-19, although a perinatal infection could not be excluded. The authors conclude that at present, the available evidence does not make clear whether pregnant patients require a different approach from standard care.

34 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Children, 18-Apr-20 Chloroquine for Clinical Current Opinion This article discusses the pharmacokinetics and safety of chloroquine, an old The pharmacokinetic Smit C, Peeters MYM, van chloroquine, SARS-CoV-2: Pharmaco- antimalarial drug, that should be considered in SARS-CoV-2 infections. and safety properties den Anker JN, Knibbe CAJ. treatment, Implications of Its kinetics Chloroquine is well absorbed and distributes extensively, with an apparent of chloroquine suggest Chloroquine for SARS-CoV-2: pharmaco- Unique and terminal half-life of 1.6 days and 2 weeks, respectively. Chloroquine is that chloroquine can Implications of Its Unique kinetics, safety Pharmacokinetic metabolized by cytochrome P450 and renal clearance is responsible for one be used safely for an Pharmacokinetic and Safety margin and Safety third of total clearance. There is a lack of reliable information on target acute SARS-CoV-2 Properties [published online, Properties concentrations of chloroquine for COVID-19, thus doses that have proven infection, but the 2020 Apr 18]. Clin safe in malaria treatment should be considered. Clinical experience has safety margin is small, Pharmacokinet. 2020. shown that chloroquine has a narrow safety margin, as three times the adult particularly in doi:10.1007/s40262-020- therapeutic dosage for malaria can be lethal when given as a single dose. children. 00891-1 Although infrequent, poisoning in children is extremely dangerous where one to two tablets can potentially be fatal. Children, 18-Apr-20 Novel Coronavirus Turkish Review Article According to the current literature, children account for 1-5% of diagnosed Authors Bedir Demirdağ T, Tezer H. clinical Disease (COVID-19) Journal of COVID-19 cases. Approximately 90% of pediatric patients are diagnosed with comprehensively Novel Coronavirus disease characteristics, in Children Medical asymptomatic, mild, or moderate disease. However, up to 6.7% of cases may review existing (COVID-19) in children epidemiology, Sciences be severe. Severe illness is generally seen in patients younger than 1 year of literature on the [published online, 2020 Apr vertical age and patients who have underlying diseases. The epidemiological and pathogenesis, 18]. Turk J Med Sci. 2020. transmission clinical patterns of COVID-19 and treatment approaches in pediatric patients transmission, doi:10.3906/sag-2004-174 still remain unclear. Mother to infant transmission of SARS-CoV-2, through epidemiology, clinical breast milk or vertical transmission, is also controversial. This review findings, diagnosis, summarizes the current epidemic, clinical presentation, diagnosis, and and treatment of treatment of COVID-19 in pediatric patients. COVID-19 in pediatric patients. Pregnancy, 18-Apr-20 Severe COVID-19 American Short A 41-year-old pregnant woman with a history of previous cesarean deliveries This case study Alzamora MC, Paredes T, neonate, During Pregnancy Journal of Communication and diabetes mellitus presented with a 4-day history of malaise, low-grade describes severe Caceres D, Webb CM, Valdez vertical and Possible Perinatology fever, and progressive shortness of breath. A nasopharyngeal swab was presentation of LM, La Rosa M. Severe transmission, Vertical positive for COVID-19, and COVID-19 serology was negative. The patient COVID-19 in a COVID-19 during Pregnancy maternal Transmission developed respiratory failure requiring mechanical ventilation on day 5 of pregnant woman. This and Possible Vertical antibodies, disease onset. The patient underwent a cesarean delivery, and neonatal is the earliest reported Transmission [published serology isolation was implemented immediately after birth, without delayed cord positive diagnosis for online, 2020 Apr 18]. Am J clamping or skin-to-skin contact. The neonatal nasopharyngeal swab, 16 COVID-19 in a Perinatol. 2020. hours after delivery, was positive for SARS-CoV-2 on RT-PCR. Neonatal IgM neonate. Maternal doi:10.1055/s-0040-1710050 and IgG for SARS-CoV-2 were negative. Maternal IgM and IgG were positive anti-SARS-CoV-2 on postpartum day 4 (day 9 after symptom onset). To the authors' antibodies were not knowledge, this is the earliest reported positive PCR in the neonate, raising detectable until after concern for the possibility of vertical transmission. delivery. COVID-19; 17-Apr-20 COVID-19 Clinics Review This review aims to verify the epidemiologic, clinical, diagnostic and This review aims to Carlotti APCP, Carvalho WB, Pediatric Diagnostic and therapeutic aspects of COVID-19 in critically ill pediatric patients. Experts verify the Johnston C, Rodriguez IS, Critical Care Management from a large Brazilian public university analyzed all recently published epidemiologic, clinical, Delgado AF. COVID-19 Medicine; Protocol for material to produce a report aiming to standardize the care of critically ill diagnostic and Diagnostic and Management Infection; Pediatric Patients children and adolescents. A case series of 2143 pediatric patients in China therapeutic aspects of Protocol for Pediatric Ventilatory showed that of 731 confirmed cases of COVID-19, 94 (4.4%) patients were COVID-19 in critically Patients. Clinics (Sao Paulo). Support; asymptomatic, 1091 (50.9%) patients had mild symptoms, and 831 (38.8%) ill pediatric patients. 2020 Apr 17;75:e1894. doi: Diagnostic patients had moderate symptoms. 125 (5.8%) patients developed severe or The authors suggest 10.6061/clinics/2020/e1894. Criteria critical disease. Younger children were more susceptible to severe or critical that the guidelines PMID: 32321116; PMCID: symptoms (10.6% <1 year old vs. 3% ³16 years old). With regard to developed by experts PMC7153362. laboratory testing, white blood cell count can be normal or reduced; a series can help all 35 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication of 171 pediatric cases of COVID-19 reported leukopenia in 26.3% of patients; practitioners only 3.5% developed lymphocytopenia. C reactive protein levels can either standardize their care be normal or elevated and may be accompanied by increased hepatic or and improve the muscular enzymes and/or elevated d-dimer levels. Chest radiography and treatment of COVID- chest CT can show abnormalities such as ground glass opacities and 19. consolidation; children presenting with severe infection may present with bilateral consolidation on imaging. A diagnosis is made considering clinical findings, epidemiology, and laboratory testing to confirm SARS-CoV-2 infection. The main principles of therapeutic management include early identification, early isolation, early diagnosis, and early treatment. Severe cases with respiratory distress and/or hypoxia (SaO2 <94%) should be admitted to the hospital with indications for ICU admission identified as: respiratory failure requiring mechanical ventilation and shock or other organ dysfunction requiring treatment. The authors suggest that the guidelines developed by experts can help all practitioners standardize their care and improve the treatment of COVID-19. SARS-CoV-2, 17-Apr-20 Considerations for American Review The authors review information known about SARS-CoV-2 infections in In this review article, Dotters-Katz SK, Hughes BL. COVID-19, Obstetric Care Journal of pregnancy and discuss subsequent outpatient and inpatient management pregnant women were Considerations for Obstetric Pandemic, During the COVID- Perinatology considerations. At the time of this review, there were no reported SARS- noted to be at no Care during the COVID-19 Coronavirus, 19 Pandemic CoV-2 infections in the first trimester. In general, pregnant women do not greater risk of Pandemic. American Journal Pregnancy, appear to be at increased risk of developing SARS-CoV-2 infections than the developing SARS-CoV- of Perinatology. Vertical general population. Additionally, early data does not demonstrate an 2 than the general 2020;37(8):773-779. Transmission, increased risk of severe infection among pregnant women. Cases of severe population, and in doi:10.1055/s-0040-1710051 Prenatal Care disease described in pregnant women show multisystem organ failure and those that did get the need for extracorporeal membrane oxygenation (ECMO). No cases of infected, no maternal maternal deaths were reported, and only one case of intrauterine fetal deaths were reported. demise was documented in the setting of multisystem organ failure and The authors discuss ECMO use in a pregnant woman with SARS-CoV-2. At the time of this article, management vertical transmission of SARS-CoV-2 infections was not confirmed. considerations for Prevention is recommended as the best management modality of SARS-CoV- outpatient and 2 in pregnant women. For pregnant women with mild SARS-CoV-2 infections, inpatient obstetric supportive care at home is recommended. If there are no urgent obstetric care during the issues, prenatal visits can be deferred until the patient is outside the COVID-19 pandemic. infectious window. For urgent obstetric issues, SARS-CoV-2 specific clinics could be established to see these patients and limit exposure to noninfected patients. In the inpatient setting, universal screening for SARS-CoV-2 and mask-wearing can be utilized. Operative deliveries should only be reserved for usual obstetric indications. Additionally, after delivery, the separation of infected mothers from infants should be considered to minimize transmission risk. Canada, France, 17-Apr-20 COVID-19 and acute Journal of Case Report In this case report, the authors present a possible link between maternal The authors present Koumoutsea, EV, Vivanti, AJ, maternal coagulopathy in Thrombosis peripartum COVID-19 infection and rapid maternal deterioration with early two case reports of Shehata, N, et al. COVID‐19 COVID-19, pregnancy & organ dysfunction and coagulopathy. Case 1 was a 40-year old at Mount COVID-19 positive and acute coagulopathy in coagulopathy Haemostasis Sinai Hospital, Toronto, Canada. She had familial neutropenia and a mothers that may pregnancy. J Thromb pregnancy complicated by gestational diabetes, neutropenia, and mild demonstrate a link Haemost. 2020; 18: 1648– respiratory infections. She was admitted at 35.3 weeks’ gestation and tested between maternal 1652. positive for SARS-CoV-2 via nasopharyngeal (NP) swab. 48 hours prior to peripartum COVID-19 36 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication delivery, she experienced progressive thrombocytopenia, declining infection and rapid https://doi.org/10.1111/jth.1 fibrinogen, and rising activated partial thromboplastin time (APTT). She maternal deterioration 4856 delivered a healthy male neonate (2.93kg) via C-section but had a severe with progressive post-partum hemorrhage (1.5L). Case 2 was a 23-year old woman admitted coagulopathy. The at 35.2 weeks who tested positive for SARS-CoV-2 via NP swab. authors recommend Thrombocytopenia, prolonged APTT, and transaminitis prompted her routine measurements transfer to a hospital in Clamart, France. She delivered a healthy male infant of D-dimers, at 35.5 weeks (2.54kg) by emergency C-section. Pregnancy may not protect prothrombin time, and COVID-19 patients from coagulopathy, and coagulopathy is linked to poorer platelet count in all prognosis outside pregnancy. The authors emphasize the importance of patients presenting routine measurements of D-dimers, prothrombin time, and platelet count in with COVID-19. all patients presenting with COVID-19 per the International Society of on Furthermore, Thrombosis and Haematosis recommendations. In pregnancy, the activated partial measurement of APTT and fibrinogen values may also be valuable. thromboplastin time and fibrinogen levels may be valuable for pregnant patients. Obstetric 17-Apr-20 Considerations and Saudi Journal Review Although SARS CoV-2 has a lower mortality rate compared to the other This article reviewed Alyamani O, Abushoshah I, anesthesia, Recommendations of coronaviruses, it has a higher human-to-human transmission rate. the literature and Tawfeeq NA, et al. labor and for Obstetric Anaesthesia Anesthesiologists may benefit from a review of the current evidence related professional medical Considerations and delivery, Anesthesia Care to the obstetric patient with COVID-19 in order to help limit infection in societies' experts' Recommendations for cesarean During COVID-19 obstetric patients, protect healthcare workers, and prepare administrations opinions to shed light Obstetric Anesthesia Care delivery, airway Pandemic - Saudi and leadership. This review aims to present obstetric anesthesia on considerations and During COVID-19 Pandemic - management Anesthesia Society considerations and recommendations during the COVID-19 pandemic and recommendations in Saudi Anesthesia Society Guidelines highlight the current evidence and experts' opinions. The authors searched obstetric anesthesia Guidelines. Saudi J Anaesth. the databases (PubMed and Embase) for papers published before April 2020 care during the 2020 Jul-Sep;14(3):359-364. on COVID-19 that are relevant to the obstetric anesthesia practice. The COVID-19 pandemic. doi: 10.4103/sja.SJA_310_20. results include recommendations for obstetrics departments and Epub 2020 Apr 17. institutional leaderships, recommendations (including checklists) for anesthesia providers working in labor and delivery units, neuraxial anesthesia for cesarean delivery, and general anesthesia and airway management. These recommendations may be adapted for future droplet- or airborne-based pandemics. Pregnancy, pre- 17-Apr-20 COVID19 During American Review 6 studies, including 51 women, were eligible for this systematic review of A high rate of pre- Della Gatta AN, Rizzo R, Pilu term cesarean Pregnancy: A Journal of PubMed, CINAHL, and Scopus databases. Three pregnancies were ongoing at term cesarean delivery G, Simonazzi G. COVID19 delivery, Systematic Review Obstetrics & the time of the report; of the remaining 48, 46 were delivered via cesarean among pregnant during pregnancy: a stillbirth, fetal of Reported Cases Gynecology section and 2 vaginally; there was 1 stillbirth and 1 neonatal death. Although women with COVID-19 systematic review of death, neonatal vertical transmission of SARS-Cov2 has been excluded in these studies, and warrants concern. reported cases [published outcomes, maternal and neonatal outcomes have been generally favorable, the high online, 2020 Apr 17]. Am J vertical rate of pre-term cesarean delivery is a reason for concern. These Obstet Gynecol. 2020. transmission interventions were typically elective, and it is reasonable to question doi:10.1016/j.ajog.2020.04.0 whether or not they were warranted. COVID-19 associated with respiratory 13 insufficiency in late pregnancies creates a complex clinical scenario. Nutrition, 17-Apr-20 The Impact of Brain, Review The high rate of consumption of diets high in saturated fats, sugars, and Consumption of Butler MJ, Barrientos RM. Western diet, Nutrition on COVID- Behavior, refined carbohydrates (collectively called Western diet, WD) worldwide, Western diets, The impact of nutrition on obesity, type II 19 Susceptibility and contribute to the prevalence of obesity and type II diabetes, and could place contributing to obesity COVID-19 susceptibility and diabetes, Immunity these populations at an increased risk for severe COVID-19 pathology and and type II diabetes, long-term consequences 37 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication chronic and Long-Term mortality. WD consumption activates the innate immune system and impairs leads to chronic [published online, 2020 Apr inflammation, Consequences adaptive immunity, leading to chronic inflammation and impaired host inflammation and 17]. Brain Behav Immun. immune defense against viruses. Furthermore, peripheral inflammation caused by impaired host defense 2020. response, COVID-19 may have long-term consequences in those that recover, leading against SARS-CoV-2, in doi:10.1016/j.bbi.2020.04.04 neuro- to chronic medical conditions such as dementia and neurodegenerative addition to potentially 0 inflammatory disease, likely through neuroinflammatory mechanisms that can be long-term compounded by an unhealthy diet. neuroinflammatory complications. Neonate, 17-Apr-20 Preterm delivery in Prenatal Research Letter On March 7, 2020, a 22-year-old female (32 weeks' gestation), presented at In this case report Zamaniyan M, Ebadi A, preterm pregnant woman Diagnosis Imam Khomeini Hospital in Sari, Iran with a 4-day history of dyspnea, from Iran, amniotic Aghajanpoor Mir S, Rahmani delivery, with critical COVID- myalgia, anorexia, nausea, non-productive cough and fever. The mother’s fluid and neonatal Z, Haghshenas M, Azizi S. amniotic fluid 19 pneumonia and nasopharyngeal swabs tested positive for SARS-CoV-2. On March 11, a nasal/throat swab Preterm delivery in pregnant sample, vertical preterm female neonate was delivered via cesarean section, weighing samples tested woman with critical COVID- maternal death transmission 2.35kg; she was kept in an isolated NICU and fed with powdered milk. positive for SARS-CoV- 19 pneumonia and vertical Umbilical cord blood and neonatal nasal and throat swab samples, collected 2 following cesarean transmission [published after delivery, tested negative for SARS-CoV-2 on RT-PCR; whereas, amniotic delivery by a mother online, 2020 Apr 17]. Prenat fluid samples tested positive. 24 hours later, the neonate's nasal and throat with COVID-19. The Diagn. 2020. swab samples turned positive for SARS-CoV-2. After cesarean delivery, the mother died due to doi:10.1002/pd.5713 mother's condition progressively worsened, despite treatment with respiratory antivirals and corticosteroids, and she died on March 26. complications. Immunization, 17-Apr-20 COVID-19 disrupts The Lancet Newsdesk The impact of the ongoing pandemic of coronavirus 2019 on immunization "Catch-up" Nelson R. COVID-19 disrupts vaccine vaccine delivery Infectious campaigns in low- and middle-income countries is concerning. Immunization immunization vaccine delivery [published delivery, LMICs, Diseases services will be disrupted due to the interplay of multiple factors. One campaigns will be online, 2020 Apr 17]. Lancet catch-up reason is that healthcare services are stretched and directed to other necessary to account Infect Dis. 2020. campaigns priorities, and a second factor is that because of social distancing for disruptions in doi:10.1016/S1473- recommendations, parents are not bringing their children to clinics. Another vaccine delivery across 3099(20)30304-2 issue has to do with the supply chain, which is under historic strain due to LMICs due to the transport disruptions. Preventive mass vaccination campaigns can also COVID-19 pandemic. inadvertently contribute to COVID-19 spread, and UNICEF is recommending that these campaigns be suspended for now. There will be a need for “catch- up” campaigns, to identify those who missed their immunizations as well as re-establishing community demand. Household 17-Apr-20 The Characteristics Clinical Major Article A total of 105 index patients and 392 household contacts were enrolled in The rate of secondary Li W, Zhang B, Lu J, et al. The transmission, of Household Infectious this household cohort study. Both index patients and household members transmission of SARS- characteristics of household children, Transmission of Diseases were evaluated by SARS-CoV-2 RT-PCR. Secondary transmission of SARS- CoV-2 within transmission of COVID-19 secondary COVID-19 CoV-2 developed in 64 of 392 household contacts (16.3%). The secondary households from index [published online, 2020 Apr attack rate, attack rate to children was 4% comparing with 17.1% to adults. The cases to contact 17]. Clin Infect Dis. 2020. contact secondary attack rate to contacts within the households with index patients members was 16.3% doi:10.1093/cid/ciaa450 members quarantined by themselves since onset of symptoms was 0%, compared with in this study. The 16.9% to the contacts without index patients quarantined. The secondary secondary attack rate attack rate to contacts who were spouses of index cases was 27.8% to children was 4%, comparing with 17.3% to other adult members in the households. Ages of compared to 17.1% to household contacts and spouse relationship with index case are risk factors adults. for transmission of SARS-CoV-2 within household.

38 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Infant, febrile, 17-Apr-20 SARS-CoV-2 Clinical Brief Report Two cases of SARS-CoV-2 infection in male infants (25-day-old full-term and In the context of an Paret M, Lighter J, Pellett routine testing, Infection (COVID- Infectious 56-day-old pre-term) presenting with fever in the absence of respiratory ongoing outbreak, Madan R, Raabe VN, Shust respiratory 19) in Febrile Diseases distress are reported. The infants required hospitalization for evaluation of authors encourage GF, Ratner AJ. SARS-CoV-2 symptoms Infants Without possible invasive bacterial infections. In the first months of life, infants routine testing of infection (COVID-19) in Respiratory Distress presenting with fever typically undergo diagnostic evaluations for invasive febrile infants for febrile infants without bacterial disease, even in the absence of clinical signs. Diagnoses in this SARS-CoV-2, even in respiratory distress study resulted from routine isolation and RT-PCR-based testing for SARS- the absence of [published online, 2020 Apr CoV-2 in febrile infants in an outbreak setting. respiratory symptoms. 17]. Clin Infect Dis. 2020. doi:10.1093/cid/ciaa452 Pregnancy, 17-Apr-20 Clinical New England Correspondence From December 8, 2019, to March 20, 2020, 118 pregnant women with In this study of 118 Chen L, Li Q, Zheng D, et al. neonates, Characteristics of Journal of COVID-19 in Wuhan were identified in the epidemic reporting system of the pregnant women with Clinical Characteristics of clinical Pregnant Women Medicine National Health Commission of China. 84 women (71%) had positive PCR COVID-19, there were Pregnant Women with Covid- characteristics, With Covid-19 in testing for SARS-CoV-2 infection, and the remaining 34 (29%) had suggestive no maternal deaths. 19 in Wuhan, China abortions, Wuhan, China findings on chest CT. 75 of 118 (64%) had been infected with SARS-CoV-2 in Of 68 women who [published online, 2020 Apr breast milk the third trimester. The most common symptoms in 112 women with delivered during the 17]. N Engl J Med. 2020. samples, China available data were fever (in 75%) and cough (in 73%). Lymphopenia was study period, 63 (93%) doi:10.1056/NEJMc2009226 present in 51 of 116 patients (44%). A total of 88 of the 111 women (79%) underwent cesarean who underwent chest CT had infiltrates in both lungs. A total of 109 of 118 section. All neonates women (92%) had mild disease, and 9 (8%) had severe disease (hypoxemia), tested negative for 1 of whom received noninvasive mechanical ventilation (critical disease). COVID-19 infection. Severe disease developed in 6 of the 9 women after delivery. There were no Breastmilk samples deaths. Among the study population, there were 3 spontaneous abortions, 2 also tested negative. ectopic pregnancies, and 4 induced abortions (all owing to patients’ concerns about COVID-19). A total of 68 of 118 patients (58%) delivered during the study period and had 70 births (2 sets of twins). Of these 68 patients, 63 (93%) underwent a cesarean section; in 38 of 62 cases (61%), the procedure was performed because of concern about the effects of COVID-19 on the pregnancy. A total of 14 deliveries (21%) were premature; 8 were induced (7 owing to concern about COVID-19). No babies had neonatal asphyxia. SARS-CoV-2 testing of throat swabs from 8 newborns and breastmilk samples from 3 mothers was negative. Children, aging, 17-Apr-20 A Geroscience The Journals Research Report COVID-19 can have serious health consequences, though risks of The dynamics of age- Promislow DEL. A geroscience immune Perspective on of complications are highly age-dependent. Rates of hospitalization and death specific mortality due perspective on COVID-19 function, pro- COVID-19 Mortality Gerontology are less than 0.1% in children but increase to 10% or more in older people. to COVID-19 mirror mortality [published online, inflammatory Moreover, at all ages, men are more likely than women to suffer serious other major causes of 2020 Apr 17]. J Gerontol A response, consequences from COVID-19. These patterns are familiar to the mortality. Biol Sci Med Sci. 2020. causes of geroscience community. The effects of age and sex on mortality rates from doi:10.1093/gerona/glaa094 mortality, COVID-19 mirror the effects of aging on almost all major causes of mortality. geroscience Age-related decline in adaptive immune function and increase in pro- inflammatory response are likely contributing factors, as well as an increasing number of comorbid conditions as people age. These factors underscore the need to consider the role of basic biological mechanisms of aging on potential treatment.

39 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Telehealth, 17-Apr-20 Rapid Development Journal of Brief The COVID-19 national emergency has led to surging care demand and the This report outlines Patel PD, Cobb J, Wright D, et children, of Telehealth the Communication need for unprecedented telehealth expansion. Rapid telehealth expansion recommendations for al. Rapid Development of pediatric Capabilities Within American can be especially complex for pediatric patients. From the experience of a rapid implementation Telehealth Capabilities within patient Pediatric Patient Medical large academic medical center, this report describes a pathway for of remote pediatric Pediatric Patient Portal enrollment Portal Informatics efficiently increasing capacity of remote pediatric enrollment for telehealth enrollment for Infrastructure for COVID-19 Infrastructure for Association while fulfilling privacy, security, and convenience concerns. The design and telehealth services. Care: Barriers, Solutions, COVID-19 Care: implementation of the process took two days. Weekly enrollment Results [published online, Barriers, Solutions, subsequently increased 10-fold for children (age 0-12 years) and 1.2-fold for 2020 Apr 17]. J Am Med Results adolescents (age 13-17 years). Weekly telehealth visits increased 200-fold Inform Assoc. 2020. for children and 90-fold for adolescents. The obstacles and solutions doi:10.1093/jamia/ocaa065 presented in this report can provide guidance to health systems for similar challenges during the COVID-19 response and future disasters. Children, 17-Apr-20 Hospitalization Morbidity Report COVID-NET was implemented to produce robust, weekly, age-stratified and Hospitalization rates Garg S, Kim L, Whitaker M, et hospitalization Rates and and population-based surveillance for laboratory-confirmed COVID-19- for persons 17 years al. Hospitalization Rates and rate, United Characteristics of Mortality associated hospitalization rates in 99 counties of 14 states. The catchment and younger in the Characteristics of Patients States, CDC Patients Weekly area represents approximately 10% of the U.S. population. Among 1482 United States were <1 Hospitalized with Laboratory- Hospitalized with Report patients admitted during March 1-30, 2020, the first month of U.S. per 100,000. Rates of Confirmed Coronavirus Laboratory- surveillance, the hospitalization rate was 0.3 per 100,000 in persons aged 0- hospitalization Disease 2019 — COVID-NET, Confirmed 4 years, 0.1 in those aged 5-17 years, 2.5 in those aged 18-49 years, 7.4 in increase with age. 14 States, March 1–30, 2020. Coronavirus Disease those aged 50-64 years, and 13.8 in those aged ≥65 years. Hospitalization MMWR Morb Mortal Wkly 2019 — COVID-NET, rates increase with age and are highest among older adults; the majority of Rep 2020;69:458–464. DOI: 14 States, March 1– hospitalized patients have underlying conditions. Ongoing monitoring of http://dx.doi.org/10.15585/ 30, 2020. hospitalization rates is critical to understanding the evolving epidemiology of mmwr.mm6915e3 COVID-19 in the U.S. and to guide planning of health care resources. human 16-Apr-20 Prior and novel Fertility and Review To summarize current understanding of the effects of SARS-CoV-2 and prior This review compares Segars J, Katler Q, McQueen reproduction, coronaviruses, Sterility coronaviruses on human reproduction and pregnancy, the authors available evidence on DB, et al. Prior and novel gametes, SARS- Coronavirus Disease conducted a review of English language publications published up to 6 April the effects of SARS- coronaviruses, Coronavirus CoV-2, 2019 (COVID-19), 2020. 79 reports formed the basis of the review. Reports indicate decreased CoV-2 and other Disease 2019 (COVID-19), and coronaviruses, and human sperm concentration and motility for 72–90 days following SARS-CoV-2 coronaviruses on human reproduction: what is MERS, SARS, reproduction: what infection. Gonadotropin-dependent expression of ACE2 was found in human human reproduction known?. Fertil Steril. maternal is known? ovaries, but it is unclear whether SARS-CoV-2 adversely affects female and pregnancy, as well 2020;113(6):1140-1149. outcomes, gametogenesis. Comparisons of maternal and fetal outcomes based on as the safety of using doi:10.1016/j.fertnstert.2020 preterm available evidence are summarized in a table for COVID-19, SARS, and MERS. currently available .04.025 delivery COVID-19 has a lower maternal case fatality rate (2%) than SARS (18%) or treatments for COVID- MERS (25%); however, evidence suggests maternal COVID-19 is associated 19 in pregnant with higher rates of preterm delivery (38%) when compared with SARS (25%) patients. While or MERS (27%). Case reports available at the time of review showed no viral maternal case fatality SARS-CoV-2 RNA in placental, umbilical cord blood, amniotic fluid, or rates are lower for breastmilk samples of infected mothers. The authors consider evidence of SARS-CoV-2 than SARS-CoV-2 vertical transmission to be inconclusive at the time of this MERS or SARS, review. Several medical treatments for COVID-19 are known either to be evidence suggests safe or non-teratogenic in pregnancy. These include SARS-CoV-2 infection hydroxychloroquine/chloroquine, methylprednisolone/glucocorticoids, and is associated with lopinavir-ritonavir. Although non-teratogenic, the use of glucocorticoids in higher rates of pregnancy has been associated with diabetes, weight gain, preterm preterm delivery. premature rupture of membranes, hypertension, and intra-uterine growth restriction. Interferon therapy, often used in hepatitis C treatment, has been 40 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication well established to be safe in pregnancy. The use of convalescent plasma has been shown to reduce COVID-19 severity; given that its risk profile should be similar to a blood transfusion, there are no overt contra-indications in pregnancy. Nutrition, 16-Apr-20 Enhancing Diabetes & Review This review presents a systematic search of previous clinical trials that Previous clinical trials Jayawardena R, vitamins, trace Immunity in Viral Metabolic studied nutrition-based interventions for viral diseases (with special show evidence of Sooriyaarachchi P, elements, Infections, With Syndrome: emphasis on respiratory infections). 43 studies were obtained (vitamins: 13; benefit from vitamins Chourdakis M, et al. nutraceuticals, Special Emphasis on Clinical minerals: 8; nutraceuticals: 18 and probiotics: 4). Among vitamins, A and D A and D, trace Enhancing immunity in viral probiotics, COVID-19: A Review Research & showed a potential benefit, especially in deficient populations. Among trace elements like selenium infections, with special micronutrients Reviews elements, selenium and zinc have also shown favorable immune-modulatory and zinc, emphasis on COVID-19: A effects in viral respiratory infections. Several nutraceuticals and probiotics nutraceuticals and review [published online, may also have some role in enhancing immune functions. Micronutrients probiotics in viral 2020 Apr 16]. Diabetes may be beneficial in nutritionally depleted elderly population. infections. Metab Syndr. 2020. doi:10.1016/j.dsx.2020.04.01 5 Children, 16-Apr-20 Clinical Journal of Original Article A systematic review was performed using PubMed and Embase to find case Authors conclude that Chang TH, Wu JL, Chang LY. clinical Characteristics and the series of children with COVID-19. Nine case series were included. In the disease severity in Clinical characteristics and characteristics, Diagnostic Formosan pooled data, most of patients (75%) had a household contact history. The children is relatively diagnostic challenges of diagnosis, Challenges of Medical disease severity was mainly mild to moderate (98%). Only 2 children (2%) mild, and current pediatric COVID-19: A household Pediatric COVID-19: Association received intensive care. Fever occurred in 59% of the patients, while cough diagnosis is based systematic review and meta- contact history A Systematic in 46%. Gastrointestinal symptoms (12%) were uncommon. There are 26% mainly on ground glass analysis [published online, Review and Meta- children are asymptomatic. The most common radiographic finding was opacities on chest CT, 2020 Apr 16]. J Formos Med Analysis ground glass opacities (48%). Currently, there is no evidence of vertical epidemiological Assoc. 2020. transmission to neonates born to mothers with COVID-19. Compared with suspicion and contact doi:10.1016/j.jfma.2020.04.0 SARS-CoV, SARS-CoV-2 causes less severe disease in children. tracing. 07 Children, 16-Apr-20 The COVID-19 Journal of Editorial Authors explore different uses of technology to maintain the social, physical, Technology has been Goldschmidt K. The COVID-19 wellbeing, pandemic: Pediatric emotional, intellectual, and spiritual wellbeing of children during the COVID- leveraged to maintain pandemic: Technology use to technology, Technology use to Nursing 19 pandemic. Of note, the American Academy of Pediatrics recommends the wellbeing of support the wellbeing of vaccinations, support the that newborns, infants, and young children continue to be seen in person by children in a variety of children [published online, food insecurity wellbeing of a primary care provider for their routine vaccinations and well visits. ways. 2020 Apr 16]. J Pediatr Nurs. children pediatricians are encouraged to monitor community spread of COVID-19. 2020. doi:10.1016/j.pedn.2020.04.0 13 Children, 16-Apr-20 Fecal-Oral The Pediatric Brief Report Two pediatric cases of COVID-19 in Italy were confirmed using Based on evidence of Donà D, Minotti C, Costenaro gastro- Transmission of Infectious nasopharyngeal and rectal swabs. This report also reviews current evidence viral shedding patterns P, Da Dalt L, Giaquinto C. intestinal, fecal- SARS-CoV-2 in Diseases on SARS-CoV-2 detection via RT-PCR in stool and rectal swabs in adults and in fecal samples, this FECAL-ORAL TRANSMISSION oral Children: Is It Time Journal children. Only one study used electron microscopy for live virus detection. report suggests the OF SARS-COV-2 IN CHILDREN: transmission, to Change Our Additional evidence exists in support of viral viability in environmental inclusion of rectal IS IT TIME TO CHANGE OUR rectal swab, Approach? settings that may predispose fecal-oral transmission. Since gastrointestinal swab testing in COVID- APPROACH? [published Italy symptoms appear more frequent in pediatric populations, surveillance with 19 surveillance efforts, online, 2020 Apr 16]. Pediatr rectal swabs should be extended to infants and children, to better diagnose especially in children. Infect Dis J. 2020. and define the duration of isolation. doi:10.1097/INF.0000000000 002704

41 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Pregnancy, 16-Apr-20 Women and Journal of Editorial Only changes that are well supported in deliberative clinical judgment Cancellation of Grünebaum A, Dudenhausen children, Children First: The Perinatal should be made in response to the COVID-19 pandemic. "Elective" means elective procedures J, McCullough LB, Chervenak elective Need for Medicine that a form of clinical management is time-sensitive, in that it can be during the COVID-19 FA. Women and children first: procedures, Ringfencing During postponed as long as there is no short-term or long-term increased risk of must not apply to the need for ringfencing obstetric the COVID-19 serious morbidity or mortality. While pregnancy is a condition and not a obstetric services or during the COVID-19 services, labor Pandemic disease, pregnancy is never elective, by its very nature. Justified prohibition impair the capacity of pandemic [published online, and delivery of elective surgical procedures during the COVID-19 pandemic does not labor and delivery 2020 Apr 16]. J Perinat Med. apply to scheduled obstetric surgical procedures, such as cesarean delivery. units to care for 2020. doi:10.1515/jpm-2020- Bans on support persons during labor are contrary to recommendations pregnant women and 0149 made by national and international organizations, including WHO. No their newborns. professional organizations have supported the alternative of homebirth to protect pregnant women from nosocomial COVID-19 infection. Human and material maternity resources should be ringfenced from redeployment that impairs the capacity of labor and delivery units to ensure that women and their newborns continue to receive the safest possible care. Children, age- 16-Apr-20 Clinical Infection Original Paper Sixty-seven hospitalized cases, including 53 adult and 14 children with This study reports Du W, Yu J, Wang H, et al. related Characteristics of COVID-19, between January 23, 2020 and February 15, 2020 from Jinan and substantial lung injury, Clinical characteristics of difference, COVID-19 in Rizhao were enrolled in this study. Most children had mild clinical signs and despite less clinical COVID-19 in children clinical Children Compared symptoms, and all cases were of family clusters. Fever (35.7%) and dry disease, in children compared with adults in characteristics, With Adults in cough (21.4%) were described as clinical manifestations in children. In the with mild cases of Shandong Province, China lung injury, Shandong Province, early stages of the disease, neutrophil count declined in children, compared COVID-19. [published online, 2020 Apr China China with adults (p = 0.02). There was a lower level of CRP (p = 0.00) in children 16]. Infection. 2020. compared with adults. There were 8 (57.1%) asymptomatic cases and 6 doi:10.1007/s15010-020- (42.9%) symptomatic cases among the 14 children cases. The age of 01427-2 asymptomatic patients was younger than that of symptomatic patients (p = 0.03). Even among asymptomatic patients, 5 (62.5%) cases had lung injuries caused by COVID-19, including 3 (60%) cases with bilateral involvement, which was not different compared with that of symptomatic cases (p = 0.58, p = 0.74). The clinical symptoms of children are mild, there is substantial lung injury even among children, but that there is less clinical disease, perhaps because of a less pronounced inflammatory response. Children, co- 16-Apr-20 Coinfection of Clinical Letter Authors report two cases of COVID-19 in children who were coinfected with This study indicates Jiang S, Liu P, Xiong G, et al. infection, SARS-CoV-2 and Chemistry human respiratory viruses and Mycoplasma pneumoniae (MP) in China. A that co-infection of Coinfection of SARS-CoV-2 respiratory Multiple and total of 161 hospitalized children (≤14 years of age) with positive respiratory SARS-CoV-2 and other and multiple respiratory pathogens, Respiratory Laboratory virus PCR results were enrolled in a retrospective study of respiratory respiratory viral and pathogens in children screening Pathogens in Medicine infections in the pediatric ward of a tertiary hospital in Wuhan, China from bacterial pathogens [published online, 2020 Apr Children December 1, 2019 to January 16, 2020. Nasopharyngeal swab, sputum or occurs in children, 16]. Clin Chem Lab Med. bronchoalveolar lavage fluid specimens were tested for respiratory viruses who should be 2020. doi:10.1515/cclm- by RT-PCR or multiplex PCR combined with capillary electrophoresis. A total screened to prevent 2020-0434 of 239 positive targets of pathogens were detected in 161 children. The missed diagnosis and highest proportion of pathogens were human respiratory syncytial virus transmission of (HRSV) (in 76 patients [31.80%]) and influenza A virus (in 72 patients COVID-19. [30.13%]). SARS-CoV-2 virus that causes COVID-19, was detected in two patients and accounted for 0.84%. SARS-COV-2, HRSV and human metapneumovirus (HMPV) were found in the bronchoalveolar lavage fluid of patient 1, and SARS-COV-2, MP and HMPV were found in the bronchoalveolar lavage fluid of patient 2. 42 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Children, 16-Apr-20 The role of children Acta Short Authors respond to a systematic review published by Ludvigsson on SARS‐ Children may play a de Niet A, Waanders BL, disease in the transmission Paediatrica Commentary CoV‐2 infection in children and large age-related disparity in disease smaller role in COVID- Walraven I. The role of transmission, of mild SARS-CoV-2 severity, which may be fundamental in filling knowledge gaps. Currently, it 19 transmission based children in the transmission co-infection, infection. is not clear if children are important in transmitting SARS-CoV-2, like they on evidence that of mild SARS-CoV-2 infection cross- are for other respiratory viruses. The majority of children infected thus far suggests the children [published online, 2020 Apr protection, viral have a documented family cluster outbreak, suggesting that they might not often have 16]. Acta Paediatr. 2020. load play such an important role in disease transmission. In previous studies, the documented family doi:10.1111/apa.15310 majority of children infected with human coronaviruses showed regular cluster outbreaks, may coinfection with other respiratory viruses. Children are also inoculated with have cross-protection antiviral vaccines due to immunization programs; there are multiple high- from high-titer titer antibodies in the blood of children, which may offer cross-protection antibodies, and may against progressive SARS-CoV-2 infection. Since only a small number of transmit lower viral severe cases have involved children, and higher viral load is observed in load compared to critically ill patients, one could argue that when children are infectious, a severely affected lower viral load is transmitted compared to severely affected adults. adults. Pediatric, onco- 16-Apr-20 How we deal with British Letter The first cases of the novel COVID-19 coronavirus in Italian patients, An Italian pediatric on- Sainati L, Biffi A. How we deal hematology the COVID-19 Journal of following the epidemic in China which began in December 2019, were hematology clinic has with the COVID-19 epidemic clinic, epidemic in an Haema- reported on February 20, 2020. Since then, 15,362 deaths and over 124,632 established screening in an Italian pediatric onco- screening, Italy Italian pediatric tology positive cases have been registered at the time of writing. The concern for and infection control hematology clinic located in a onco-hematology pediatric patients with onco-hematological diseases, particularly those protocols. Of 855 region at high density of clinic located in a actively undergoing chemotherapy or other immunosuppressing treatments, pediatric oncology cases [published online, 2020 region at high has led this group of authors to establish a series of measures aimed at patients tested, no Apr 16]. Br J Haematol. 2020. density of cases. minimizing infection. Since establishing these measures, over the course of 6 positive cases have doi:10.1111/bjh.16699 weeks, over 855 pediatric oncology patients were screened for COVID-19. been registered thus No positive cases have been registered among these patients, as well as far. caregivers and hospital or clinic staff. In contrast, the frequency of positive nasopharyngeal swabs detected in the general population of the Veneto region is estimated to be 8.2%. ACE2 receptor 16-Apr-20 The SARS-CoV-2 PLOS ONE Research Article Angiotensin-converting enzyme 2 (ACE2) is now confirmed as the receptor of This study reveals that Li M, Chen L, Zhang J, Xiong expression, receptor ACE2 SARS-CoV-2 and plays essential roles in human infection and transmission. the ACE2 receptor for C, Li X. The SARS-CoV-2 maternal-fetal expression of This study collects available single-cell RNA sequencing (scRNA-seq) data to SARS-CoV-2 viral entry receptor ACE2 expression of interface, fetal maternal-fetal evaluate the cell specific expression of ACE2 in the maternal-fetal interface, is widely expressed in maternal-fetal interface and organs, interface and fetal as well as in multiple fetal organs. Results revealed that ACE2 was highly specific cell types of fetal organs by single-cell placental organs by single-cell expressed in maternal-fetal interface cells including stromal cells and the maternal-fetal transcriptome study. PLoS function, single- transcriptome perivascular cells of decidua, and cytotrophoblast and syncytiotrophoblast in interface and fetal One. 2020;15(4):e0230295. cell study. placenta. Meanwhile, ACE2 was also expressed in specific cell types of organs. The study calls Published 2020 Apr 16. transcriptome human fetal heart, liver and lung, but not in kidney. In a study containing for further doi:10.1371/journal.pone.02 series fetal and post-natal mouse lung, ACE2 was dynamically changed over investigation of 30295 time, and ACE2 was extremely high in neonatal mice at post-natal day 1~3. vertical transmission Biophysical and structural evidence has shown that SARS-CoV-2 binds ACE2 potential and with higher affinity than SARS-CoV, which suggests that SARS-CoV-2 might placental patho- have more potential to attack placenta. It is crucial to pay special attention physiology caused by to pregnant women infected with SARS-CoV-2 in the early stage of SARS-CoV-2, especially pregnancy, during which the virus may affect the placental function and in the first trimester of increase the risk of miscarriage. pregnancy.

43 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Neonatal 16-Apr-20 Sequential analysis Clinical Brief Report This brief report describes changes in viral load over time in a 27-day old Nasopharyngeal and Han MS, Seong MW, Heo EY, infection, viral of viral load in a Infectious neonate with COVID-19 who presented with fever, cough, and vomiting. The stool samples from a et al. Sequential analysis of RNA, South neonate and her Diseases virus seemed to be transmitted from one of her family members, and the neonate remained viral load in a neonate and Korea mother infected neonate had been directly breastfed from birth. The neonate was positive for SARS-CoV- her mother infected with with SARS-CoV-2. hospitalized on March 8, 2020 and placed in an isolation room with her 2 until 17 and 18 days SARS-CoV-2 [published mother. SARS-CoV-2 RNA was detected in the neonate’s nasopharynx, after symptom onset, online, 2020 Apr 16]. Clin oropharynx, stool, saliva, plasma, and urine. Levels of viral RNA were highest respectively. Viral RNA Infect Dis. 2020. in the nasopharynx, decreased over time, and were undetectable after 17 was not detected in doi:10.1093/cid/ciaa447 days from onset of symptoms. SARS-CoV-2 RNA in stool samples remained breast milk samples. high until the 18th day since onset, even though the neonate's gastrointestinal symptoms had improved. The virus was not detected in the mother's breast milk. Covid-19, 15-Apr-20 The European European Editorial This editorial emphasizes the European midwifery organizations’ role in This editorial Vermeulen J, Jokinen M. The European Midwives Journal of supporting midwives to work as safely as possible during the COVID-19 highlights the role of European Midwives Midwives, Association call for Midwifery pandemic while allowing them to keep the focus on family-centered care. European midwifery Association call for action to Pregnancy, action to protect The authors insist the physical health of staff must be supported with PPE organizations in protect our midwives in Childbirth our midwives in and regular testing for SARS-CoV-2 while mental health is addressed with supporting both delivering best care amidst delivering best care appropriate support services. Midwifery organizations must remain focused women and babies, the COVID-19 pandemic. Eur J amidst the COVID- on family centered care in an environment where virtual technology is and maternity care Midwifery. 2020 Apr 15;4:10. 19 pandemic replacing face-to-face encounters. Midwives must be supported as they professionals during doi: 10.18332/ejm/120443. address the fears and concerns of pregnant women. These include the the COVID-19 PMID: 33537612; PMCID: concern that birth partners would be banned from birth, fears that births pandemic. PMC7839121. would be electively induced at 40 weeks, or that skin-to-skin contact and breastfeeding might be unnecessarily discouraged as it is considered potentially unsafe. The role of the midwifery organization is to promote the mental and physical health of women and babies, and of midwives working in the community during the COVID-19 pandemic. Neonates, 15-Apr-20 SARS-CoV-2 Clinical Case report This case report focuses on a 2-week-old male infant who presented to the This report highlights Patek P, Corcoran J, Adams L, clinical Infection in a 2- Pediatrics pediatric emergency department of Beaumont Hospital, Royal Oak MI, USA, the importance of Khandhar P. SARS-CoV-2 symptoms, the Week-Old Male with fever and fussiness. During the 3 days before admission, the mother clinical suspicion of Infection in a 2-Week-Old USA With Neutropenia noted a progressively worsening erythema of the right thumb and fourth COVID-19 in neonates Male With Neutropenia. Clin digit. Additionally, the patient had been having increased somnolence over with fever. Neonatal Pediatr (Phila). 2020;59(9- the past day and decreased breast milk feeds. There was no nasal patients should be 10):918-920. congestion, cough, increased work of breathing, vomiting, nor diarrhea. admitted to a doi:10.1177/0009922820920 Hematological studies in the infant demonstrated isolated neutropenia with quarantine ward to 014 granulocytosis and monocytosis, normal white blood cell, and lymphocyte limit further count, which is atypical when compared with prior novel coronavirus strains. transmission. The infant was admitted to the pediatric ICU. On day 1 of admission, the SARS-CoV-2 PCR returned positive. Apart from fever, the patient exhibited no other symptoms of COVID-19. On hospital day 4, the patient discharged home with oral antibiotic therapy for soft tissue infection. Pregnancy, 15-Apr-20 Pregnant vs American Original Research This study investigated the number of pregnant and nonpregnant COVID-19 The authors describe Tekbali A, Grünebaum A, New York, Nonpregnant Journal of cases during hospital admissions in the state of New York, U.S. during the the influx of pregnant Saraya A, McCullough L, hospital Severe Acute Obstetrics initial phase of the pandemic (March 2th – 29th, 2020). Data were collected and nonpregnant Bornstein E, Chervenak FA. admissions, Respiratory and at a large hospital group (14 hospitals) and included week of admission, patients with SARS- Pregnant vs nonpregnant rate of Syndrome Gynecology pregnancy status, and SARS-CoV-2 status. Routine SARS-CoV-2 testing was CoV-2 in a large severe acute respiratory infection Coronavirus 2 and not performed. A total of 21,980 admissions during the 4-week period was hospital group (14 syndrome coronavirus 2 and 44 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Coronavirus Disease noted; 3064 were pregnant or postpartum patients, and 18,916 were hospitals) during coronavirus disease 2019 2019 Hospital nonpregnant patients. The SARS-CoV-2 infection status for pregnant and March in the state of hospital admissions: the first Admissions: The postpartum patients increased from 0.14% of all hospital admissions in week New York U.S. 4 weeks in New York. Am J First 4 Weeks in 1 to 5.65% of all hospital admissions in week 4 (relative risk [RR], 14.81; 95% Pregnant women with Obstet Gynecol. New York confidence interval [CI], 2.07-107.38). The SARS-CoV-2 status for COVID-19 had a 2020;223(1):126-127. nonpregnant patients increased from 1.21% of all hospital admissions in significantly lower doi:10.1016/j.ajog.2020.04.0 week 1 to 56.79% of all hospital admissions in week 4 (RR, 46.99; 95% CI, admission percentage 12 36.72-60.15).The authors attribute the lower rate of COVID-19 infection than nonpregnant among pregnant patients to a lack of universal testing and to the routine patients with similar admission of women to labor and delivery irrespective of infectious infection status, symptoms although universal testing was not performed. Thymopoiesis, 15-Apr-20 Role of Pediatrics Letter to the The most important mechanisms underlying severe adult COVID-19 Thymic involution and Scarpa R, Costa L, Del Puente pro- Thymopoiesis and and Editor pneumonia cases are a reduction in CD4+ and CD8+ T cells and a decrease in increased pro- A, Caso F. Role of inflammatory Inflamm-Aging in Neonatology regulatory T cells, likely due to the pro-inflammatory cytokine storm of TNF- inflammatory markers thymopoiesis and inflamm- phenotype, COVID-19 alpha, IL-1, and IL-6 in COVID-19 patients. Furthermore, it is known that in are associated with aging in COVID-19 phenotype age-related Phenotype older age, the production of naive T cells is severely impaired due to older age and may [published online, 2020 Apr immune decreased output of lymphoid cells from the involution of the thymus, which contribute to immune 15]. Pediatr Neonatol. 2020. response, is a central lymphoid organ. Thymopoiesis leads to the maturation of responses that lead to doi:10.1016/j.pedneo.2020.0 cytokine storm peripheral naive T cells with diverse recognition capacity against various greater clinical 4.001 microorganisms and subset of regulatory T cells to inhibit overactive severity of COVID-19 immune responses. Inflamm-aging is defined as a progressive propensity in adults, compared to toward a pro-inflammatory phenotype and plays a key role in immune children. system remodeling at older ages. Thus, the role of the thymus could be crucial in the modulation of the immune response to SARS-CoV-2, leading to a less severe phenotype in children compared to adult COVID-19 patients. Pediatric, 15-Apr-20 COVID-19: Four International Case Series In Malaysia, until end of February 2020, there were four COVID-19 pediatric This brief report See KC, Liew SM, Ng DCE, et asymptomatic Paediatric Cases in Journal of cases with ages ranging from 20 months to 11 years. All four cases were describes four al. COVID-19: Four Paediatric infection, Malaysia Infectious likely to have contracted the virus in China. Two children were pediatric cases of mild Cases in Malaysia [published quarantine, Diseases asymptomatic, and two children had mild respiratory symptoms. The cases COVID-19 in Malaysia online, 2020 Apr 15]. Int J Malaysia were managed symptomatically. None required antiviral therapy. In caring and raises questions Infect Dis. 2020. for the infected children, two issues arose. First, the quarantine of an over the issues doi:10.1016/j.ijid.2020.03.04 infected child with a parent who tested negative posed an ethical dilemma. surrounding 9 Secondly, oropharyngeal and nasal swabs in children were at risk of false quarantine and negative results (possibly due to sampling error). These issues have infection control implications for infection control. Consequently, there is a need for clearer measures for children. guidelines for child quarantine and testing methods in the management of COVID-19 in children. Children, 15-Apr-20 COVID-19 in Journal of Special Invitation This report from Taiwan reviews recently published articles and on-line open Based on review of the Jeng MJ. COVID-19 in neonatal Children: Current the Chinese messages on SARS-CoV-2-positive infants and children <20 years old. existing literature, 12 children: Current status infection, Status Medical Symptoms are usually less severe in children than in adults. Twelve critically children with critical [published online, 2020 Apr systematic Association or fatally ill children were found in publications or news reports globally, cases of COVID-19, 6 15]. J Chin Med Assoc. 2020. review, prior to April 6, 2020. Vertical transmission has not been proven definitively. cases of early-onset doi:10.1097/JCMA.00000000 epidemiology However, six early-onset (<7 days) and 3 late-onset cases of neonatal SARS- neonatal SARS-CoV-2 00000323 CoV-2 infection were found in the literature. The presentation and contact infection, and 3 cases information of 24 SARS-CoV-2-positive children, announced by the Taiwan of late-onset neonatal 45 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Centers for Disease Control, are also summarized here. Early identification SARS-CoV-2 infection and isolation, adequate management, prevention, and vaccine development have been identified. are the keys to controlling the disease spread. Clinical physicians should be alert to asymptomatic children with COVID-19. Co-infection, 15-Apr-20 Rates of Co- JAMA Research Letter The CDC endorsed testing for other respiratory pathogens, suggesting that Patients aged 1-100 Kim D, Quinn J, Pinsky B, respiratory infection Between evidence of another infection could aid the evaluation of patients with were included in this Shah NH, Brown I. Rates of pathogens, age- SARS-CoV-2 and potential COVID-19 in the absence of widely available rapid testing for SARS- study. Patients Co-infection Between SARS- related Other Respiratory CoV-2. Authors report on co-infection rates between SARS-CoV-2 and other identified with co- CoV-2 and Other Respiratory difference, Pathogens respiratory pathogens, based on RT-PCR testing of nasopharyngeal swabs of infection did not differ Pathogens [published online, northern symptomatic patients in Northern California. 1217 specimens were studied, significantly in age 2020 Apr 15]. JAMA. 2020. California and 116 (9.5%) were positive for SARS-CoV-2, and 318 (26.1%) were positive from those infected doi:10.1001/jama.2020.6266 for 1 or more non-SARS-CoV-2 pathogens. Of 318 specimens positive for 1 or with SARS-CoV-2 only. more non–SARS-CoV-2 pathogens, 24 (7.5%) were also positive for SARS- Further study of the CoV-2. Patients with co-infections did not differ significantly in age (mean, co-infection rates in 46.9 years) from those infected with SARS-CoV-2 only (mean, 51.1 years) children, in particular, (4.2-year difference [95% CI, –4.8 to 13.2]). is needed. Pregnancy, 15-Apr-20 Importance of Clinical Viewpoint Investigators are employing unprecedented innovation in the design of This Viewpoint calls LaCourse SM, John-Stewart breastfeeding, inclusion of Infectious clinical trials to rapidly and rigorously assess potentially promising therapies attention to the G, Adams Waldorf KM. therapeutic pregnant and Diseases for COVID-19; this is in stark contrast to the continued, near universal, urgent need to engage Importance of inclusion of trials breastfeeding regressive practice of excluding pregnant and breastfeeding women from pregnant women in pregnant and breastfeeding women in COVID- these trials. The few trials which allow their inclusion focus on post-exposure COVID-19 treatment women in COVID-19 19 therapeutic prophylaxis or outpatient treatment of milder disease, limiting the options trials in order to therapeutic trials [published trials. available to pregnant women with severe COVID-19 to compassionate use of develop data-driven online, 2020 Apr 15]. Clin remdesivir, or off-label drug use of hydroxychloroquine or other therapies. recommendations Infect Dis. 2020. These restrictions were put in place despite experience with these drugs in regarding the risks and doi:10.1093/cid/ciaa444 pregnant women. benefits of therapies in this unique population. Children, PICU, 15-Apr-20 Novel Coronavirus Indian Special Article Use of high flow devices and non-invasive ventilation in COVID-19 positive This report provides Sundaram M, Ravikumar N, viral 2019 (2019-nCoV) Pediatrics patients has been discouraged due to high chances of aerosol generation further guidance on Bansal A, et al. Novel pneumonia, Infection: Part II - and viral transmission. Early intubation and mechanical ventilation are non-invasive Coronavirus 2019 (2019- resource- Respiratory Support essential to prevent complications and worsening, especially in resource- respiratory support, nCoV) Infection: Part II - limited settings in the Pediatric limited settings with very few centers having expertise to manage critical intubation and Respiratory Support in the Intensive Care Unit cases. A hydrophobic viral filter in the ventilator circuit can minimize risk of management of ARDS Pediatric Intensive Care Unit in Resource-limited viral transmission. Strategies to manage ARDS in COVID-19 include low tidal in children with in Resource-limited Settings. Settings. volume ventilation with liberal sedation-analgesia. At the same time, COVID-19 in PICUs in Indian Pediatr. prevention of transmission of the virus to healthcare workers is extremely low-resource settings. 2020;57(4):335–342. important in the intensive care setting dealing with severe cases and requiring procedures generating aerosol. Children, PICU, 15-Apr-20 Novel Coronavirus Indian Special Article The clinical course of COVID-19 often starts with a respiratory illness and This report provides Ravikumar N, Nallasamy K, viral 2019 (2019-nCoV) Pediatrics about 5-16% of general patients require intensive care management for guidelines on Bansal A, et al. Novel pneumonia, Infection: Part I - acute respiratory distress syndrome (ARDS) and multi-organ dysfunction. preparedness Coronavirus 2019 (2019- resource- Preparedness and Children account for about 1-2% of the total cases. 6% of all pediatric cases strategies to re- nCoV) Infection: Part I - limited settings Management in the fall under severe or critical categories, requiring pediatric intensive care unit allocate resources and Preparedness and Pediatric Intensive (PICU) care. Diagnosis involves a combination of clinical and epidemiological implement infection Management in the Pediatric Care Unit in features with laboratory confirmation. Preparedness strategies should control protocols in Intensive Care Unit in involve setting up cohort ICUs with isolation rooms. Re-allocation of low-resource settings. Resource-limited Settings. 46 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Resource-limited resources in managing this crisis involves careful planning, halting elective Indian Pediatr. Settings surgeries and training of healthcare workers. Strict adherence to infection 2020;57(4):324–334. control like personal protective equipment and disinfection is the key to contain the disease transmission. Although many therapies have been tried in various regions, there is a lack of strong evidence to recommend antivirals or immunomodulatory drugs. Viral shedding, 15-Apr-20 SARS-CoV-2 The Lancet Correspondence Authors of this correspondence argue that the presence of nucleic acid Recent literature has Atkinson B, Petersen E. SARS- RT-PCR test, shedding and alone cannot be used to define viral shedding or infection potential. For suggested there is CoV-2 shedding and infectivity infectivity many viral diseases (SARS-CoV, MERS-CoV, influenza virus, Ebola virus, and prolonged SARS-CoV-2 infectivity [published online, Zika virus), it is well known that viral RNA can be detected long after the viral shedding in 2020 Apr 15]. Lancet. 2020. disappearance of infectious virus. The immune system can neutralize viruses children, however doi:10.1016/S0140- by lysing their envelope or aggregating virus particles; these processes findings from studies 6736(20)30868-0 prevent subsequent infection but do not eliminate nucleic acid, which that use PCR methods degrades slowly over time. Although the use of sensitive PCR methods offers to draw conclusions value from a diagnostic viewpoint, caution is required when using such data on infectivity should to assess the duration of viral shedding and infectivity because PCR does not be interpreted with distinguish between infectious virus and non-infectious nucleic acid. caution. Viral shedding, 15-Apr-20 SARS-CoV-2 The Lancet Correspondence Replying to the correspondence by Atkinson et al., authors agree that the Although a more Zhou F, Fan G, Liu Z, Cao B. RT-PCR test, shedding and presence of SARS-CoV-2 viral RNA in a respiratory specimen cannot be accurate method of SARS-CoV-2 shedding and infectivity, viral infectivity – directly interpreted as a potential for disease transmission and infection. assessing viral infectivity – Authors' reply culture Authors' reply That said, although viral culture is an important method to evaluate viral infectivity, viral [published online, 2020 Apr infectivity and activity, it is unavailable in clinical practice because of its low culture has low 15]. Lancet. 2020. sensitivity and long turn-around time for virus detection. Two negative sensitivity and a long doi:10.1016/S0140- SARS-CoV-2 RNA PCR tests, at least 24 hours apart, was recommended by turn-around time. 6736(20)30869-2 WHO as one of several criteria for discharge. Prolonged periods of Future studies should detectable SARS-CoV-2 RNA suggest a sustained viral replication in some evaluate the host cells in patients with COVID-19. A comparison has previously been correlation between made between viral shedding, as quantified by RT-PCR, and median tissue viral shedding, as culture infectious dose (TCID50) in patients with influenza. The temporal quantified by RT-PCR, changes in viral load by RT-PCR were similar to that of TCID50. For COVID-19, and infectious dose, as the association between viral load in respiratory tract specimens, quantified quantified by tissue by RT-PCR, and viral culture needs evaluation. culture of SARS-CoV-2. Pregnancy, 15-Apr-20 COVID-19 Vaginal Australian Short This case report describes an uncomplicated vaginal birth in a SARS-CoV-2 The SARS-CoV-2 Lowe B, Bopp B. COVID-19 vaginal Delivery - A Case and New Communication positive mother at a tertiary Australian hospital. To the authors' knowledge, positive mother vaginal delivery - a case delivery, Report Zealand this is also the first case describing a mother with COVID‐19 who was not described in this case report [published online, neonate, Journal of separated from her infant. Management provided supports the current study was not 2020 Apr 15]. Aust N Z J maternal- Obstetrics Royal College of Obstetricians and Gynaecologists and World Health separated from her Obstet Gynaecol. 2020. neonatal and Organization guidelines suggesting that it is possible to consider rooming in infant following birth. doi:10.1111/ajo.13173 separation, Gynaecology post-delivery for COVID‐19 positive parents. Encouragement of breast Breastfeeding was also breastfeeding, feeding appears possible and safe when viral precautions are observed. encouraged with Australia observation of hygiene precautions.

47 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Infant, severe 15-Apr-20 Severe Pneumonia Clinical Case Report A rare case of a 2-month 21-day old patient with co-infection of COVID-19 This case report Shi B, Xia Z, Xiao S, Huang C, pneumonia, Due to SARS-CoV-2 Pediatrics and respiratory syncytial virus (RSV) is reported in this study. The infant was describes atypical Zhou X, Xu H. Severe respiratory and Respiratory admitted to the PICU of Maternal and Child Health Hospital of Hubei clinical presentation of Pneumonia Due to SARS-CoV- syncytial virus, Syncytial Virus Province on February 3, 2020. On admission, the infant presented with a young infant co- 2 and Respiratory Syncytial China Infection: A Case cough and wheezing for 3 days, dyspnea for the past 12 hours, but no other infected with COVID- Virus Infection: A Case Report Report signs of discomfort. Chest CT findings and arterial blood gas analysis 19 and RSV. [published online, 2020 Apr indicated severe pneumonia, and non-invasive continuous positive airway 15]. Clin Pediatr (Phila). 2020. pressure ventilation was performed. Antibiotic treatment, IV doi:10.1177/0009922820920 immunoglobulins, and methylprednisone were administered, and alpha- 016 interferon atomization inhalation was performed. Thirty-six hours after admission, RT-PCR of a pharyngeal swab sample tested negative for SARS- CoV-2 but later tested positive on day 10, despite improved conditions. After consecutive negative RT-PCR results were obtained on days 17 and 19, the patient was discharged. Children, 14-Apr-20 The Clinical and Genes & Full Length The clinical features, immunological features, and treatment outcomes of 12 Compared to adults in Chen J, Zhang ZZ, Chen YK, et immune profile, Immunological Diseases Article pediatric patients with confirmed COVID-19 were analyzed and compared this study, children al. The clinical and clinical Features of with 20 adult patients. The median age was 14.5 years (range: 0.64 to 17 with SARS-CoV-2 immunological features of characteristics, Pediatric COVID-19 years), and 6 patients were male. The average incubation period was 8 days. infection had an pediatric COVID-19 patients age-related Patients in China Clinically, cough (9/12, 75%) and fever (7/12, 58.3%) were the most common immune profile in China [published online, difference, T symptoms. Four patients (33.3%) had diarrhea. Compared with adults, characterized by 2020 Apr 14]. Genes Dis. cell counts, C- children had higher total T cell, CD8+ T cell and B cell counts but lower CRP higher T cell counts 2020. reactive protein levels (p< 0.05). Similar to adults, ground-glass opacities and local patchy and lower levels of doi:10.1016/j.gendis.2020.03 shadowing were the typical radiological findings on chest CT scan. All inflammatory factors, .008 patients received antiviral and symptomatic treatment, and symptoms which may be improved within 3-4 days of hospital admission. Pediatric patients showed associated with milder milder symptom but longer incubation periods than adults. clinical symptoms observed. Pregnancy, 14-Apr-20 Severe ARDS in American COVID-19 Few resources exist to guide the multi-disciplinary team through decisions This case report Schnettler WT, Al Ahwel Y, severe ARDS, COVID-19-infected Journal of Pregnancy regarding optimal maternal-fetal surveillance, intensive care procedures, describes rapid clinical Suhag A. Severe ARDS in intensive care, Pregnancy: Obstetrics & Research and delivery timing. This report presents a case of rapid clinical decompensation and COVID-19-infected hypoxia Obstetric and Gynecology decompensation and development of severe Acute Respiratory Distress development of ARDS pregnancy: obstetric and Intensive Care MFM Syndrome (ARDS) in a woman at 31 weeks' gestation. She presented to the in a pregnant woman, intensive care considerations Considerations emergency department with a 5-day history of worsening non-productive highlighting [published online, 2020 Apr cough, shortness of breath, fever, and malaise. Chest CT scan was physiologic and 14]. Am J Obstet Gynecol compatible with viral pneumonia, and SpO2 level of 93% on 4 liters/minute management MFM. 2020. (L/min) warranted admission to the intensive care unit. After SpO2 levels considerations for the doi:10.1016/j.ajogmf.2020.10 decreased to 78%, maximal ventilatory assistance was applied, and both care of critically ill 0120 maternal and fetal status improved. Currently (hospital day 17 / COVID women with COVID- disease day 22), the patient is improving but continues on synchronized 19. intermittent mandatory ventilation.

48 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Pregnancy, 14-Apr-20 Pre-labor Anorectal European Correspondence To date, it is unknown whether vaginal delivery increases the risk of vertical This case report Carosso A, Cosma S, Borella neonatal Swab for SARS-CoV- Journal of transmission of COVID-19, since mainly cesarean deliveries have been suggests that SARS- F, et al. Pre-labor anorectal infection, 2 in COVID-19 Obstetrics & reported. Current guidelines for pregnant women with confirmed COVID-19 CoV-2 can enter the swab for SARS-CoV-2 in anorectal Patients: Is It Time Gynecology suggest that delivery mode should be determined by obstetric indication, neonatal nasopharynx COVID-19 patients: is it time sample, vaginal to Think About It? and Repro- and vaginal delivery should be favored to avoid unnecessary surgical during vaginal delivery to think about it? [published delivery ductive complications. However, the presence of SARS-CoV-2 in the genital tract and through fecal online, 2020 Apr 14]. Eur J Biology stool has been demonstrated in prior studies. Authors report a 28-year-old contamination, Obstet Gynecol Reprod Biol. woman with gestational diabetes, who was admitted for active labor at 37 especially when recent 2020. weeks' gestation. A nasopharyngeal swab taken at admission tested positive onset of COVID-19 doi:10.1016/j.ejogrb.2020.04. for SARS-CoV-2. Three hours later, a female neonate was delivered by symptoms is reported 023 vaginal route and quarantined. Post-delivery, maternal rectal and stool in the mother. swabs, as well as neonatal nasopharyngeal swab tested positive for SARS- CoV-2. Further RT-PCR was performed on the same neonatal nasopharyngeal swab 37 hours later and tested negative, likely explained by the low amount of viral RNA in the sample. To reduce the potential risk of vertical transmission, a pre-labor anorectal swab could be taken from COVID-19 positive pregnant patients to identify newborns at high risk of perinatal infection. Pregnancy, 14-Apr-20 SARS-CoV-2: Is it Journal of Review Data are limited on outcomes of COVID-19 disease during pregnancy and Authors consider Muldoon KM, Fowler KB, neonates, the Newest Spark in Clinical consequences for fetuses and newborns. Therefore, information on illnesses limited data on COVID- Pesch MH, Schleiss MR. SARS- TORCH the TORCH? Virology associated with other highly pathogenic coronaviruses (i.e. SARS, MERS), as 19 in pregnancy in the CoV-2: Is it the newest spark infection, SARS, well as comparisons to common congenital infections, such as context of SARS, in the TORCH? [published MERS, vertical cytomegalovirus (CMV), are warranted. Research regarding the potential MERS, and common online, 2020 Apr 14]. J Clin transmission routes of acquisition of SARS-CoV-2 infection in the prenatal and perinatal congenitally or Virol. 2020. setting is of a high public health priority. Breast milk acquisition of infection perinatally acquired doi:10.1016/j.jcv.2020.10437 has not been recognized to date, and strategies to ensure that this remains TORCH infections, like 2 the preferred source of infant nutrition are needed. Vaccines targeting CMV. women of reproductive age, and in particular pregnant patients, should be evaluated in clinical trials and should include the endpoints of neonatal infection and disease. Children, 14-Apr-20 The Intriguing Jornal de Editorial One of the most striking and consistent findings from COVID-19 reports This editorial provides Safadi MAP. The intriguing comorbidities, Features of COVID- Pediatria globally is that, in contrast with infected adults, children rarely experience an overview of current features of COVID-19 in vertical 19 in Children and severe forms of the disease. Available data on COVID-19 severity in children literature on notable children and its impact on the transmission, Its Impact on the with comorbidities are scarce, limiting the possibility to identify conditions findings related to pandemic [published online, community Pandemic at increased risk of complications and mortality. Although at this time we do COVID-19 in children, 2020 Apr 14]. J Pediatr (Rio J). transmission, not know whether mothers with COVID-19 can transmit the SARS-CoV-2 via highlighting current 2020. treatment, breast milk, the WHO, as well as the Brazilian Society of Pediatrics, made gaps in data. doi:10.1016/j.jped.2020.04.0 breastfeeding clear recommendations supporting mothers to breastfeed their infants. A 01 crucial point for investigation – yet to be determined – is the role of children in transmission. Despite being asymptomatic or oligosymptomatic, infected infants and children may have high viral loads in their nasopharynx, as well as fecal shedding of SARS-CoV-2 for longer periods, thus may play a substantial role in viral community transmission. At the time of writing, treatment in children includes fluid and nutritional intake, together with oxygen supplementation and ventilatory support. Due to the rare number of severe cases in children, there is no data on the safety and efficacy of the different therapeutic interventions that are being tested in adults. 49 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Epidemiology, 14-Apr-20 Spread of SARS- New England Original Article During the current worldwide pandemic, COVID-19 was first diagnosed in This epidemiological Gudbjartsson DF, Helgason A, population CoV-2 in the Journal of Iceland at the end of February 2020. As of April 4, a total of 1221 of 9199 report shows lower Jonsson H, et al. Spread of screening, Icelandic Medicine (13.3%) who were recruited for targeted testing in this study had positive incidence of SARS- SARS-CoV-2 in the Icelandic children under Population results for SARS-CoV-2 infection, based on RT-PCR testing of combined CoV-2 in children Population [published online, 10 years old, oropharyngeal and nasopharyngeal samples. Of those tested in the general under 10 years of age 2020 Apr 14]. N Engl J Med. Iceland population, 87 (0.8%) in the open-invitation screening and 13 (0.6%) in the in Ireland, raising the 2020. random-population screening tested positive for the virus. In total, 6% of the question of utility for doi:10.1056/NEJMoa2006100 population was screened. Of the 564 children under the age of 10 years in routine testing of the targeted testing group, 38 (6.7%) tested positive, in contrast to positive asymptomatic children test results in 1183 of 8635 persons who were 10 years of age or older in the general (13.7%). In the population-screening group, the difference was even more population. marked: none of the 848 children under the age of 10 years tested positive, as compared with 100 of 12,232 persons (0.8%; 95% CI, 0.7 - 1.0%) 10 years of age or older. This report provides the most accurate and complete national epidemiological data published to date. Children, chest 14-Apr-20 CT Features of European Review There is growing evidence that children are also susceptible to COVID-19 and Chest CT should be Duan YN, Zhu YQ, Tang LL, CT, lung Novel Coronavirus Radiology have atypical presentations compared with adults. This review found that used with caution to Qin J. CT features of novel abnormalities, Pneumonia (COVID- chest CT characteristics in pediatric patients with COVID-19 were also avoid missed coronavirus pneumonia radiation risk 19) in Children atypical, with more localized ground glass opacity (GGO) extent, lower GGO diagnoses as well as (COVID-19) in children attenuation, and relatively rare interlobular septal thickening. Relying only reduce risk of [published online 2020 Apr on chest CT to screen pediatric patients may lead to missed diagnosis. In unnecessary radiation 14]. Eur Radiol. 2020. addition, chest CT should be used with caution to protect children from for children. doi:10.1007/s00330-020- unnecessary radiation risk. 06860-3 Pediatric 14-Apr-20 Pediatric Otolaryn- Commentary The role children and adolescents play in COVID-19 transmission is unclear, A report from Seattle Parikh SR, Bly RA, Bonilla- otolaryngology, Otolaryngology gology–Head and it is possible that healthy pediatric patients serve as a reservoir for the Children's Hospital Velez J, et al. Pediatric preparatory Divisional and and Neck virus. This article summarizes the COVID-19 response of Seattle Children's describes an Otolaryngology Divisional and response, Institutional Surgery Hospital in Washington State, with the goal of protecting both patients and institutional response Institutional Preparatory Seattle, Preparatory health care providers while providing ongoing care to critically ill patients to COVID-19, with the Response at Seattle Washington Response at Seattle who require urgent interventions. Main interventions included reduced staff goals of preventing Children's Hospital after Children's Hospital presence at hospital, backup call systems, postponement of all elective infection spread and COVID-19 Regional Exposure After COVID-19 cases, conversion to telemedicine visits when possible, use of COVID-19 protecting the health [published online 2020 Apr Regional Exposure testing and full PPE for high-risk procedures, and creating new educational care workforce. 14]. Otolaryngol Head Neck content for trainees. Surg. 2020. doi:10.1177/0194599820919 748 Micronutrients, 14-Apr-20 Nutritional European Perspective Antioxidants have been shown to increase the number of T-cell subsets, Vitamin D plays an Muscogiuri G, Barrea L, antioxidants, Recommen-dations Journal of enhance lymphocyte response to mitogens, increase interleukin-2 important role in Savastano S, Colao A. vitamin D, zinc, for CoVID-19 Clinical production, potentiate natural killer cell activity, and increase response to protecting against Nutritional recommendations immune Quarantine Nutrition the influenza virus vaccine compared with placebo. Notably, vitamin D respiratory viral for CoVID-19 quarantine function deficiency in the winter has been reported to be associated to viral pathogens, as well as [published online, 2020 Apr epidemics. Indeed, adequate vitamin D status reduces the risk of developing decreasing production 14]. Eur J Clin Nutr. 2020. several chronic diseases such as cancers, cardiovascular disease, diabetes of pro-inflammatory doi:10.1038/s41430-020- mellitus, and hypertension that contribute to higher risk of death from cytokines to reduce 0635-2 respiratory tract infections. Further, vitamin D protects the respiratory tract risk of a cytokine by preserving tight junctions, killing enveloped viruses through induction of storm. Zinc has also cathelicidin and defensins, and decreasing production of proinflammatory been shown to inhibit cytokines by the innate immune system, therefore reducing the risk of a viral replication of 50 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication cytokine storm leading to pneumonia. Another essential trace element that SARS in cell cultures; is crucial for the maintenance of immune function is zinc. It has been its properties should reported that zinc inhibits the RNA-dependent RNA polymerase template be further evaluated binding and elongation of SARS virus, thus blocking viral replication in cell in the context of cultures. COVID-19. Turkey, 13-Apr-20 Acute stress Dusunen Letter to the The authors present the case of a 10-year-old male 5th-grade elementary The authors present Kaba D, Sari BA. Acute stress children, stress, disorder with panic Adam: The Editor school student in Turkey who was admitted due to intense concerns related the case of a 10-year- disorder with panic episodes acute stress episodes induced Journal of to the COVID-19 pandemic during the past month. The patient had intrusive old male student in induced by exposure to disorder, panic by exposure to Psychiatry thoughts about COVID-19, experiencing psychological distress and showing Turkey who was COVID-19 outbreak news in a episodes, COVID-19 outbreak and physiological symptoms in response to internal or external cues reminding admitted due to child. Dusunen Adam: The exposure news in a child Neurological him of the virus; he felt unhappy, avoiding COVID-19-reminding situations intense concerns Journal of Psychiatry and Sciences while having problems with concentration and sleep, and he had shown related to the COVID- Neurological Sciences. symptoms of Trauma and Stressor-Related Disorders according to the 19 pandemic during 2020;33:221-222. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for around the past month. The doi:10.14744/DAJPNS.2020.0 one month and described panic attacks. The patient’s State-Trait Anxiety patient was diagnosed 0084 Inventory (STAI) state score was 61 (scale range: 20-80), the trait score was with acute stress 68 (scale range: 20-80), and Children’s Depression Inventory (CDI) score was disorder with panic 21 (scale range: 0-54). In STAI, the cut-off value is 40 for anxiety and higher episodes according to scores indicate increased anxiety levels, and in CDI, the cut-off value is 19 for DSM-5 and was depression and higher scores indicate severe depression. The patient was started on 20 mg/day diagnosed with acute stress disorder with panic episodes according to DSM- fluoxetine. The 5 and was started on 20 mg/day fluoxetine. The authors recommend that authors report this is parents and clinicians should inform children about COVID-19, without going the first case report into too much detail, in a manner appropriate to their level of development. demonstrating acute stress disorder with panic episodes induced by COVID-19 news exposure. Pregnancy, HIV, 13-Apr-20 Contracting HIV or AIDS and Editorial The authors argue that for pregnant women at high-risk of HIV acquisition in Because of the high Joseph Davey D, Bekker LG, AIDS, PrEP, risk Contracting SAR- Behavior South Africa, the benefits for continued PrEP provision and HIV risk prevalence of HIV in Coates TJ, Myer L. benefit, South CoV-2 (COVID- 19) reduction counselling in HIV-uninfected pregnant and breastfeeding women South Africa, the Contracting HIV or Africa in Pregnancy? outweigh the risk of acquisition and spread of COVID-19. HIV incidence is authors argue that the Contracting SAR-CoV-2 Balancing the Risks high during pregnancy and breastfeeding with HIV acquisition risk more than benefits of PrEP (COVID- 19) in Pregnancy? and Benefits doubling during pregnancy and the postpartum period compared to when provision and HIV Balancing the Risks and women are not pregnant. Additionally, acute maternal HIV infection counseling in Benefits. AIDS Behav. threatens maternal health and increases the risk of vertical transmission. uninfected pregnant 2020;24(8):2229-2231. Though South Africa has the largest SARS-CoV-2 epidemic in Africa, it also and breastfeeding doi:10.1007/s10461-020- has the largest HIV epidemic in the world, with 7.7 million people living with women outweigh the 02861-x HIV. A final consideration is the growing evidence for increasing sexual risks associated with activity, intimate partner violence, and rape during the pandemic which the COVID-19 could lead to greater risk of HIV acquisition. Therefore, the authors feel that pandemic, and these risks necessitate continued PrEP enrolment, drug provision, and therefore these adherence counselling in high risk HIV-uninfected pregnant women in South services should Africa. continue.

51 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Infant, cystic 13-Apr-20 Asymptomatic Case Journal of Letter To date, only one adult case with mild symptoms of COVID-19 has been This letter reports the Poli P, Timpano S, Goffredo fibrosis, of Covid-19 in an Cystic reported in Italian patients affected by Cystic Fibrosis (CF). This letter reports first case of M, et al. Asymptomatic case asymptomatic Infant With Cystic Fibrosis a case of COVID-19 in a 1-month-old male infant with positive newborn asymptomatic SARS- of Covid-19 in an infant with infection, Italy Fibrosis screening for CF. Due to close contact with his grandfather who was later CoV-2 infection in an cystic fibrosis [published hospitalized for COVID-19, the infant was found positive for asymptomatic infant with CF, in Italy. online, 2020 Apr 13]. J Cyst infection, diagnosed by RT-PCR on nasopharyngeal swab. The patient never Fibros. 2020. developed fever or any signs of infection, in accordance with the low doi:10.1016/j.jcf.2020.03.017 incidence and good outcomes of SARS-CoV-2 infection in children. Infant, 13-Apr-20 The First Case of Journal of Correspondence The presented case is a 75-day-old infant that was referred to the pediatric This report describes Mogharab V, Pasha AMK, intercostal COVID-19 Infection the emergency department, with a history of severe dry cough, abnormal noisy the first case of infant Javdani F, Hatami N. The first retraction, in a 75-day-old Formosan breathing, and fever. On arrival, the infant had a respiratory rate of 50 infection, seemingly case of COVID-19 infection in oxygen hood, Infant in Jahrom Medical breaths per minute, a temperature of 37.6 centigrade, pulse rate of 172 and based on clinical a 75-day-old infant in Jahrom Iran City, South of Iran Association oxygen saturation of 85%. On physical examination, an intercostal retraction diagnosis, in Iran. City, south of Iran [published was seen, and lung auscultation revealed diminished wheezing and rales on online, 2020 Apr 13]. J both sides. Oxygen saturation and intercostal retraction improved under the Formos Med Assoc. 2020. oxygen hood. Two hours after the patient’s arrival, CT scans showed doi:10.1016/j.jfma.2020.03.0 bilateral peripheral consolidation with a ground glass view. Authors do not 15 mention use of RT-PCR testing to confirm this clinical diagnosis of COVID-19. Pediatric airway 13-Apr-20 Pediatric Airway Anesthesia & Report The Pediatric Difficult Intubation Collaborative (PeDI-C), which currently This collaborative of Matava CT, Kovatsis PG, management, Management in Analgesia includes 35 hospitals from six countries, generated consensus guidelines on hospitals has Summers JL, et al. Pediatric anesthesia, COVID-19 patients – airway management in pediatric anesthesia based on expert opinion and developed Airway Management in intubation, Consensus early data about the disease. Overarching goals include minimizing recommendations for COVID-19 patients - consensus Guidelines aerosolized respiratory secretions, minimizing the number of clinicians in airway management in Consensus Guidelines guidelines contact with a patient, and recognizing that undiagnosed asymptomatic pediatric patients with [published online, 2020 Apr patients may shed the virus and infect healthcare workers. COVID-19. 13]. Anesth Analg. 2020. Recommendations include administering anxiolytic medications, intravenous doi:10.1213/ANE.000000000 anesthetic inductions, tracheal intubation using video laryngoscopes and 0004872 cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Neonates, 13-Apr-20 Clinical Frontiers in Research Article Nineteen neonates were admitted to Tongji Hospital from January 31 to No evidence of vertical Liu W, Wang J, Li W, Zhou Z, clinical Characteristics of Medicine February 29, 2020. Among them, 9 mothers were clinically diagnosed with transmission was Liu S, Rong Z. Clinical characteristics, 19 Neonates Born COVID-19, and 10 mothers had confirmed infection based on RT-PCR testing found in this cohort of characteristics of 19 vertical to Mothers With of throat swab samples. All deliveries occurred in an isolation room, and 19 neonates born to neonates born to mothers transmission, COVID-19 neonates were immediately separated from their mothers, for at least 14 mothers with clinically with COVID-19 [published breast milk days. No fetal distress was found. Mean gestational age of the neonates was diagnosed or online, 2020 Apr 13]. Front samples, China 38.6 ± 1.5 weeks, and mean birth weight was 3293 ± 425 g. SARS-CoV-2 RT- laboratory-confirmed Med. 2020. PCR test results for throat swab, urine, and feces samples of all neonates COVID-19. Amniotic doi:10.1007/s11684-020- were negative following birth. RT-PCR test results for breast milk and fluid, cord blood, and 0772-y amniotic fluid samples were also negative. None of the neonates developed breast milk samples all clinical, radiologic, hematologic, or biochemical evidence of COVID-19. No tested negative for vertical transmission of SARS-CoV-2 and no perinatal complications in the SARS-CoV-2. third trimester were found.

52 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Infant, febrile, 13-Apr-20 Febrile Infant: The Pediatric Letter to the This letter describes a previously healthy, fully vaccinated, late preterm, 58- This case Robbins E, Ilahi Z, Roth P. non-specific COVID-19 in Infectious Editor day-old male who presented with fever in Staten Island University Hospital, demonstrates that Febrile Infant: COVID-19 in symptoms, Addition to the Disease New York. There was no respiratory distress, cough, decreased intake, young infants with Addition to the Usual respiratory Usual Suspects Journal decreased frequency of wet diapers, sick contacts, or travel. Chest X-ray was COVID-19 may present Suspects [published online, viruses, United normal. Rapid flu, respiratory syncytial virus and respiratory viral panel were with non-specific 2020 Apr 13]. Pediatr Infect States negative, and a COVID-19 test was performed. The patient was treated with symptoms. Providers Dis J. 2020. one dose of intramuscular ceftriaxone and acetaminophen for fever. must consider COVID- doi:10.1097/INF.0000000000 Eighteen hours after admission, the patient was afebrile and was discharged. 19 in infants with 002693 His COVID-19 test results came back positive 24 hours later. This case fever and minimal demonstrates that presentation of COVID-19 is non-specific and easily other findings or attributed to many etiologies. Despite being in the highest risk sub-group of historical risk factors. children, the patient in this report recovered quickly. Pregnancy, 12-Apr-20 Clinical Features Journal of Original Research The purpose of this study is to investigate the clinical features, imaging There were no Yang H, Sun G, Tang F, et al. neonates, and Outcomes of Infection findings, laboratory indicators and outcomes of maternal-fetal cases of 55 statistically significant Clinical Features and pulmonary CT, Pregnant Women pregnant women with suspected COVID-19, who gave birth at a tertiary care differences in Outcomes of Pregnant China Suspected of hospital in Wuhan, China between January 23 to March 5, 2020. Of 55 total pulmonary CT findings Women Suspected of Coronavirus Disease suspected cases, the confirmed COVID-19 group contained 13 patients, and between pregnant Coronavirus Disease 2019 2019 the control group contained 42 patients. There were 2 patients with women with and [published online, 2020 Apr prenatal fever and 8 patients with postpartum fever in the confirmed without confirmed 12]. J Infect. 2020. COVID-19 group, in contrast with 11 prenatal fever patients and 20 COVID-19. Of 20 doi:10.1016/j.jinf.2020.04.00 postpartum fever patients in the control group (p<0.05). Pulmonary CT neonates with 3 images in the confirmed COVID-19 group were non-specific and showed no suspected infection, statistical difference from those of the control group. In total, 57 neonates all tested negative for were delivered, and 20 were tested for SARS-CoV-2 using throat swab SARS-CoV-2 within 24 samples. All tested negative. hours after birth. Children, 12-Apr-20 Coronavirus Disease Indian Special Article Although SARS-CoV-2 is primarily a respiratory pathogen, it can also involve This article Matthai J, Shanmugam N, gastro- (COVID-19) and the Pediatrics the gastrointestinal tract. Similar to the respiratory mucosa, angiotensin summarizes available Sobhan P; Indian Society Of intestinal tract, Gastrointestinal converting enzyme-2 (ACE-2) receptors and transmembrane serine protease data on COVID-19 Pediatric Gastroenterology, ACE-2 receptor, System in Children 2 (TMPRSS2) are co-expressed in the gastrointestinal tract, which facilitates involvement of the Hepatology And Nutrition; TMPRSS2, viral entry into the tissue. Less than 10% of children with infection develop gastrointestinal (GI) Pediatric Gastroenterology inflammatory diarrhea and vomiting. Prolonged RT-PCR positivity in the stool of children tract in children, Chapter Of Indian Academy bowel disease, has raised the possibility of fecal-oral transmission. Elevated transaminases including Of Pediatrics. Coronavirus post-liver are common, especially in those with severe COVID-19 disease. Children pathogenesis, clinical Disease (COVID-19) and the transplant, with inflammatory bowel disease and post liver transplant patients do not markers, and Gastrointestinal System in chronic liver have an increased risk of disease and should remain on medications they are implications for Children [published online, disease already on. Children with chronic liver disease should continue their children with 2020 Apr 12]. Indian Pediatr. medications as usual. All elective procedures like endoscopy should be underlying GI 2020;S097475591600162. postponed. conditions. Children, 12-Apr-20 We Urgently Need Acta Letter This letter emphasizes noteworthy conclusions drawn from the systematic This letter calls for a Dayal D. We urgently need comorbidities, Guidelines for Paediatrica review by Ludvigsson on COVID-19 in children, published on March 23, 2020: pediatric task force to guidelines for managing high-risk Managing COVID-19 In early data from China, children only accounted for 1-5% of cases, with low develop and COVID-19 in children with pediatric in Children With progression to severe or critical conditions requiring intensive care. Overall disseminate guidelines comorbidities [published population, Comorbidities mortality rate was low, at about 0.18% compared to 4.3% in adults. on managing high-risk online, 2020 Apr 12]. Acta guidelines However, an increased risk of critical disease and mortality has been pediatric patients with Paediatr. 2020. observed in infants and younger children, particularly those with underlying COVID-19. doi:10.1111/apa.15304 comorbidities, such as hydronephrosis, leukemia, intussusception, and lacrimal sac dredge. Special management of children with pre-existing 53 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication chronic conditions (e.g. diabetes, adrenal insufficiency, chronic renal failure, chronic pulmonary disorders, cancers, immune deficiencies, and chronic neurological disorders) will be necessary to minimize their risk of progression to critical disease or death. Pregnancy, 11-Apr-20 Unlikely SARS-CoV- Journal of Case Report Though some studies indicated the risk of vertical transmission of SARS-CoV- Authors state that Peng Z, Wang J, Mo Y, et al. neonate, 2 Vertical Infection and 2 infection is low, few cases have been reported with comprehensive serial vertical transmission Unlikely SARS-CoV-2 vertical vertical Transmission From Public Health tests from multiple specimens. In this case, a female preterm infant was of COVID-19 is unlikely transmission from mother to transmission, Mother to Child: A born to a mother with confirmed COVID-19. The infant presented with mild but advise caution, child: A case report breast milk Case Report respiratory distress and received general management and a short period of until further evidence [published online, 2020 Apr samples nasal continuous positive airway pressure support. During her stay at the from epidemiological 11]. J Infect Public Health. hospital, a series of SARS-CoV-2 nucleic acid tests from her serum, throat surveillance and 2020. and anal swabs, bronchoalveolar lavage fluid, and urine were negative. experiment studies on doi:10.1016/j.jiph.2020.04.00 Nucleic acid tests of the mother's amniotic fluid, vaginal secretions, cord transmission potential 4 blood, placenta, serum, anal swab, and breast milk were also negative. The through birth canal most comprehensively tested case reported to date confirmed that the contact and breast vertical transmission of COVID is unlikely, but still, more evidence is needed. milk is available. Neonatal 11-Apr-20 Neonatal COVID-19: Jornal de Editorial The lack of high-quality evidence on neonatal SARS-CoV-2 infection and the Brazilian authors Procianoy RS, Silveira RC, infection, Little Evidence and Pediatria steadfast pace of new and conflicting information has been an overall compile existing Manzoni P, Sant'Anna G. vertical the Need for More challenge to neonatal intensive care. Internationally and nationally in Brazil, information on how to Neonatal COVID-19: little transmission, Information a number of important groups have been diligently working on the care for neonates with evidence and the need for breastfeeding, development of protocols and guidelines for the neonatal COVID-19 SARS-CoV-2 infection, more information [published neonatal outbreak. Given the constant updating and some conflicting information, from a variety of online, 2020 Apr 11]. J providers, health care providers face difficulties in determining best local guidelines. national and Pediatr (Rio J). 2020. respiratory This editorial outlines what is currently known about neonatal infection, international sources. doi:10.1016/j.jped.2020.04.0 strategies, vertical transmission, what neonatal health care providers should do about 02 Brazil COVID-19, how to provide overall care after birth (including notes on supporting breastfeeding), and respiratory strategies. Pregnancy, 11-Apr-20 Classification Acta Special Editorial Current studies on intrauterine transmission of COVID-19 from mother to This paper presents a Shah PS, Diambomba Y, fetuses, system and case Obstetricia fetus or intrapartum transmission from mother to neonate are limited by classification scheme Acharya G, Morris SK, Bitnun neonates, definition for SARS- et Gynecolo- the sensitivity and specificity of diagnostic tests used, as well as that specifies criteria A. Classification system and classification CoV-2 infection in gica questionable classification of patients based on results. Differing for the likelihood of case definition for SARS-CoV- system, case pregnant women, Scandinavica recommendations have emerged regarding which samples should be infection in different 2 infection in pregnant definition, fetuses, and collected and when, and how to distinguish infection from contamination. In perinatal scenarios. women, fetuses, and congenital neonates addition, the fact that a significant proportion of maternal and neonatal neonates [published online, infection, infections can be asymptomatic creates difficulty in ascertaining the disease 2020 Apr 11]. Acta Obstet intrapartum, burden. Authors present a system that could aid healthcare practitioners in Gynecol Scand. 2020. postpartum evaluating patients, determining appropriate infection control measures, doi:10.1111/aogs.13870 planning appropriate follow-up for neonates and infants, allowing large epidemiological studies and helping collaboration between international efforts to learn about potential effects of maternal infection. This classification system provides case definitions, based on specified COVID-19 test results, for the following scenarios: maternal infection during pregnancy, congenital infection with intrauterine fetal death/stillbirth, congenital infection in live born neonate, neonatal infection acquired intrapartum, and neonatal infection acquired postpartum.

54 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Infection 11-Apr-20 Cluster of Clinical Case Study In this cluster, 12 Covid-19 cases (one asymptomatic) were linked to a single In this cluster, a Danis K, Epaulard O, Bénet T, cluster, Coronavirus Disease Infectious index case. 172 contacts were monitored, including 73 who tested negative symptomatic child et al. Cluster of coronavirus pediatric 2019 (Covid-19) in Diseases for SARS-CoV-2. SARS-CoV-2 was detected in one child, co-infected with with COVID-19 did not disease 2019 (Covid-19) in transmission the French Alps, picornavirus and influenza A, visited three schools while symptomatic, but transmit the virus to the French Alps, 2020 dynamics, 2020 did not transmit the virus. This suggests potentially different transmission others despite close [published online, 2020 Apr coinfection, dynamics in children. In addition, the potential dissociation between upper interactions at three 11]. Clin Infect Dis. French Alps and lower respiratory tract results, possibly related to the distribution of different schools. 2020;ciaa424. virus receptors and compartmentalization of infection over time, underscore Transmission doi:10.1093/cid/ciaa424 the risk for missed diagnosis and the need for close monitoring of the clinical dynamics of COVID-19 evolution and screening of suspected COVID-19 cases. may be different in children. Human milk, 10-Apr-20 Using the Journal of Editorial The author aims to provide guidance regarding breastfeeding and COVID-19 The author provides Spatz DL. Using the breastfeeding, Coronavirus Obstetric, and reaffirm the importance to promote and protect the use of human milk guidance regarding Coronavirus Pandemic as an medical Pandemic as an Gynecologic, and breastfeeding. If a mother has any flu -like symptoms, she should wear a breastfeeding and Opportunity to Address the intervention Opportunity to and mask when near her infant, including during breastfeeding; wash her hands COVID-19 including Use of Human Milk and Address the Use of Neonatal before and after contact; and clean/disinfect all surfaces. If separation of the precautions for Breastfeeding as Lifesaving Human Milk and Nursing mother and infant is warranted, the mother should start to express milk symptomatic mothers Medical Interventions. J Breastfeeding as immediately to establish and maintain milk supply. If someone who is and continuation of Obstet Gynecol Neonatal Lifesaving Medical breastfeeding becomes ill, the infant was already exposed to the virus by the breastfeeding after Nurs. 2020 May;49(3):225- Interventions mother and/or family and will benefit most from continued direct diagnosis. The author 226. doi: breastfeeding. Disruption of breastfeeding will increase the risk of the infant argues that healthcare 10.1016/j.jogn.2020.03.002. becoming ill because of the lack of immune support. The author emphasizes providers should how breastfeeding and the provision of human milk are recommended by leverage breastfeeding national and international organizations in the current COVID-19 crisis but as a critical aims for healthcare providers to leverage breastfeeding as a critical intervention to intervention to improve health and developmental outcomes and save the improve health and lives of children around the world. developmental outcomes and save lives. Children, 10-Apr-20 Epidemiologic and Journal of Case Series In this retrospective study, 10 children with SARS-COV-2 infection were Findings from this Tan YP, Tan BY, Pan J, Wu J, clinical Clinical Clinical recruited from January 27 to March 10, 2020, in Changsha, China. Three report indicate that Zeng SZ, Wei HY. characteristics, Characteristics of Virology were male and seven were female. Three were from Wuhan, Hubei intrafamily Epidemiologic and clinical family cluster, 10 Children With Province, and seven were from Changsha. All had a history of close contact transmission may be characteristics of 10 children fecal viral Coronavirus Disease with adults with COVID-19 before the onset of disease. Clinical the main form of with coronavirus disease shedding, China 2019 in Changsha, manifestations included fever in four cases, respiratory symptoms in three transmission of 2019 in Changsha, China China cases, febrile convulsions in one case, vomiting in one case, abdominal pain COVID-19 in children. [published online, 2020 Apr in one case, and asymptomatic infection in two cases. All the children tested Persistent intestinal 10]. J Clin Virol. 2020. positive for nucleic acid in throat swabs at admission. Stool swabs of three excretion of viral doi:10.1016/j.jcv.2020.10435 cases were positive for nucleic acid after several days of fever. In nine nucleic acid was also 3 children, blood routine results were normal, whereas in one case the white observed; results from blood cell count was elevated. In four cases, CT findings of the lungs showed stool swab tests light ground-glass opacities, one case showed changes similar to should be considered bronchopneumonia, and the remaining cases were normal. All were treated for discharge and with symptomatic support without complications. release from isolation. Pregnancy, 10-Apr-20 Clinical Journal of Case Series Authors prospectively collected and analyzed the clinical features, There is no current Yang P, Wang X, Liu P, et al. neonatal Characteristics and Clinical laboratory data and outcomes of 7 newborns delivered by SARS-CoV-2 evidence supporting Clinical characteristics and infection, Risk Assessment of Virology infected pregnant women in Zhongnan Hospital of Wuhan University during the vertical risk assessment of newborns 55 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication clinical Newborns Born to January 20 to January 29, 2020. 4 of the 7 newborns were late preterm with transmission of SARS- born to mothers with COVID- characteristics, Mothers With gestational age between 36 weeks and 37 weeks, and the other 3 were full- CoV-2 infection from 19 [published online, 2020 vertical COVID-19 term infants. The average birth weight was 2096 ± 660 g. All newborns were mother to neonate. Apr 10]. J Clin Virol. 2020. transmission born without asphyxia. 2 premature infants performed mild grunting after Neonatal pharyngeal doi:10.1016/j.jcv.2020.10435 birth, but relieved rapidly with non-invasive continuous positive airway swabs, amniotic fluid, 6 pressure (nCPAP) ventilation. 3 cases had chest X-ray, 1 was normal and 2 and umbilical cord who were supported by nCPAP presented mild neonatal respiratory distress blood tested negative syndrome. There were no positive qRT-PCR results for SARS-CoV-2 nucleic for viral nucleic acid in acid in pharyngeal swab samples from 6 cases and amniotic fluid and this study. umbilical cord blood from 4 cases. Current data show that the infection of SARS-CoV-2 in women who are in late pregnancy does not cause adverse neonatal outcomes. However, the authors state it is necessary to separate newborns from mothers immediately to avoid potential risks. Children, mass 10-Apr-20 Pandemic Brings Science In Depth: Global In efforts to stop the spread of COVID-19, mass vaccination campaigns Due to social Roberts L. Pandemic brings vaccination, Mass Vaccinations Health against a host of diseases are now grinding to a halt in many countries. Some distancing orders, the mass vaccinations to a halt. measles, to a Halt 13.5 million have already missed out on vaccinations for polio, measles, suspension of mass Science. poliomyelitis human papillomavirus, yellow fever, cholera, and meningitis since the vaccination campaigns 2020;368(6487):116–117. suspensions began. The fallout may last long after the pandemic subsides. In for highly contagious doi:10.1126/science.368.648 the case of polio, the postponement announced by the Global Polio diseases, including 7.116 Eradication Initiative, on March 24, 2020, imperils the success of a 3-decade measles and polio, eradication campaign that was already in trouble. On March 26, WHO's place children, Strategic Advisory Group of Experts on Immunization issued a broader call, especially those who recommending that countries stop mass vaccination campaigns against all are malnourished, at vaccine-preventable diseases. Twenty-three countries have already risk. suspended their measles campaigns, and as a result, 78 million children will miss out on the vaccine. In poor countries, the virus can kill 3% to 6% of those it infects, with malnourished children especially at risk. WHO, GAVI, and other health organizations stress that routine immunization of individual children at clinics must continue as much as possible during the pandemic. Pregnancy, 10-Apr-20 Current Resources Journal of Special Report This report presents a review of resources to support the provision of This letter discusses Bovbjerg ML. Current place of birth, for Evidence-Based Obstetric, evidence-based care for women and infants, including discussion of a new the potential value of Resources for Evidence- planned Practice, May 2020 Gynecologic National Academy of Medicine report on planned place of birth and planned community Based Practice, May 2020 community & Neonatal implications during the SARS-CoV-2 pandemic. Planned community birth birth during a time [published online, 2020 Apr birth Nursing should be considered as a safe alternative to delivery in currently when hospitals and 10]. J Obstet Gynecol overwhelmed hospitals. medical staff are Neonatal Nurs. 2020. overwhelmed. doi:10.1016/j.jogn.2020.04.0 01 Pregnancy, 10-Apr-20 Mortality of a Travel Case Report A 27-year-old Iranian woman at 30 and 3/7 weeks gestation was hospitalized To the authors' Karami P, Naghavi M, Feyzi A, mortality, pre- Pregnant Patient Medicine after presenting with fever, myalgia, and cough. Lab results showed knowledge, this is the et al. Mortality of a pregnant term delivery, Diagnosed With and leukopenia and lymphopenia as well as increased creatinine and CRP levels. first report of death in patient diagnosed with cyanotic fetus, COVID-19: A Case Infectious The first chest X-ray (faint bilateral patchy opacities) and CT scan (some faint a pregnant woman COVID-19: A case report with Iran Report With Disease subpleural ground-glass opacities associated with pleural thickening) were with confirmed clinical, radiological, and Clinical, not typical for initial COVID-19 pulmonary infection, nevertheless, treatment COVID-19 infection. histopathological findings Radiological, and for COVID-19 was started. Due to respiratory distress, she was intubated and The woman died due [published online, 2020 Apr Histopathological put under mechanical ventilation. Following spontaneous contractions, a to multi-organ failure, 10]. Travel Med Infect Dis. Findings cyanotic fetus was delivered vaginally with an Apgar score of 0 and did not after delivering a 2020. react to neonatal cardiopulmonary resuscitation. After deteriorating 56 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication RETRACTED 2 May clinically, the female patient died due to multi-organ failure. An autopsy was cyanotic fetus, who doi:10.1016/j.tmaid.2020.101 2020 performed, and histopathologic evaluation of the lungs showed evidence of did not survive. 665 viral pneumonia (viral cytopathic effect and a mild increase in alveolar wall thickness) and ARDS (hyaline membrane). RT-PCR testing also confirmed SARS-CoV-2 infection in the lungs. To our knowledge, this is the first report of maternal death with confirmed COVID-19 infection.

Children, PICU, 10-Apr-20 COVID-19 in Journal of Original Article The objective of this empirical case projection study is to provide evidence- This study provides Pathak EB, Salemi JL, Sobers hospitalization, Children in the Public Health based estimates of children infected with SARS-CoV-2 and projected estimated projections N, Menard J, Hambleton IR. cumulative case United States: Manage- cumulative numbers of severely ill pediatric COVID-19 cases requiring for pediatric cases in COVID-19 in Children in the projections, Intensive Care ment & hospitalization during the US 2020 pandemic. By April 6, 2020, there were 74 the United States. It United States: Intensive Care United States Admissions, Practice children who had been reported admitted to pediatric intensive care units states that a surge in Admissions, Estimated Total Estimated Total (PICUs) in 19 states, reflecting an estimated 176,190 children nationwide severe cases of COVID- Infected, and Projected Infected, and infected with SARS-CoV-2 (52,381 infants and toddlers <2 years, 42,857 19 in children, despite Numbers of Severe Pediatric Projected Numbers children 2-11 years, and 80,952 children 12-17 years). Under a cumulative displaying lower Cases in 2020 [published of Severe Pediatric pediatric infection proportion (CPIP) scenario of 5%, there would be 3.7 severity than adults, online, 2020 Apr 10]. J Public Cases in 2020 million children infected with SARS-CoV-2, 9907 severely ill children could overwhelm Health Manag Pract. 2020. requiring hospitalization, and 1086 critically ill children requiring PICU pediatric hospital doi:10.1097/PHH.000000000 admission. Under a CPIP scenario of 50%, 10,865 children would require capacity and present 0001190 PICU admission, 99,073 would require hospitalization for severe pneumonia, further challenges to and 37 million would be infected with SARS-CoV-2. Because there are 74.0 public health efforts in million children 0-17 years old in the US, the projected numbers of severe the US. cases could overwhelm available pediatric hospital care resources under several moderate CPIP scenarios, despite lower severity of COVID-19 in children than in adults. Fecal viral 10-Apr-20 Dynamics of Faecal Journal of Letter to the In response to the recent paper by He et al. reviewing current evidence on Recent evidence raises Xing Y, Ni W, Wu Q, et al. shedding, SARS-CoV-2 in Infection Editor COVID-19 and fecal shedding of SARS-CoV-2 as a possible route of viral the possibility of fecal- Dynamics of Faecal SARS- transmission Infected Children transmission, this letter shares findings from a series of three pediatric oral transmission of CoV-2 in Infected Children dynamics, During the patients, in Qingdao, China, who tested positive for SARS-CoV-2 viral RNA in SARS-CoV-2, during the Convalescent children, Convalescent Phase stool samples up to 8-20 days after clearance of viral RNA in respiratory reinforcing the need Phase [published online, convalescent specimens. All patients were diagnosed with mild pneumonia, and only one for nucleic acid testing 2020 Apr 10]. J Infect. 2020. phase, China child had gastrointestinal symptoms. All children were in stable condition of stool samples from doi:10.1016/j.jinf.2020.03.04 during the course of hospitalization. Laboratory and radiological features COVID-19 patients, 9 were not typical for COVID-19. The children showed good response to particularly children, supportive and anti-viral treatment. Negative conversion of viral RNA in during the respiratory specimens occurred within 2 weeks after disease onset. In convalescent phase. contrast, viral RNA remained detectable in feces for approximately 4 weeks. Children, 10-Apr-20 COVID-19 - Clinical Review Article A significant proportion of adult patients with COVID-19 require Immune-modulating Hedrich CM. COVID-19 - immune Considerations for Immunology hospitalization and may develop severe life-threatening complications. treatment should be Considerations for the response, the Paediatric Children, on the other hand, can carry and transmit the virus, but usually do continued for children, paediatric rheumatologist cytokine storm Rheumatologist not develop severe disease. Mortality in the pediatric age-group is relatively with close clinical [published online, 2020 Apr syndromes, low. Differences in virus containment and clearance, as well as reduced monitoring. Delayed 10]. Clin Immunol. 2020. immune- inflammation-related tissue and organ damage may be caused by age- activation of adaptive doi:10.1016/j.clim.2020.1084 modulating specific environmental and host factors. Since severe complications in adults immune responses 20 treatment are frequently caused by uncontrolled immune responses and a resulting may be beneficial in “cytokine storm” that may be controlled by targeted blockade of cytokines. mitigating cytokine

57 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Although children receiving immunosuppressive treatment may be at storm syndromes increased risk for SARS-CoV-2 infections, immunosuppression may indeed associated with protect them from complications. COVID-19.

Pediatrics, 10-Apr-20 COVID-19 - A Guide Journal of Invited The COVID-19 pandemic has triggered an unprecedented expansion in Telemedicine is rapidly Berg EA, Picoraro JA, Miller telemedicine, to Rapid Pediatric Commentary telemedicine across the United States and world, in an effort to slow the expanding in an effort SD, et al. COVID-19 - A Guide gastro- Implementation of Gastro- spread of disease, particularly in high-risk healthcare settings. This to reduce risk of SARS- to Rapid Implementation of enterology, Telehealth Services: enterology commentary establishes best practices for telehealth in pediatric CoV-2 transmission in Telehealth Services: A inflammatory A Playbook for the and gastroenterology to improve clinical outcomes. For example, telemonitoring health care settings. Playbook for the Pediatric bowel disease, Pediatric Gastro- Nutrition systems for inflammatory bowel disease that utilize remote tracking of This commentary can Gastroenterologist [published intestinal enterologist clinical data have shown promise in improving outcomes, specifically in help guide providers online, 2020 Apr 10]. J failure reducing hospitalizations. Similarly, transitioning multi-provider visits to during the transition Pediatr Gastroenterol Nutr. telehealth provides the opportunity to conduct multiple family and care to telehealth services, 2020. team members simultaneously, reducing risk of exposure for children who with specific regard to doi:10.1097/MPG.000000000 are medically complex, like those undergoing intestinal rehabilitation. pediatric 0002749 gastroenterology. Perinatology, 10-Apr-20 Perinatal Aspects Journal of Review This review presents analysis of literature on COVID-19 using Medline and This comprehensive Mimouni F, Lakshminrusimha pregnancy, on the Covid-19 Perinatology Google scholar to summarize available evidence on perinatal aspects of review of available S, Pearlman SA, et al. neonates Pandemic: A COVID-19. From scant data: vertical transmission from maternal infection literature on COVID-19 Perinatal aspects on the Practical Resource during the third trimester probably does not occur or likely it occurs very in pregnant women covid-19 pandemic: a for Perinatal- rarely. Consequences of COVID-19 infection among women during early and neonates includes practical resource for Neonatal Specialists pregnancy remain unknown. Whether or not pregnancy is a risk factor for useful links to perinatal-neonatal specialists more severe disease in women with COVID-19 cannot be concluded. Little is guidelines and expert [published online, 2020 Apr known about disease severity in neonates, and from very few samples, the opinions, as well as 10]. J Perinatol. 2020. presence of SARS-CoV-2 has not been documented in human milk. infographics on doi:10.1038/s41372-020- treatment strategies. 0665-6 Children, school 10-Apr-20 COVID-19, School Obesity Letter to the In response to the publication on "COVID-19 Related School Closings and This correspondence Joob B, Wiwanitkit V. COVID- closure, food Closings and Editor Risk of Weight Gain Among Children" (Rundle et al., 2020), authors share provides a global 19, School Closings and insecurity, poor Weight Gain observations from Thailand, the second country in the timeline of COVID-19. perspective, from Weight Gain [published childhood In Thailand, school aged children in rural areas where COVID-19 disease Thailand, on the online, 2020 Apr 10]. Obesity nutritional outbreak exists are usually underweight. Thus, poorer childhood nutritional impact of school (Silver Spring). status, Thailand status may result from school closings and lack of access to government closings on nutritional 2020;10.1002/oby.22825. funded meals at school. status among children doi:10.1002/oby.22825 from poor families. Neonate, 10-Apr-20 Vaginal Delivery Journal of Short This case report describes a pregnant woman, who was admitted to Beijing A neonate, born to a Xiong X, Wei H, Zhang Z, et al. pregnancy, Report of a Healthy Medical Communication YouAn Hospital on January 29, 2020 (33 weeks 1 day gestation) and convalescing mother, Vaginal Delivery Report of a vaginal Neonate Born to a Virology diagnosed with COVID-19. She received antiviral, anti-infection, and tested negative for Healthy Neonate Born to a delivery, Convalescent corticosteroid therapies and recovered following treatment. Follow-up RT- COVID-19 infection. Convalescent Mother with serological Mother With PCR tests were negative, and virus-specific IgG and IgM antibodies in Although virus-specific COVID-19 [published online, testing, breast COVID-19 maternal venous blood were positive. Thirty-seven days after diagnosis, a IgG and IgM were 2020 Apr 10]. J Med Virol. milk samples, male neonate was delivered successfully by vaginal delivery. RT-PCR testing detected in maternal 2020. doi:10.1002/jmv.25857 vertical of breast milk, amniotic fluid, and neonatal throat and rectal samples tested sera following negative. Neonatal sera samples were also negative for IgG and IgM recovery, antibodies

58 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication transmission, antibodies, and SARS-CoV-2 N protein was not detected in the placenta by were absent in China immunohistochemical analysis. Findings indicate that there is no neonatal sera. Breast intrauterine transmission in a woman who develops COVID-19 pneumonia in milk samples also late pregnancy. tested negative.

China, 9-Apr-20 Acute stress, Asian Journal Original Article Children with attention deficit hyperactivity disorder (ADHD) face notable The authors Zhang J, Shuai L, Yu H, et al. attention- behavioural of Psychiatry challenges during the COVID-19 pandemic. The loss of daily routine and the conducted a survey of Acute stress, behavioural deficit/hyperact symptoms and lack of social interaction are potential risk factors for mental health 241 parents of school symptoms and mood states ive disorder, mood states among problems and could worsen ADHD symptoms. A total of 241 parents in China aged children with among school-age children ADHD, children, school-age children who had children aged 6-15 years with ADHD completed a survey on ADHD attention deficit with attention- mental health, with attention- symptoms, parent and child mood, and child time allocation on different hyperactivity disorder deficit/hyperactive disorder mood states, deficit/hyperactive activities during the COVID-19 pandemic. 9 domains of ADHD behavioral (ADHD) in China and during the COVID-19 study time disorder during the symptoms (attention, neatness, quietness, interrupting adults, listening to determined that outbreak. Asian J Psychiatr. COVID-19 outbreak instructions, anger, eating behavior, sleeping behavior, and ability to keep a children’s ADHD 2020;51. routine) were measured on a 4-point scale, with 2 indicating no difference in symptoms were doi:10.1016/j.ajp.2020.10207 current behavior compared to before the pandemic and 4 indicating severe significantly worse 7 worsening of symptoms compared to before the pandemic. The mean during the COVID-19 ADHD behavioral score was 2.25, which was significantly different than a pandemic compared score of 2 (95% CI = 2.18–2.3, p <0.001), and indicated worsening ADHD to before. Children’s symptoms during the pandemic. Mood state of the children and parents and parent’s negative were asked by a single item each, rated on a 1–4 scale, with higher score mood state was indicated worse mood. Parents were also asked to approximate child time associated with allocation on activities including studying, using electronic devices, increased ADHD entertainment without using electronic devices, and interacting with the symptoms, but parents. Children’s overall mood, parents’ overall mood, and children’s increased time spent study time significantly predicted children’s ADHD behaviors (p<0.001, studying was P<0.001, and P=0.01 respectively). The authors found children’s and parents’ associated with a worse mood states were associated with increased ADHD symptoms. A decrease in ADHD longer time spent studying was associated with fewer ADHD symptoms. symptoms. Pregnancy, 9-Apr-20 A Spanish- The Lancet Correspondence No standardized guidelines for treating pregnant women with SARS-CoV-2 Authors translate a Martinez-Portilla, RJ, Goncé, clinical translated clinical Infectious infection are currently available in Spanish. Authors of this correspondence proposed clinical A, Hawkins-Villarreal, A, algorithm, algorithm for Diseases call for dissemination of the clinical algorithm, proposed by Favre et al. for algorithm for the Figueras F. A Spanish- Spanish management of the management of pregnant women with suspected COVID-19, to Spanish- management of translated clinical algorithm suspected SARS- speaking countries where such information is urgently needed. A translated pregnant women with for management of CoV-2 infection in algorithm in Spanish is proposed in the appendix, and recommendations for COVID-19 into suspected SARS-CoV-2 pregnant women breastfeeding are discussed as well. Spanish. infection in pregnant women [published online, 2020 Apr 9]. Lancet Infect Dis. 2020. doi:10.1016/S1473- 3099(20)30285-1 Recovered 9-Apr-20 Rehospitalization of The Pediatric Instructive Cases A recent study reported that 14% of adult patients, who were hospitalized This case indicates Wang H, Li Y, Wang F, Du H, children, re- a Recovered Infectious and recovered from COVID-19, showed positive results of SARS-CoV-2 that children who Lu X. Rehospitalization of a hospitalization, Coronavirus Disease Disease nucleic acid tests (NATs) soon after discharge, raising concern that recovered recover clinically from Recovered Coronavirus post-discharge 19 (COVID-19) Child Journal patients may be potential carriers of the virus. Little attention, however, has COVID-19 may still Disease 19 (COVID-19) Child surveillance, With Positive been paid to recovered children. In this case, authors describe an 8-year-old carry trace amounts of With Positive Nucleic Acid China Nucleic Acid child, who was hospitalized on February 7, 2020 after exposure to his virus, which could lead Detection [published online, Detection grandmother with suspected COVID-19. Following antiviral and symptomatic to potential 2020 Apr 9]. Pediatr Infect 59 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication treatment, his throat swab NATs turned negative on February 16, and he reactivation. After Dis J. 2020. was discharged on February 19. Ten days later, while quarantined at home, patients meet doi:10.1097/INF.0000000000 the patient developed an unexplained fever and was re-hospitalized the discharge criteria, it 002690 following day on March 1. Throat swab NATs were negative on March 3, may take several while positive on March 5. Serum antibody tests showed weakly positive additional days for results for IgM and strong positive results for IgG on March 6. their immune systems to completely clear the virus. Children, 9-Apr-20 Delayed Access or The Lancet Correspondence During Italy's national lockdown for COVID-19, official hospital statistics, in A small case series Lazzerini M, Barbi E, Apicella pediatric ED Provision of Care in Child & the period of March 1–27, 2020, show substantial decreases—ranging from from hospitals in Italy A, Marchetti F, Cardinale F, visits, delayed Italy Resulting From Adolescent 73% to 88%—in pediatric emergency department visits compared with the reveals that delayed Trobia G. Delayed access or access to Fear of COVID-19 Health same time period in 2019 and 2018. Family pediatricians also widely report a access to hospital care provision of care in Italy hospital care, considerable reduction in clinic visits. Since schools and sports activities have for emergency resulting from fear of COVID- comorbidities, been closed since March 1, the numbers of acute infections and trauma conditions in children 19 [published online, 2020 acute onset of among children are understandably lower than usual. In addition, relatively may pose greater risk Apr 9]. Lancet Child Adolesc chronic few cases of COVID-19 among children (<18 years old) have been reported, to health than COVID- Health. 2020. conditions, only accounting for 1.5% of total positive cases in Italy. However, children 19, especially for doi:10.1016/S2352- severe continue to acquire other infections and complications or acute onset of children with pre- 4642(20)30108-5 malnutrition, chronic conditions, such as cancer, endocrine disorders (e.g. diabetes), existing chronic pediatric surgical conditions (e.g. appendicitis), and severe malnutrition. The conditions. Further deaths, Italy substantial decreases in pediatric care access in Italy might reflect scarcity of monitoring of access available resources due to pandemic-related redistribution, or reticence on to routine clinical care the part of parents and caregivers to risk exposure to SARS-CoV-2 in a as well as clear health-care setting. Within an Italian Pediatric Hospital Research Network, guidance for health 12 cases of delayed access to hospital care have been reported during the care workers and the week of March 23–27, 2020 across five hospitals. Of this small series of 12 general population are cases, half of the children were admitted to the ICU and four died, compared needed during the to a typical yearly range of zero to three total pediatric deaths in these COVID-19 pandemic. hospitals. In five cases, the family had contacted health services before accessing care, but their health provider was unavailable, or hospital access was discouraged. All cases were negative for SARS-CoV-2 or had clinical presentation that did not justify diagnostic testing. Since delay in access to care was not monitored systematically, this case series, although clearly a small sample, might underestimate the problem. Children, 9-Apr-20 Children are The Lancet Original Article At present, there is concern that children could be an important source of An analysis of 31 Zhu Y, Bloxham CJ, Hulme KD, household unlikely to have Infectious SARS-CoV-2 infection in household transmission clusters. This study analyzes household et al. Children are unlikely to transmission, been the primary Diseases literature published between December 2019 and March 2020 on the clinical transmission clusters have been the primary family cluster source of features of SARS-CoV-2 in children and descriptions of household from various studies source of household SARS- household SARS- transmission clusters. The index case of each cluster is defined as the revealed that children CoV-2 infections. medRxiv. CoV-2 infections. individual in the cluster who first developed symptoms. Drawing on studies comprised the index 2020. from China, Singapore, South Korea, Japan, and Iran, a broad range of case for only 3 doi:10.2139/ssrn.3564428 clinical symptoms were observed in children. These ranged from clusters, thus may play asymptomatic to severe disease. Of the 31 household transmission clusters a smaller role in intra- that were identified, 9.7% (3/31) were identified as having a pediatric index household case. This is in contrast other zoonotic infections (namely H5N1 influenza transmission of SARS- virus) where 54% (30/56) of transmission clusters identified children as the CoV-2. index case. Whilst SARS-CoV-2 can cause mild disease in children, existing 60 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication data suggest that children have not played a substantive role in the intra- household transmission of SARS-CoV-2.

Children, 9-Apr-20 Coronavirus Disease Indian Special Article Pediatric COVID-19 infection is relatively mild when compared to adults, and This article considers Balasubramanian S, Rao NM, immune- (COVID-19) in Pediatrics children are reported to have a better prognosis. Clinical features of COVID- the impact of COVID- Goenka A, Roderick M, suppressed Children - What We 19 in children include fever and cough, but a large proportion of infected 19 on Ramanan AV. Coronavirus children, socio- Know So Far and children appears to be asymptomatic and may contribute to transmission. It immunosuppressed Disease (COVID-19) in economic What We Do Not? remains unclear why children and young adults are less severely affected children, reviewing Children - What We Know So consequences than older individuals, but this might involve differences in immune system recent data that Far and What We Do Not? function in the elderly and/or differences in the expression and function of suggests that lower [published online, 2020 Apr the cellular receptor for SARS-CoV-2 - Angiotensin converting enzyme 2 immune response may 9]. Indian Pediatr. (ACE2). Laboratory findings and chest imaging may not be specific in children actually protect 2020;S097475591600159. with COVID-19. Diagnosis is by RT-PCR testing of upper or lower respiratory children from tract secretions. Despite concerns that immunocompromised children may infection. have severe infection analogous to other respiratory viruses, Antiga et al. (March 20, 2020) described that children were not at greater risk of severe COVID-19, probably owing to their lower functional host innate immune response, which is the main driver for lung damage. No data are available on the severity of COVID-19 infection in children with malnutrition, rheumatic heart disease, or HIV. This review also suggests a management algorithm for the few children who appear to present with life threatening infection, including the potential use of antiviral and immunomodulatory treatment. Pregnancy, 9-Apr-20 COVID-19 infection American Case Series Authors describe a series of 43 test-confirmed cases of COVID-19 in No neonates born to Breslin N, Baptiste C, Gyamfi- neonates, among Journal of pregnant women presenting to a pair of affiliated New York City hospitals mothers with Bannerman C, Miller R, universal asymptomatic and Obstetrics & over two weeks from March 13 to 27, 2020. Fourteen (32.6%) patients confirmed COVID-19 Martinez R, BernsteinK, Ring testing, symptomatic Gynecology presented without any COVID-associated symptoms and were identified were found to have L, Landau R, Purisch S, breastfeeding, pregnant women: MFM either after developing symptoms during admission or following the infection when tested Friedman AM, Fuchs K, New York City Two weeks of implementation of universal testing for all obstetrical admissions on March on the first day of life. Sutton D, Andrikopoulou M, confirmed 22. Of these, 10/14 (71.4%) developed symptoms or signs of COVID-19 IgG and IgM SARS- Rupley D,Sheen J-J, Aubey J, presentations to an infection over the course of their delivery admission or early after CoV-2 testing was not Zork N, Moroz L, Mourad M, affiliated pair of postpartum discharge. Of the other 29 (67.4%) patients who presented with performed. Among Wapner R, Simpson LL, New York City symptomatic COVID-19 infection, three women ultimately required the pregnant women, D’Alton ME, GoffmanD, hospitals antenatal admission for viral symptoms, and an additional patient the proportions of COVID-19 infection among represented six days postpartum with worsening respiratory status that mild, severe, and asymptomatic and required oxygen supplementation. There were no confirmed cases of COVID- critical disease are symptomatic pregnant 19 detected in neonates upon initial testing on the first day of life. One similar to those women: Two weeks of neonate had an "indeterminant" test result, which was clinically managed as described for non- confirmed presentations to a "presumptive negative" diagnosis. Another neonate was admitted to the pregnant adults with an affiliated pair of New York NICU for respiratory distress with concern for sepsis at 37 weeks but tested COVID-19. Mothers City hospitals, American negative for COVID-19 infection. Healthy newborns either roomed in with were encouraged to Journal of Obstetrics their mothers in isolettes whenever possible or were cared for in an isolated breastfeed with &Gynecology MFM (2020), nursery. Breastfeeding was encouraged with use of hand hygiene and proper precautions. doi:10.1016/j.ajogmf.2020.10 maternal masking. Applying COVID-19 disease severity characteristics as Universal testing of 0118 described by Wu et al, 38 (86%) women possessed mild disease, four (9.3%) pregnant women upon 61 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication exhibited severe disease, and two (4.7%) developed critical disease; these admission for delivery percentages are similar to those described for non-pregnant adults with has potential clinical COVID-19 infections (about 80% mild, 15% severe, and 5% critical disease). value, to quickly identify asymptomatic patients. Pregnancy, 9-Apr-20 Delivery in International Review Article This study aims to review the available information on mode of delivery, This review of current Parazzini F, Bortolus R, Mauri neonates, Pregnant Women Journal of vertical/peripartum transmission, and neonatal outcome in pregnant literature on pregnant PA, Favilli A, Gerli S, Ferrazzi vertical Infected With SARS- Gynaecology women infected with SARS‐CoV‐2. Searches were conducted used a women and neonates E. Delivery in pregnant transmission, CoV-2: A Fast & Obstetrics combination of the following key words: COVID‐19, SARS‐CoV‐2, and with COVID-19 women infected with SARS- breastfeeding, Review pregnancy in Embase and PubMed databases, from January 1 to March 31, suggests that the rate CoV-2: A fast review preterm birth 2020. Of 13 included studies reporting on 61 pregnant women, vaginal of vertical [published online, 2020 Apr delivery was reported in 6 cases (9.4%; 95% CI, 3.5–19.3). Worsening of transmission of SARS- 9]. Int J Gynaecol Obstet. maternal conditions was the indication for cesarean delivery in 31 cases CoV-2 is low, if any, for 2020. doi:10.1002/ijgo.13166 (48.4%; 95% CI, 35.8–61.3). Preterm birth was observed in 19 cases among cesarean delivery. the 48 for which information on gestational age was available (39.6%; 95% Crucial data are not CI, 25.8-54.7). In only two cases, delivery was due to spontaneous preterm available for vaginal labor. Eleven newborns with respiratory disease and two newborns testing delivery. positive for SARS‐CoV‐2 by real‐time RT‐PCR assay were reported. In three Breastfeeding was not neonates, SARS‐CoV‐2 IgG and IgM levels were elevated, but the RT‐PCR test generally reported, was negative. The rate of vertical or peripartum transmission of SARS‐CoV‐2 thus the risk of is low, if any, for cesarean delivery; no data are available for vaginal delivery. transmission during breastfeeding is unknown. Children, 9-Apr-20 Impact of COVID-19 Indian Correspondence Authors highlight similarities and differences in the Indian government's A country-wide Kulkarni RK, Kinikar AA, pediatricians, on Children and Pediatrics response to the 2009 H1N1 pandemic and the current SARS-CoV-2 lockdown in India may Chandanwale A. Impact of 2009 H1N1 Pediatricians pandemic, and their impact on children and pediatricians. In 2009, the create barriers for COVID-19 on Children and pandemic, India government response was much more limited to advisories on prevention of children from Pediatricians [published H1N1. During this pandemic, the government has taken very protective communities with few online, 2020 Apr 9]. Indian measures by placing the entire country in lockdown beginning March 24, resources and lead to Pediatr. 2020. This has implications for children's physical and mental health. higher rates of 2020;S097475591600157. Children from less privileged sections of society may become malnourished. malnutrition. The Online and domestic child abuse may increase during this period. possibility of using Pediatricians must be on the lookout for severe disease in "high risk" measles and BCG children (immunocompromised, lung or airway disease, long term steroids, vaccines to protect thalassemia, nephrotic syndrome, etc.) in addition to continuing their against SARS-CoV-2 ongoing management. In addition, there is some interest in the possible role must be explored of measles and BCG vaccines in providing protection against SARS-CoV-2. further. Children, 9-Apr-20 Interim Guidance Circulation Consensus The American Heart Association has compiled interim guidance to adapt Various task forces of Edelson DP, Sasson C, Chan neonates, basic for Basic and Report current cardiopulmonary resuscitation guidelines to treating victims of the American Heart PS, et al. Interim Guidance for and advanced Advanced Life cardiac arrest with suspected or confirmed COVID-19. Approximately 12- Association, in Basic and Advanced Life life support, Support in Adults, 19% of COVID positive patients require hospital admission and 3-6% become collaboration with Support in Adults, Children, cardio- Children, and critically ill. Hypoxemic respiratory failure secondary to acute respiratory supporting and Neonates With pulmonary Neonates With distress syndrome (ARDS), myocardial injury, ventricular arrhythmias, and organizations, outline Suspected or Confirmed resuscitation, Suspected or shock are common among critically ill patients and predispose them to general principles for COVID-19. [published online, task forces Confirmed COVID- cardiac arrest, as do some of the proposed treatments, such as resuscitation in 2020 Apr 9]. Circulation. 19 hydroxychloroquine and azithromycin, which can prolong the QT. suspected and 2020. Resuscitations, however, carry added risk to healthcare workers––the confirmed COVID-19 62 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication administration of CPR involves performing numerous aerosol-generating patients, with special doi:10.1161/CIRCULATIONAH procedures, and require providers to work in close proximity to one another considerations for A.120.047463 and the patient. Routine neonatal care and the initial steps of resuscitation maternal and neonatal are unlikely to be aerosol-generating; however, the mother is a potential populations. source of aerosolization.

Serial CT 9-Apr-20 Serial Computed Indian Clinical Case Computed tomography (CT) manifestations and treatment of children with This brief case study Guiqing HE, Sun W, Jing WU, imaging, child, Tomography Pediatrics Letter COVID-19 are still unclear. Authors report serial CT findings of an 11-year-old reports on serial CT Cai J. Serial Computed pneumonia, Manifestations in a child with COVID-19 pneumonia, who recovered on interferonα-2b findings from an 11- Tomography Manifestations China Child With combined with aerosol therapy, without any sequelae. Repeat chest CT year-old child with in a Child with Coronavirus Coronavirus Disease revealed patchy ground-glass opacities in left lower lobe with air COVID-19 pneumonia. Disease (COVID-19) (COVID-19) bronchogram, on admission, which gradually resolved to scattered then The use of CT imaging Pneumonia [published online, Pneumonia slightly scattered ground-glass opacities after two weeks of therapy. to diagnose COVID-19 2020 Apr 9]. Indian Pediatr. children is currently 2020;S097475591600158. debated. COVID-19; 8-Apr-20 Respectful European Editorial The authors discussed the need for respectful midwifery care during the The authors discussed Vivilaki VG, Asimaki E. pregnancy; midwifery care Journal of COVID-19 pandemic. The International Council of Midwives (ICM) has the need for Respectful midwifery care midwifery care during the COVID- Midwifery expressed concerns regarding the violation of the human rights of women, respectful midwifery during the COVID-19 19 pandemic neonates, and midwives, with increasing cases of C-sections, not initiating care during the pandemic. Eur J Midwifery. breastfeeding, and isolating mothers from their birth partners and newborns COVID-19 pandemic. 2020;4:8. during the pandemic. In these challenging times, pregnant women and Pregnant and laboring doi:10.18332/ejm/120070. mothers should not feel less safe and discouraged from making decisions for women form a themselves and their infants. Pregnant and laboring women form a vulnerable, but not vulnerable, but not homogenous, group with fundamental human rights to homogenous, group dignity and respectful, individualized midwifery care, which safeguards both with fundamental the physical and mental health of the mother-infant dyad. Even if there is a human rights to need for further monitoring and interventions, it is essential to provide dignity and respectful, woman-centered care, establish good communication with mothers, and individualized offer emotional support and stress management. midwifery care, which safeguards both the physical and mental health of the mother- infant dyad. Adolescent, 8-Apr-20 Pandemic school The Lancet Editorial This editorial proposes that school closures during the COVID-19 pandemic This editorial focuses The Lancet Child pediatric, closures: risks and Child & are of limited public health benefit. The authors discuss the negative effects on the negative Adolescent Health. schools, opportunities Adolescent of these closures, including the possible loss of education, physical activity, consequences of Pandemic school closures: pandemics Health meals, health care, and mental health services that schools provide. school closures during risks and Adolescents may experience social development and mental health the COVID-19 opportunities. Lancet Child difficulties. The authors recommend that public health officials prioritize pandemic. It reminds Adolesc Health. school re-opening, albeit with reduced hours or alternative frameworks. readers that the They conclude by noting that some young people have shown resilience by experiences of youth 2020;4(5):341. helping with the COVID-19 response in their communities. The experiences during this time need doi:10.1016/S2352- of youth during this pandemic need to be recognized and validated. to be recognized and 4642(20)30105-X validated.

63 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Discharged 8-Apr-20 PCR Assays Turned Clinical Brief Report A total of 172 COVID-19 infected patients were discharged from Shenzhen RT-PCR tests detecting Yuan J, Kou S, Liang Y, Zeng J, children, Positive in 25 Infectious Third People's Hospital between January 23 to February 21, 2020. All met SARS-CoV-2 infection Pan Y, Liu L. PCR Assays recurrent viral Discharged COVID- Diseases criteria for hospital discharge, including normal body temperature for >3 of 6 children (<12 Turned Positive in 25 activity, serum 19 Patients consecutive days, reduction in respiratory symptoms, improvement years) with COVID-19 Discharged COVID-19 D-dimer, detected by chest radiography, and at least two consecutively negative who met hospital Patients [published online, lymphocyte results of RT-PCR testing separated by at least a 24-hour interval. Following criteria for discharge, 2020 Apr 8]. Clin Infect Dis. count discharge, cloacal and nasopharyngeal swab samples were collected every turned positive again 2020. three days. 25/172 discharged patients (14.5%) had positive RT-PCR results. following discharge. doi:10.1093/cid/ciaa398 An average of 7.32 +/- 3.86 days passed between their last negative RT-PCR result and turning positive again. 17 were female, and 6 were children under 12 years old. There was a significant inverse correlation between serum D- dimer levels before discharge and the duration of treatment in these 25 patients compared to the 147 patients who were not re-admitted (r=-0.637; p=0.002). In addition, lymphocyte concentrations prior to discharge were significantly positively correlated with the time interval for virus reappearing (r=0.52; p=0.008). Child, family 8-Apr-20 Four Cases From a Journal of Letter to the Four cases of SARS-CoV-2 were identified within a family cluster, following a Varying lengths of Chen D, Li Y, Deng X, et al. cluster, Family Cluster Were Medical Editor 14-day quarantine period. One of the patients was a 7-year-old boy, who incubation periods Four cases from a family incubation Diagnosed as Virology presented with low fever. The time period from infection to symptom onset were observed in this cluster were diagnosed as period, China COVID-19 After 14- was estimated to be 30 days. CT scans of the chest showed right lobular and family cluster of SARS- COVID-19 after 14-day of day of Quarantine subsegmental areas of ground-glass opacity. A 13-year-old girl in the family CoV-2 infection. The quarantine period [published Period did not present with any symptoms and tested negative for SARS-CoV-2, time from infection to online, 2020 Apr 8]. J Med detected by qRT-PCR, on three sequential nasopharyngeal swabs. symptom onset in a 7- Virol. 2020. year old boy was 30 doi:10.1002/jmv.25849 days. Pregnancy, 8-Apr-20 Association of Clinical Case Series This case series describes 17 pregnant women (3 health workers) with qRT- Two neonates with Khan S, Jun L, Nawsherwan, neonatal COVID-19 Infection Microbiology PCR and/or CT imaging confirmed COVID-19 admitted to Hubei General suspected COVID-19 et al. Association of COVID-19 infection, With Pregnancy and Infection Hospital from January 25 to February 15, 2020. All deliveries occurred via C- infection, and five infection with pregnancy vertical Outcomes in section, and there were no neonatal deaths. Three cases of preterm delivery neonates with outcomes in healthcare transmission, Healthcare Workers were reported. Cord blood and neonatal throat swab samples from neonatal pneumonia workers and general women health worker and General neonates were collected. Neonatal pneumonia was observed in five were identified. [published online, 2020 Apr infection, China Women neonates, and two were found to have suspected COVID-19 based on Although intrauterine 8]. Clin Microbiol Infect. positive test results within 24 hours after delivery. Intrauterine tissue tissue samples were 2020. samples, such as placenta, cord blood or amniotic fluid were not tested to not tested, the doi:10.1016/j.cmi.2020.03.03 confirm whether or not neonatal infection was the result of vertical potential of vertical 4 transmission. transmission cannot be ruled out. Family cluster, 8-Apr-20 Asymptomatic The Lancet Correspondence This case study reports the clinical characteristics of a family cluster of SARS- To prevent and control Pan X, Chen D, Xia Y, et al. asymptomatic cases in a family Infectious CoV-2 infection. In this family of three, one 35-year-old man had clinical this highly infectious Asymptomatic cases in a child, China cluster with SARS- Diseases symptoms, a decreased lymphocyte count, abnormal chest CT images, and a disease, people with family cluster with SARS-CoV- CoV-2 infection. positive result on qRT-PCR. By contrast, the other two family members—a family members with 2 infection. Lancet Infect Dis. 33-year-old woman and a 3-year-old boy—were both asymptomatic, with SARS-CoV2 infection 2020;20(4):410–411. normal lymphocyte counts and chest CT images but positive qRT-PCR results. should be closely doi:10.1016/S1473- In this family cluster, any of the three individuals could have been the first monitored and 3099(20)30114-6 one to become infected and thus transmitted the virus to the other two examined to rule out family members. Importantly, asymptomatic patients might be unaware of infection, especially in

64 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication their disease and/or be overlooked by health care professionals, thus may family clusters with unknowingly transmit the virus to others. children. Children, 8-Apr-20 Clinical Pediatric Original Article This case series reports the clinical characteristics of 10 patients with COVID- Consistent with adults, Zhu L, Wang J, Huang R, et al. clinical Characteristics of a Pulmonology 19 aged from 1 year to 18 years, retrospectively recruited from 3 designated fever and cough were Clinical characteristics of a characteristics, Case Series of hospitals in Jiangsu province, China between January 24 and February 22, frequently reported case series of children with prognosis, Children With 2020. Seven patients had contact with confirmed COVID-19 family members symptoms among coronavirus disease 2019 China Coronavirus Disease before onset. Fever (4 [40%]) and cough (3 [30%]) were the most common children with COVID- [published online, 2020 Apr 2019 symptoms. No patient showed leucopenia and lymphopenia on admission. 19. In contrast with 8]. Pediatr Pulmonol. 2020. Pneumonia was observed in chest CT images in 5 (50%) patients. Oxygen adults, children were doi:10.1002/ppul.24767 therapy was required in 1 (20%) patient. Five (50%) patients received less susceptible to antiviral treatment. No patient had severe complications or developed a severe disease, and severe illness in our study. This study indicated that COVID-19 children family clusters of present less severe symptoms and have better outcomes. infection were common. Neonatal 8-Apr-20 Neonatal American Clinical Opinion Pregnant women and newborns represent a vulnerable population in the This article provides a Chandrasekharan P, Vento M, resuscitation, Resuscitation and Journal of global COVID-19 pandemic. However, the precise impact of this novel virus comprehensive Trevisanuto D, et al. Neonatal post- Post-resuscitation Perinatology on the fetus and neonate remains uncertain. There is some disagreement overview of Resuscitation and resuscitation Care of Infants Born among experts on an optimal approach to protect health care workers and recommendations for Postresuscitation Care of care, to Mothers with newborns during and after delivery by a COVID-19. Decisions must be based perinatal management Infants Born to Mothers with pregnancy, Suspected or on resource availability, surge volume, and potential risk of transmission. of pregnant women Suspected or Confirmed perinatal Confirmed SARS- This manuscript outlines the precautions and steps to be taken before, with confirmed SARS-CoV-2 Infection management, CoV-2 Infection. during, and after resuscitation of a newborn born to a COVID-19 mother, COVID-19 and [published online, 2020 Apr breastfeeding including three optional variations of current standards involving shared- newborns. Parents 8]. Am J Perinatol. 2020. decision making with parents for perinatal management, resuscitation of the should be engaged in doi:10.1055/s-0040-1709688 newborn, disposition, nutrition, and post-discharge care. The availability of shared decision- resources may also drive the application of these guidelines. More evidence making with options and research are needed to assess the risk of vertical and horizontal for rooming in, skin- transmission of SARS-CoV-2 and its impact on fetal and neonatal outcomes. to-skin contact, and breastfeeding. Neonatal 8-Apr-20 Novel Coronavirus European Research Letter Previous studies have described the clinical features of COVID-19 in adults Based on four cases of Zhang ZJ, Yu XJ, Fu T, et al. infection, Infection in Respiratory and infants under 1 year of age. Little is known about features, outcomes neonatal infection, Novel Coronavirus Infection clinical Newborn Babies Journal and intrauterine transmission potential in newborns aged 28 days or less. neonates appear in Newborn Babies Under 28 characteristics, Under 28 Days in Through systematic searching, authors identified 4 infections in newborns in susceptible to COVID- Days in China [published China China China as of March 13, 2020. The age range was 30 hours to 17 days old. 19 but experience online, 2020 Apr 8]. Eur Three were male. One newborn had fever and cough, 1 had fever only, 1 had milder symptoms than Respir J. 2020;2000697. shortness of breath, and 1 had no symptoms. Supportive treatment was adults. doi:10.1183/13993003.00697 provided for all 4 newborns. None required intensive unit care or -2020 mechanical ventilation. Three newborns recovered by the end of this study. All 4 mothers were infected with SARS-CoV-2, 3 showing symptoms before and 1 after delivery. Cesarean section was used for all 4 deliveries. Three newborns were separated from their mothers and were not breastfed. In summary, newborns are susceptible to SARS-CoV-2 infection and present milder symptoms and better outcomes compared to adults. Intrauterine vertical transmission is possible, but direct evidence is still lacking. Children, 8-Apr-20 Possible causes for Nature Editorial Children have been shown to have progressively increasing levels of serum Increased levels of Zhu L, Lu X, Chen L. Possible susceptibility, decreased Pediatric ACE (angiotensin-converting enzyme) from 4 to 13 years of age, after which ACE, an enzyme that causes for decreased angiotensin- susceptibility of Research levels gradually decrease until they reach adult values. High ACE activity has converts inactive susceptibility of children to 65 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication converting children to also been documented in the serum of newborns, whose rapid development angiotensin I to active coronavirus [published enzyme (ACE), coronavirus. of lung capillary endothelial cells may provide the source for circulating ACE. angiotensin II (a online, 2020 Apr 8]. Pediatr adjuvant drug In terms of immunity, several studies have shown higher CD4 T lymphocyte potent Res. 2020. therapy counts and lower CD8 T lymphocyte counts in children, compared to adults. vasoconstrictor) may doi:10.1038/s41390-020- Changing levels of T lymphocytes with age is related to thymus contribute to lower 0892-8 development. Like SARS-CoV, 2019-nCoV may act primarily on T susceptibility to lymphocytes, so adjuvant thymosin drug therapy may provide benefit for COVID-19 disease in 2019-nCoV patients. children. The details of this pathway are not clearly described in this article. Pediatric 8-Apr-20 Special Pediatric Special Interest The pediatric population has been found to be less susceptible to COVID-19 Authors present Thampi S, Yap A, Lijia F, Ong management, considerations for Anesthesia Article disease with the majority of children having milder symptoms and only one strategies for infection J. Special considerations for operating the management of pediatric death being reported globally so far. Despite this, strategies need control in operating the management of COVID- room, PICU, COVID-19 pediatric to be put in place to prevent further spread of the virus. Authors present a rooms, pediatric 19 pediatric patients in the general patients in the summary of the general measures implemented at a large adult and intensive care units, operating room and pediatric anesthesia, operating room and pediatric tertiary hospital in Singapore (National University Hospital) as well and during code blue intensive care unit in a Singapore pediatric intensive as the specific strategies in place for the operating room, pediatric intensive workflow, within a tertiary hospital in Singapore care unit in a care unit, and code blue workflow. These strategies include but are not tertiary hospital in [published online, 2020 Apr tertiary hospital in limited to use of designated negative pressure rooms, personal protective Singapore. 8]. Paediatr Anaesth. 2020. Singapore. equipment policies, restrictions on accompaniment by one caregiver, early doi:10.1111/pan.13863 anticipatory planning for intubation, and simulation training. Children, 8-Apr-20 Screening and JAMA Research Letter Europe has displaced Asia as the epicenter of the COVID-19 pandemic. Compared to 2.8% of Tagarro A, Epalza C, Santos screening, Severity of Pediatrics Authors identified 41 children of 4695 confirmed cases in a testing registry children with M, et al. Screening and severe disease, Coronavirus Disease from 30 hospitals in Madrid, Spain, between March 2 and March 16, 2020. confirmed COVID-19 Severity of Coronavirus Europe, Spain 2019 (COVID-19) in The median age of tested patients was 3 years, and the median age of who had severe or Disease 2019 (COVID-19) in Children in Madrid, patients with positive results was 1 year. Twenty-five of 41 children with critical disease in Children in Madrid, Spain.

Spain confirmed COVID-19 (60%) were hospitalized, 4 of 41 (9.7%) were admitted China, 60% of children JAMA Pediatr. Published to a pediatric intensive care unit (PICU), and 4 of 41 (9.7%) needed with infection online April 08, 2020. respiratory support beyond nasal prongs. Of these, 1 of 4 (25%) had only 1 required doi:10.1001/jamapediatrics.2 previous condition (recurrent wheezing). No patients died. The most hospitalization in 020.1346 common initial syndromic diagnoses were upper respiratory tract infection Madrid. Testing and fever without a source. Two patients (5%) had a coinfection with protocols may have influenza B. biased results to more severe patients. Community 8-Apr-20 Community Morbidity Report Early reports of person-to-person transmission of SARS-CoV-2 have been Beyond immediate Ghinai I, Woods S, Ritger KA, transmission, Transmission of and among household contacts, health care workers, and within congregate family clusters, et al. Community family SARS-CoV-2 at Two Mortality living facilities. Investigation of COVID-19 cases in Chicago identified a community Transmission of SARS-CoV-2 gatherings, Family Gatherings Weekly cluster of 16 confirmed or probable cases, including three deaths, likely transmission has at Two Family Gatherings — Chicago, IL — Chicago, Illinois, Report resulting from one introduction. Extended family gatherings including a occurred between Chicago, Illinois, February– February–March funeral and a birthday party likely facilitated transmission of SARS-CoV-2 in non-household March 2020. MMWR Morb

2020 this cluster. U.S. residents should adhere to CDC recommendations for social contacts at family Mortal Wkly Rep. ePub: 8 distancing, avoid gatherings, and follow stay-at-home orders when required gatherings. April 2020. DOI: by state or local authorities. http://dx.doi.org/10.15585/ mmwr.mm6915e1 COVID-19; risk 7-Apr-20 Pregnant women in The Journal Letter to the In this article, the authors discuss the role of unseen risk factors that put In this article, the Mirzadeh M, Khedmat L. factor; the exposure to of Maternal- Editor pregnant women at risk for COVID-19. Pre-eclampsia and gestational authors discuss the Pregnant women in the 66 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication gestational COVID-19 infection Fetal and diabetes (GDM) can cause a significant suppression of the immune system, unseen risk factors in exposure to COVID-19 diabetes; outbreak: the Neonatal putting pregnant women at risk for contracting COVID-19 if exposed. The pregnant women for infection outbreak: the preeclampsia; unseen risk factors Medicine risk of developing GDM and pre-eclampsia is higher in women who have the development of unseen risk factors and pregnancy; and preventive undergone IVF, and thus there is a higher risk of COVID-19 in this population COVID-19 upon SARS- preventive healthcare anxiety; stress; healthcare patterns as well. Additionally, prenatal stress and anxiety are growing exponentially CoV-2 exposure. They patterns. J Matern Fetal SARS-CoV-2 under COVID-19. The authors recommend establishing management explore the role of Neonatal Med. 2020 Apr 7:1- practices in hospitals to not only care for women in the last trimester but factors such as pre- 2. doi: also the first 3-months postpartum. They also recommend following steps in eclampsia, gestational 10.1080/14767058.2020.174 decreasing COVID-19-related pregnancy complications: the creation of a diabetes, prenatal 9257. Epub ahead of print. proper self-care and hygiene protocol; the design and development of an stress and anxiety. PMID: 32223477. Internet-based guided self-help therapy for nutrition and healthy eating; They discuss their role maintenance of an active lifestyle through continuous monitoring. These in the susceptibility practices can help reduce/prevent SARS-CoV-2 infection in pregnant women, towards infections and as well as bring about a shift in the mode of childbirth from cesarean to the steps that can be vaginal delivery. taken to minimize infections. Children, 7-Apr-20 Flash Survey on European Original Research There is a concern that children treated for cancer may be at risk for an Children receiving Hrusak O, Kalina T, Wolf J, et immuno- Severe Acute Journal of unfavorable course of SARS-CoV-2 infection. Results from this study are chemotherapy or al. Flash survey on severe suppression, Respiratory Cancer based on responses to a flash, Web-based survey on COVID-19 incidence immunosuppressive acute respiratory syndrome anticancer Syndrome and severity among children on anticancer treatment, from pediatric therapy may not coronavirus-2 infections in chemotherapy, coronavirus-2 hematology/oncology centers in 25 countries, where approximately 10,000 experience more paediatric patients on flash survey Infections in at-risk patients are followed. At the time of the survey, more than 200 of severe illness but anticancer treatment Paediatric Patients these children were tested. Nine were positive for COVID-19, and the remain at high risk for [published online, 2020 Apr on Anticancer majority had mild or asymptomatic disease. Despite these results, the risk of infection. 7]. Eur J Cancer. 2020. Treatment developing a more severe course of COVID-19 in immunocompromised doi:10.1016/j.ejca.2020.03.0 children should not be underestimated. 21 Vitamin C, 7-Apr-20 A New Clinical Trial Critical Care Letter In addition to antioxidant properties, vitamin C supports healthy immune This letter describes a Carr AC. A new clinical trial to infusion, sepsis to Test High-Dose function. During infection, vitamin C levels can become depleted and a recently launched test high-dose vitamin C in related ARDS, Vitamin C in person’s requirement for vitamin C increases with severity of the infection. clinical trial, based in patients with COVID-19. Crit clinical trial, Patients With As of February 2020, the clinical characteristics of patients hospitalized with Wuhan, China, to Care. 2020;24(1):133. China COVID-19 COVID-19-related pneumonia indicated that 26% were transferred to the investigate IV vitamin Published 2020 Apr 7. ICU because of complications such as ARDS and shock. A recently published C as treatment for doi:10.1186/s13054-020- RCT carried out in the USA in 167 patients with sepsis related ARDS indicated severe COVID-19 02851-4 that administration of ~ 15 g/day of IV vitamin C for 4 days may decrease infection. mortality in these patients. Recently registered on clinicaltrials.gov (Identifier: NCT04264533), a new clinical trial to investigate vitamin C infusion for the treatment of severe 2019-nCoV infected pneumonia has begun in Wuhan, China. Investigators will treat 140 patients with a placebo control or IV vitamin C at a dose of 24 g/day for 7 days. They will assess requirements for mechanical ventilation and vasopressor drugs, organ failure scores, ICU length of stay and 28-day mortality. Investigators of the new study hope to complete the trial by the end of September. Maternity 7-Apr-20 Caring for the Women and Editorial Article Amidst the COVID-19 pandemic, maternity care (MC) providers must Supporting the Wilson AN, Ravaldi C, Scoullar services, Carers: Ensuring the Birth continue their core business in caring and supporting women, newborns and physical, mental, and MJL, et al. Caring for the maternity care Provision of Quality their families whilst also adapting to a rapidly changing health system emotional health of carers: Ensuring the provision providers, Maternity Care environment. This article provides an overview of important considerations maternity care of quality maternity care pregnancy, for supporting the emotional, mental and physical health needs of MC providers is essential during a global pandemic 67 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication neonates, During a Global providers in the context of the unprecedented crisis that COVID-19 presents. for providing the best [published online, 2020 Apr psychological Pandemic Cooperation, planning ahead and adequate availability of PPE is critical. quality care for 7]. Women Birth. 2020. support Thinking about the needs of MC providers to prevent stress and burnout is women and doi:10.1016/j.wombi.2020.03 essential. Emotional and psychological support for healthcare workers must newborns. .011 be made available throughout the response. Child poverty, 7-Apr-20 COVID-19, School The Lancet Comment School closures, as part of a physical distancing policy, in many countries are The current health Van Lancker W, Parolin Z. school closures, Closures, and Child Public Health affecting the education of 80% of children worldwide. The fact that schools crisis has the potential COVID-19, school closures, food insecurity, Poverty: A Social are closed for a long period of time could have detrimental social and health to become a social and child poverty: a social educational Crisis in the Making consequences for children living in poverty and are likely to exacerbate crisis with long-lasting crisis in the making attainment, existing inequalities. School closures will exacerbate food insecurity, consequences for [published online, 2020 Apr United States, associated with low educational attainment and substantial risks to the children in low-income 7]. Lancet Public Health. Europe physical and mental health of children. Closures are also likely to widen the families, affected by 2020. doi:10.1016/S2468- learning gap in mathematical and literacy skills, often seen during summer food insecurity and 2667(20)30084-0 holidays, between children from lower-income and higher-income families. learning gaps. Maternal and 7-Apr-20 Maternal and Acta Systematic This systematic review searched databases for all case reports and series of Although the majority Zaigham M, Andersson O. perinatal Perinatal Outcomes Obstetricia Review COVID-19 in pregnant women and neonates from February 12 to April 4, of mothers were Maternal and Perinatal outcomes, With COVID-19: A et Gynecolo- 2020. Eighteen articles reporting data from 108 pregnancies were included. discharged without Outcomes with COVID-19: a pregnancy, Systematic Review gica Most reports described women presenting in the third trimester with fever complications, severe systematic review of 108

systematic of 108 Pregnancies Scandinavica (68%) and coughing (34%). Lymphocytopenia (59%) with elevated C‐reactive maternal morbidity as pregnancies [published review protein (70%) was observed and 91% were delivered by cesarean section. a result of COVID‐19 online, 2020 Apr 7]. Acta Three maternal intensive care unit admissions were noted but no maternal and perinatal deaths Obstet Gynecol Scand. 2020. deaths. One neonatal death and one intrauterine death were also reported. were reported. doi:10.1111/aogs.13867 Vertical transmission could not be ruled out. Children, 7-Apr-20 Novel Coronavirus Pediatric Original Article This retrospective and the single-center study identified all hospitalized Clinical symptoms of Shen Q, Guo W, Guo T, et al. clinical Infection in Pulmonology children diagnosed with COVID-19 between January 8 and February 19, 2020 COVID-19 infection in Novel coronavirus infection characteristics, Children Outside of at the Public Health Clinic Center of Changsha, Hunan, China. Six children children were not in children outside of Wuhan,

China Wuhan, China had a family exposure. The initial symptoms of the nine children were mild, typical and showed a China [published online, 2020 including fever (3/9), diarrhea (2/9), cough (1/9), and sore throat (1/9), two less aggressive clinical Apr 7]. Pediatr Pulmonol. had no symptoms. Two enrolled patients showed small ground-glass opacity course than teenage 2020. of chest computed tomography scan. As of February 26, six patients had a and adult patients. doi:10.1002/ppul.24762 negative RT-PCR result and were discharged. Median time from exposure to a negative RT-PCR was 14 days. Twin 6-Apr-20 COVID-19 in Acta Letter to the This case report describes a 34‐year‐old primipara with a dichorionic twin It is challenging to Gidlöf S, Savchenko J, Brune pregnancy, pregnancy with Obstetricia Editor pregnancy, who was hospitalized at 36+2/7 weeks' gestation, due to discriminate between T, Josefsson H. COVID-19 in gestational comorbidities: et Gynecolo- hypertension and proteinuria. On admission, a nasopharyngeal SARS-CoV-2 common pregnancy with diabetes, high- More liberal testing gica RNA test was taken. Several hours later, an emergency cesarean section was complications of high‐ comorbidities: More liberal risk pregnancy, strategy is needed Scandinavica performed, and two female newborns were delivered in good condition. risk pregnancies with testing strategy is needed breast milk Following delivery, the mother's RT-PCR test was determined to be positive comorbidities (e.g. [published online, 2020 Apr sample, for SARS-CoV-2 infection. Due to the mother's gestational diabetes gestational diabetes, 6]. Acta Obstet Gynecol maternal (diagnosed at 29 weeks), the twin neonates were fed with formula, and preeclampsia) from Scand. 2020. vaginal breastfeeding was initiated simultaneously. Both twins had negative COVID‐19. Neonatal doi:10.1111/aogs.13862 secretion nasopharyngeal SARS-CoV-2 RNA tests, taken at 34 hours and 4.5 days of nasopharyngeal sample age. Breastmilk and maternal vaginal secretion samples also tested negative swabs, maternal on the fifth day. breast milk and vaginal secretions all

68 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication tested negative for SARS-CoV-2. Pregnancy, 6-Apr-20 Lung ultrasound Ultrasound Case Report Imaging modalities play a crucial role in the management of suspected Positive lung Kalafat E, Yaprak E, Cinar G, neonate, chest and computed in Obstetrics COVID‐19‐infected patients. Before RT-PCR test results are positive, 60–93% ultrasound findings et al. Lung ultrasound and CT, lung tomographic & of patients have positive chest CT findings consistent with COVID‐19 were obtained computed tomographic ultrasound, findings in pregnant Gynecology infection. This case report describes positive lung ultrasound (LUS) findings between negative and findings in pregnant woman cord blood, woman with consistent with COVID‐19 in a woman with an initially negative RT‐PCR subsequently positive with COVID-19 [published placental COVID-19 result. The LUS findings were present between the negative and subsequent RT-PCR results in a online, 2020 Apr 6]. sample positive RT‐PCR tests, and they correlated with CT findings. The point‐of‐care pregnant woman with Ultrasound Obstet Gynecol. LUS was easy to perform and, as such, could play an important role in the suspected COVID-19. 2020. doi:10.1002/uog.22034 triage of women with suspected COVID‐19. Neonatal swabs, cord blood, and Neonatal swabs, cord placental swab RT‐PCR tests were negative for SARS‐CoV‐2, a finding blood, and placenta consistent with the published literature, suggesting no vertical transmission samples were negative of SARS‐CoV‐2 in pregnant women. for SARS-CoV-2. Food security, 6-Apr-20 Food (In)security in Cadernos de Thematic Section In Brazil, public health efforts have focused on avoiding the spread of SARS- This article considers Oliveira TC, Abranches MV, home delivery, Brazil in the Context Saúde CoV-2, however an emerging side of the epidemic involves food security. various dimensions of Lana RM. Food (in)security in hygiene, Brazil of the SARS-CoV-2 Pública Italy, Spain, and Portugal, already under quarantine, have developed food insecurity that Brazil in the context of the Pandemic initiatives to avoid crowding that have impacted the food chain. The food are emerging in the SARS-CoV-2 pandemic. Cad industry in Brazil faces numerous uncertainties, with the suspension of context of the COVID- Saúde Pública. 2020. services at daycare centers, schools, and universities that normally provide 19 in Brazil. Published 2020 Apr 6. meals for individuals. Brazil's socioeconomic and territorial differences doi:10.1590/0102- challenge the feasibility of home deliveries of meals. Food security must be 311X00055220 analyzed beyond immediate health and hygiene issues. Children, school 6-Apr-20 School Closure and The Lancet Review In response to the COVID-19 pandemic, 107 countries had implemented School closures are Viner RM, Russell SJ, Croker closure, social Management Child & national school closures by March 18, 2020. It is unknown whether school predicted to prevent H, et al. School closure and distancing Practices During Adolescent measures are effective in coronavirus outbreaks (e.g. SARS, MERDS, or only 2-4% deaths from management practices during interventions, Coronavirus Health COVID-19). This systematic review searched three electronic databases and COVID-19, based on coronavirus outbreaks modeling Outbreaks Including included 16 of 616 identified articles to identify what is known about the recent modelling including COVID-19: a rapid studies COVID-19: A Rapid effectiveness of school social distancing practices. Data from the SARS studies. Other less systematic review [published Systematic Review outbreak in mainland China, Hong Kong, and Singapore suggest that school disruptive online, 2020 Apr 6]. Lancet closures did not contribute to the control of the epidemic. Modelling studies interventions should Child Adolesc Health. 2020. of SARS produced conflicting results. Recent modelling studies of COVID-19 be considered for doi:10.1016/S2352- predict that school closures alone would prevent only 2–4% of deaths, much long-term social 4642(20)30095-X less than other social distancing interventions. Combinations of social distancing. distancing measures should be considered. Nutritional 6-Apr-20 Nutritional European Correspondence Lack of nutritional support during hospital stay could prolong the recovery of This strategy from a Cintoni M, Rinninella E, management, Management in Journal of patients with COVID-19 and increase further infectious complications. To regional COVID-19 Annetta MG, Mele MC. malnutrition, Hospital Setting Clinical better plan the nutritional management of this hospital emergency, this reference center in Nutritional management in meal provision, During SARS-CoV-2 Nutrition institution's strategy focuses on promoting nutritional support to COVID-19 Rome, Italy hospital setting during SARS- hospital setting Pandemic: A Real- patients and meal supply for healthcare professionals. Key considerations recommends that CoV-2 pandemic: a real-life

Life Experience include increased energy expenditure related to fever and respiratory clinical nutritionists experience [published online, distress, reduced muscle mass from isolation in small areas and bed rest, the plan specific 2020 Apr 6]. Eur J Clin Nutr. already under-recognized and undertreated status of malnutrition in interventions in their 2020. doi:10.1038/s41430- hospital wards, which may worsen during a pandemic. A personalized meal hospital to care for the 020-0625-4 provision plan has begun for oral-feedable COVID-19 patients, while those nutritional status of unable to eat are supported with high protein/low glucose Enteral and isolated and fragile Parenteral Nutrition formulas. In recent Chinese experience, nutritional COVID-19 patients. 69 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication support was part of the multidisciplinary management for symptomatic SARS-CoV-2 affected patients. Breastfeeding, 6-Apr-20 Breast Feeding at Archives of Letter This letter responds to a recent commentary by Li et al. promoting the Protocols applied in Davanzo R. Breast feeding at expressed the Time of COVID- Disease in isolation of all infants with suspected COVID-19 regardless of whether or not maternity hospitals to the time of COVID-19: do not mother's milk, 19: Do Not Forget Children: they present with symptoms, without details on the management of prevent COVID-19 forget expressed mother's neonatology, Expressed Mother's Fetal & newborn feeding. Other Chinese colleagues have discouraged the use of should consider the milk, please [published

neonatal Milk, Please Neonatal expressed breast milk for infants with suspected COVID-19. In Switzerland, promotion of online, 2020 Apr 6]. Arch Dis management, Edition Favre et al. suggested the avoidance of direct breastfeeding by COVID-19 breastfeeding without Child Fetal Neonatal Ed. mother-infant positive mothers due to close contact and potential aerosol transmission. disregarding the 2020. relationship However, it is important to consider that the primary concern for risk of feasible option of doi:10.1136/archdischild- transmission is by respiratory droplets, which can be mitigated through basic expressing mother's 2020-319149 preventive measures, not by breastmilk. Second, the practice of routine milk. maternal-neonatal separation penalizes their relationship. The use of expressed mother's milk should be considered as a second choice, to rescue the nutritional benefits of breast milk when direct breastfeeding is not recommended. Lastly, in light of limited evidence, breastmilk may contain specific antibodies that modulate eventual SARS-CoV-2 infection. Pauci- 6-Apr-20 COVID-19 Infection Pediatric Case Report It is unclear whether children are less likely to be infected by COVID-19 or Caution dictates that Canarutto D, Priolo A, Russo symptomatic in a Pauci- Pulmonology rather display fewer symptoms. This case report describes a 32‐day‐old boy children should be G, Pitea M, Vigone MC, infant, symptomatic Infant: infected by COVID‐19 that presented with an upper airway infection, which considered as Barera G. COVID-19 infection epidemic Raising the Index of resolved spontaneously and did not require any therapy. Authors argue that contagious as adults, in a paucisymptomatic infant: settings Suspicion in in epidemic settings children presenting with any mild symptom potentially despite mild Raising the index of suspicion

Epidemic Settings attributable to COVID‐19 should be considered contagious until proven presentation. As in epidemic settings otherwise, and that management must be guided by clinical conditions. opposed to other [published online, 2020 Apr authors, they 6]. Pediatr Pulmonol. 2020. advocate against doi:10.1002/ppul.24754 routine CT scans in children. Children vs. 6-Apr-20 A Comparative- Journal of Research Article The medical records of 25 adults and 7 children with confirmed cases of This study adds to Han YN, Feng ZW, Sun LN, et adults, Descriptive Analysis Medical 2019‐nCoV ARD, managed at Xian Eighth Hospital in Shaanxi, China from growing research that al. A comparative-descriptive comparative of Clinical Virology January 31 to February 16, 2020, were reviewed retrospectively. All children describes differences analysis of clinical analysis, China Characteristics in were from family clusters. The median incubation period of children and in clinical characteristics in 2019- 2019-Coronavirus- adults was 5 days (range 3‐12 days) and 4 days (range 2‐12 days), manifestations of Coronavirus-infected children infected Children respectively. Diarrhea and/or vomiting (57.1%) were more common in COVID-19 infection in and adults [published online,

and Adults children, whereas for adults it was myalgia or fatigue (52%). On admission, children and adults, by 2020 Apr 6]. J Med Virol. the percentage of children having pneumonia (5, 71.4%) was roughly the conducting 2020. doi:10.1002/jmv.25835 same as adults (20, 80%). 20% of adults had leukopenia, but leukocytosis comparative analysis was more frequently in children (28.6%, P=0.014). A higher number of of clinical parameters children had elevated creatine kinase isoenzyme (57.1% vs. 4%, P=0.004). between these two Antiviral therapy was given to all adult patients but not to children. groups. Children, 6-Apr-20 Epidemiology and Clinical and Review Article Pediatric COVID-19 accounts for a small percentage of patients with Authors review Choi SH, Kim HW, Kang JM, et newborn, Clinical Features of Experimental outbreaks and is often milder than adults but can progress to severe disease published data on the al. Epidemiology and Clinical infants, clinical Coronavirus Disease Pediatrics in some cases. Even neonates can suffer from COVID-19, and children may epidemiological and Features of Coronavirus

characteristics, 2019 in Children play a role as a spreader in the community. In this review, authors clinical features of disease 2019 in Children epidemiology, summarize what is known about COVID-19 in children and adolescents until COVID-19 in neonates, [published online, 2020 Apr Korea now. infants, and children, 6]. Clin Exp Pediatr. 2020. within and outside of doi:10.3345/cep.2020.00535 70 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication China since the start of the outbreak. Pediatrics, 6-Apr-20 Coronavirus Disease Morbidity Report In this preliminary description of 2572 pediatric U.S. COVID-19 cases This is the first analysis Coronavirus Disease 2019 in epidemiology, 2019 in Children - and (occurring during Feb 12 - April 2, 2020), 5.7% of children (aged <18 years) of disease Children — United States, children vs. United States, Mortality with COVID-19 were hospitalized. 73% of children reportedly experienced characteristics of February 12–April 2, 2020. adults, February 12 - April Weekly fever, cough, or shortness of breath, compared to 93% of adults (aged 18-64 pediatric cases in the MMWR Morb Mortal Wkly

symptomology, 2, 2020 Report years). Severe outcomes have been reported in children, including 3 deaths. U.S. Figures are Rep. ePub: 6 April 2020. DOI: hospitalization, These data support research from China that suggest that pediatric COVID- included in the report. http://dx.doi.org/10.15585/ United States, 19 cases might be less severe than cases in adults and that children might mmwr.mm6914e4external CDC experience different symptoms than adults. Social distancing and preventive icon behaviors remain important for all age groups because asymptomatic patients and those with less serious illness play roles in disease transmission. Behavioral 3-Apr-20 Behavioral and European Commentary This commentary by the China-EAP-UNEPSA working group describes how This commentary by Jiao WY, Wang LN, Liu J, et al. health of Emotional Paediatric the authors used early data collected in COVID-19-affected areas in China to the China-EAP- Behavioral and Emotional children, Disorders in Association raise awareness about children's psychological needs during epidemics and UNEPSA working Disorders in Children during emotional Children during the highlight the role of families/caregivers in recognizing and managing group describes how the COVID-19 Epidemic. J health of COVID-19 Epidemic children's negative emotions. Using data from preliminary studies conducted the authors used early Pediatr. 2020;221:264- children, in China's Shaanxi province, the authors note that children in younger age data collected in 266.e1. mental health, groups (3-6 years) were more likely than older children (6-18 years) to COVID-19-affected doi:10.1016/j.jpeds.2020.03. children, exhibit high rates of fear, anxiety, and clinginess. Pediatricians of the Shaanxi areas in China to raise 013 parents, family, province emphasize that families' ability to use media entertainment, to awareness about COVID-19, express resilience, to manage children's need for social connections, and to children's China model positive psychological attitudes may mitigate psychological distress psychological needs and divert attention to more positive directions for children. during epidemic. The authors offer specific recommendations to parents for alleviating children’s psychological distress. Surgery, 3-Apr-20 Coronavirus disease American Viewpoint The authors present principles of management of obstetric and The authors share Weber LeBrun EE, Moawad prioritization, 2019 pandemic: Journal of gynecological surgical services during the COVID-19 pandemic and provide their institution's NS, Rosenberg EI, et al. Florida, USA staged Obstetrics specific guidance to help with decision making. The authors review the approach to managing Coronavirus disease 2019 management of and limited evidence from past hospital and community responses to various obstetric and pandemic: staged surgical services for Gynecology health emergencies and focus on systematic methods for adjusting surgical gynecological surgery management of surgical gynecology and services to create capacity, addressing the specific risks of COVID-19. during COVID-19. They services for gynecology and obstetrics Successful strategies for tiered reduction of surgical cases involve include the details of obstetrics. Am J Obstet multidisciplinary engagement of the entire healthcare system and use of a their categorization Gynecol. 2020;223(1):85.e1- structured risk-assessment categorization scheme that can be applied across scheme, which 85.e19. the institution. The authors' institution developed and operationalized this provides doi:10.1016/j.ajog.2020.03.0 approach over 3 working days, indicating that rapid implementation is recommendations for 38 feasible. different types of surgical procedures and different COVID- 19-related concerns. Pregnancy, 3-Apr-20 Two Cases of American Case Series Two of an initial 7 pregnant patients with confirmed severe SARS-CoV-2 This series reports two Juusela A, Nazir M, Gimovsky cardio- Coronavirus 2019- Journal of infection (28.6%; 95% CI, 8.2%–64.1%) developed cardiac dysfunction with cases of M. Two cases of coronavirus myopathy, related Obstetrics & moderately reduced left ventricular ejection fractions of 40%–45% and cardiomyopathy in 2019-related cardiomyopathy 71 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication echo- Cardiomyopathy in Gynecology hypokinesis. Patient 1 remains intubated and ventilated in the intensive care pregnant women with in pregnancy [published cardiogram, Pregnancy MFM unit. Patient 2 delivered a newborn via cesarean delivery, and both remain severe COVID-19. online, 2020 Apr 3]. Am J isolated from the general postpartum population. Viral myocarditis and Obstet Gynecol MFM. 2020. cardiomyopathy have also been reported in nonpregnant COVID-19 patients. doi:10.1016/j.ajogmf.2020.10 An echocardiogram should be performed for all pregnant women with 0113 COVID-19 pneumonia, in particular those needing oxygen or those who are critically ill, to ascertain more data on the incidence of cardiomyopathy from COVID-19 in pregnancy. Neonates, 3-Apr-20 Dilemmas and Danish Editorial In most countries, pre-term and sick newborns admitted to the neonatal In managing the Breindahl M, Zachariassen G, NICU, mother- Priorities in the Medical intensive care unit (NICU) are considered at risk of severe disease. The infant challenges raised by Christensen PS, Hinriksen TB. child Neonatal Intensive Journal is regarded as potentially infected if the mother is known to have COVID-19 the COVID-19 Dilemmas and Priorities in separation, Care Unit During during birth, and some countries recommend separation of the mother and pandemic, NICU the Neonatal Intensive Care precautionary the COVID-19 child. Approximately 10% of all newborns need transfer to the NICU, often providers must Unit during the COVID-19 principle Pandemic immediately after delivery, thus the COVID-19 pandemic raises several maintain principles of Pandemic. Dan Med J. dilemmas for families and newborn health care professionals. The authors of high-quality care for 2020;67(4):A205021. this editorial suggest operating around a basic principle of not separating infants and families. families; a precautionary principle of assessing risk of viral transmission for infants, parents, and staff; and a holistic principle of considering family situation and resources. Malnutrition, 3-Apr-20 Early Nutritional Nutrition Special Report Considering the deleterious consequences of malnutrition, which certainly Nutritional care may Caccialanza R, Laviano A, nutritional Supplementation in can affect patients with COVID-19, the aim of this article is to present a be overlooked despite Lobascio F, et al. Early support, oral Non-Critically Ill pragmatic protocol for early nutritional supplementation of non-critically ill being potentially nutritional supplementation nutritional Patients patients hospitalized for COVID-19 disease. It is based on the observation beneficial to clinical in non-critically ill patients supplements, Hospitalized for the that most patients present at admission with severe inflammation and outcomes and hospitalized for the 2019 Vitamin D, 2019 Novel anorexia leading to a drastic reduction of food intake, and that a substantial effective in preventing novel coronavirus disease Whey proteins Coronavirus Disease percentage develops respiratory failure requiring non-invasive ventilation or the consequences of (COVID-19): Rationale and (COVID-19): even continuous positive airway pressure. In addition to high-calorie dense malnutrition in feasibility of a shared Rationale and diets with highly digestible foods available for hospitalized patients, authors patients with COVID- pragmatic protocol Feasibility of a recommend oral supplementation of whey proteins and IV infusion of 19. Authors present a [published online, 2020 Apr Shared Pragmatic multivitamin, multimineral, and trace elements solutions at admission. In pragmatic approach to 3]. Nutrition. 2020. Protocol the presence of 25-hydroxyvitamin D deficit, cholecalciferol should be providing oral and doi:10.1016/j.nut.2020.1108 promptly supplied. If nutritional risk is detected, protein-calorie oral intravenous 35 nutritional supplements should be provided. If respiratory conditions nutritional support for worsen, supplemental or total parenteral nutrition should be prescribed. this population. Vitamin D, 3-Apr-20 Optimisation of Irish Medical Review Vitamin D deficiency is associated with increased risk of acute viral Vitamin D McCartney DM, Byrne DG. micronutrients, Vitamin D Status for Journal respiratory infection and community acquired pneumonia. Correction of supplementation is Optimisation of Vitamin D nutritional Enhanced Immuno- vitamin D deficiency is thought to suppress CD26, a putative adhesion thought to suppress a Status for Enhanced Immuno- supplementatio protection Against molecule for COVID-19 host cell invasion. Vitamin D may also attenuate putative adhesion protection Against Covid-19. n, Ireland Covid-19 interferon gamma and interleukin-6 inflammatory responses, both potent molecule for COVID-19 Ir Med J. 2020;113(4):58. predictors of poorer outcome in critically ill ventilated patients including host cell invasion and Published 2020 Apr 3. those with COVID-19. Supplementation with doses up to 100μg/d has been attenuate shown to be safe for adults. inflammatory responses. Safe doses of supplementation for children remain to be determined.

72 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Breastfeeding 3-Apr-20 Breastfeeding and Maternal & Review Article Recommendations from the Italian Society of Neonatology indicate that for Recommendations Davanzo R, Moro G, Sandri F, indications, Coronavirus Child a mother with suspected or confirmed COVID-19 who is asymptomatic or from Italy align with Agosti M, Moretti C, Mosca F. Italy, Europe Disease-2019. Ad Nutrition pauci-symptomatic at delivery, rooming-in is feasible and direct WHO guidelines Breastfeeding and interim indications breastfeeding is advisable under strict measures of infection control. surrounding Coronavirus Disease-2019. Ad of the Italian However, when a mother with COVID-19 is too sick to care for the newborn, breastfeeding with interim indications of the Society of the neonate should be managed separately and fed fresh expressed breast COVID-19. Italian Society of Neonatology milk, with no need to pasteurize it since human milk is not believed to be a Neonatology endorsed by the endorsed by the vehicle of COVID-19. This guidance is subject to change. Union of European Neonatal Union of European & Perinatal Societies Neonatal & [published online, 2020 Apr

Perinatal Societies. 3]. Matern Child Nutr. 2020;e13010. doi:10.1111/mcn.13010 Pediatric 3-Apr-20 Lessons unfolding Pediatric Editorial Total numbers of symptomatic pediatric cases lag dramatically behind adult Perspectives from Yonker LM, Shen K, Kinane pulmonology, from pediatric cases Pulmonology cases, suggesting a protective effect of age. Theories explaining this effect pediatric TB. Lessons unfolding from underlying lung of COVID-19 include differences in pediatric immune response or differences in airway pulmonologists on pediatric cases of COVID-19 disease, cystic disease caused by epithelial cell make-up, affecting the availability of viral binding sites. With how to care for disease caused by SARS-CoV- fibrosis, SARS-CoV-2 regard to highly vulnerable patients with underlying lung disease, cystic patients emphasize 2 infection [published online,

asthma, infection. fibrosis (CF) is rare in the Chinese populations, so the effect of COVID-19 on caring for the most 2020 Apr 3]. Pediatr asymptomatic CF patients remains to be seen. Minimizing cough related to asthma could vulnerable with Pulmonol. 2020. presentation reduce the potential aerosolization of the virus in an asymptomatic carrier. underlying lung doi:10.1002/ppul.24748 Since children are more likely to be asymptomatic and are less likely to disease. report symptoms of COVID-19, focusing on the pediatric population to prevent disease spread is critical. Child, isolation 3-Apr-20 The isolation period Pediatric Case Report A 7-year-old child with SARS-CoV-2 infection in Chongqing, outside of Another report on Lin J, Duan J, Tan T, Fu Z, Dai period, should be longer: Pulmonology Wuhan, Hubei province, was reported following the rapid spread of disease. prolonged shedding of J. The isolation period should respiratory viral Lesson from a child This case suggested that children infected with SARS-CoV-2 are more likely viral nucleic acid in be longer: Lesson from a shedding, China infected with SARS- to present milder manifestations than adults, thus children serve as throat samples from child infected with SARS-CoV- CoV-2 in potential sources of infection. The RT-PCR assay results for SARS-CoV-2 in children suggests that 2 in Chongqing, China

Chongqing, China. the child's throat swab samples consistently tested positive over a course of longer isolation [published online, 2020 Apr 20 days, suggesting a prolonged period of viral shedding in children, which periods (>14 days) 3]. Pediatr Pulmonol. 2020.. may call for an isolation period for suspected child cases that is longer than may be needed for doi:10.1002/ppul.24763 14 days. suspected pediatric cases. Breastfeeding, 3-Apr-20 Safe Handling of Journal of Insights into COVID-19 virus contaminates surfaces from respiratory droplet spread. For This report provides Marinelli KA, Lawrence RM. donor milk, Containers of Human Practice and known coronaviruses, viral lifespan ranges up to 9 days, depending on detailed information Safe Handling of Containers donor milk Expressed Human Lactation Policy volume of inoculation, material inoculated, temperature, and humidity. van on recommended of Expressed Human Milk in banking, breast Milk in all Settings Doremalen et al. (2020) found that SARS-CoV-2 was more stable on plastic disinfection all Settings During the SARS- pump, surface During the SARS- and stainless steel than on copper and cardboard; viable virus was detected procedures for breast CoV-2 (COVID-19) Pandemic contamination, CoV-2 (COVID-19) up to 72 hours after application to these surfaces although the virus titer milk containers, [published online, 2020 Apr

disinfection Pandemic was greatly reduced. Since mothers express their milk into a variety of among other hygiene 3]. J Hum Lact. 2020. plastic or glass containers, inadvertent viral spread must be avoided during precautions for doi:10.1177/0890334420919 container transfer to milk banks or other locations, through handwashing mothers expressing 083 guidelines before and after expressing milk. Containers must be disinfected milk. after milk expression with viricidal agents or appropriate bleach solutions (such as "high level disinfection" of 0.5% sodium hypochlorite solution,

73 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication according to WHO) before storage in milk banks, hospital wards, day care centers, or similar locations. Children, 3-Apr-20 COVID-19 in Nature Editorial Possible reasons for differences in severity of disease between adults and This article relates the Molloy, E.J., Bearer, C.F. inflammatory children and altered Pediatric children may relate to receptors in the Renin-angiotensin system (RAS) and evolving conversation COVID-19 in children and response, inflammatory Research altered inflammatory responses to pathogens. Studies of pediatric septic around the role of altered inflammatory

cytokine storm responses shock have shown differences in gene profiles, transcriptomic response, and immune response in responses. Pediatr Res. 2020. the ontogeny of cytokine production, which provide infants and children COVID-19 to the https://doi.org/10.1038/s413 with protection from pathogens with reduced cytokine storms. Information pediatric population, 90-020-0881-y on individualized immune response as well as further understanding of offering additional sepsis and immune responses in different age groups would be useful to explanations for age- initiate targeted immunotherapies. related differences in severity of disease. Pediatrics, 3-Apr-20 Coronavirus Disease JAMA Viewpoint Children are typically more susceptible to influenza complications but have A review of what is Rasmussen SA, Thompson LA. pediatricians, 2019 and Children: Pediatrics experienced lower-than-expected rates of COVID-19, which may be due to currently known about Coronavirus Disease 2019 underlying What Pediatric decreased exposure to the virus, decreased infection due to immunity to COVID-19 in children and Children: What Pediatric illness Health Care other coronaviruses, or decreased likelihood of illness even when infected. calls for pediatricians Health Care Clinicians Need Clinicians Need to Clinical symptoms of COVID-19 appear similar to those in adults, and to take an active to Know [published online,

Know infection from asymptomatic children is possible. Underlying illness, like stance in advocating 2020 Apr 3]. JAMA Pediatr. asthma, may increase children's susceptibility to disease. Pediatric health for child needs, such 2020. care clinicians should make accommodations to minimize exposures for as nutritional support. doi:10.1001/jamapediatrics.2 children with special health care needs, as well as advocating to limit the 020.1224 expansion of health disparities, for example, by finding ways to maintain nutrition for those dependent on school lunches. COVID-19; 2-Apr-20 Early advice on Pediatric Commentary The authors discuss the management of children with cancer during the The authors discuss Bouffet E, Challinor J, Sullivan pediatric; managing children Blood & COVID-19 pandemic. To date, there are few published reports of COVID-19 the management of M, et al. Early advice on hematology; with cancer during Cancer in children with cancer, but most patients showed mild symptoms and children with cancer managing children with oncology the COVID-19 survived. There is no reason to discontinue daily activities in pediatric during the COVID-19 cancer during the COVID-19 pandemic and a call hematology/oncology units or turn away children with suspected cancer pandemic. There is no pandemic and a call for for sharing during the pandemic. Whether patients undergoing treatment should have reason to discontinue sharing experiences. Pediatr experiences their treatment altered remains unknown though it seems prudent to daily activities in Blood Cancer. postpone high‐intensity treatments where feasible and to prepare to triage pediatric 2020;67(7):e28327. according to prognosis. The authors highlight the need to create a system hematology/oncology doi:10.1002/pbc.28327. for open case reporting and registration to advance knowledge on the units or turn away disease course in this population and share experiences in its management. children with Several organizations are working on a multi‐stakeholder initiative to create suspected cancer a COVID‐19 information resource center that would include an open registry during the pandemic. and a platform for experience sharing. Due to the large amount of Limiting the viral misinformation and potentially harmful advice available on the Internet, the spread through self‐ authors recommended consulting guidance from established health isolation, social authorities. Limiting viral spread through self‐isolation, social distancing, and distancing, and avoiding all non‐essential travel is crucial, as is the coming together of avoiding all non‐ communities to help equip and protect the most vulnerable populations. essential travel is crucial, as is the coming together of communities to help equip and protect the

74 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication most vulnerable populations. Encephalitis, 2-Apr-20 Neonatal Early- The Pediatric Letter to the This letter describes a case of a full-term female newborn who developed This is a report of Lorenz N, Treptow A, Schmidt neonate, Onset Infection Infectious Editor encephalitic symptoms following birth to a COVID-19 positive mother in encephalitic S, et al. Neonatal Early-Onset Germany, With SARS-CoV-2 in Disease Germany. The mother’s temperature was elevated during the vaginal symptoms in a Infection With SARS-CoV-2 in newborn, a Newborn Journal vacuum delivery (maximum 38.1°C) and she reported a mild respiratory neonate with COVID- a Newborn Presenting With transmission Presenting With infection and loss of smell and taste. After delivery, the newborn appeared 19, which has not Encephalitic Symptoms. Encephalitic lethargic, developed therapy refractory fever (38.6°C) at 24 hours after birth been a commonly Pediatr Infect Dis J. Symptoms and progressed to encephalitic symptoms at 54 hours of life. The neonate observed 2020;39(8):e212. was transferred to the tertiary center neonatal ICU, the newborn and the phenomenon. doi:10.1097/INF.0000000000 mother were isolated, and the mother was tested positive for SARS-CoV-2. 002735 The newborn’s nasopharyngeal and rectal swabs also tested positive for SARS-CoV-2, although the cerebrospinal fluid (CSF) tested negative. Other CSF laboratory tests were unremarkable. The newborn was treated with IV fluids and paracetamol, then developed respiratory distress at 80 hours of life requiring continuous positive airway pressure and oxygen therapy until day 6 of life. At day 10, the newborn developed a staccato-like cough and another chest radiograph confirmed bilateral viral pneumonia. Persistent and relevant hypopnea was treated by oral caffeine. 14 days after birth, the newborn was discharged free of symptoms. Nutrition 2-Apr-20 Nutrition Support in Nutrition Editorial Nutrition is part of the treatment regimen for acute and chronic diseases COVID-19 risk factors Laviano A, Koverech A, support, the Time of SARS- and applies particularly to ailments for which an etiologic treatment has not of older age and Zanetti M. Nutrition support comorbidities, CoV-2 (COVID-19) yet been discovered and validated. The 2014–2016 Ebola virus outbreak in comorbidities are in the time of SARS-CoV-2 lymphopenia, Western Africa demonstrated that immediate supportive care significantly associated with poor (COVID-19) [published online, hypoalbumine reduces case fatality rates. This may apply as well to the current SARS-CoV-2 nutritional status. In 2020 Apr 2]. Nutrition. 2020. mia, poor pandemic. Emerging evidence shows that COVID-19 is associated with addition, lymphopenia doi:10.1016/j.nut.2020.1108 nutritional negative outcomes in older, comorbid, and hypoalbuminemic patients, and low prealbumin 34 status, which are associated with impaired nutritional status and sarcopenia. levels, markers of malnutrition, Lymphopenia, which is a marker of malnutrition, is a negative prognostic malnutrition, predict rehabilitation factor in patients with COVID-19. Albumin circulating levels should not be poor prognosis in considered as a nutritional marker in patients with inflammatory response, COVID-19 patients. but a recent report revealing that a low prealbumin level predicts This protocol reviews progression to acute respiratory distress syndrome suggests that poor strategies for delivery nutritional intake contributes to the outcome. Authors present a pragmatic of nutrition therapy in protocol for the delivery of nutrition therapy in pre-ICU patients with COVID- patients with COVID- 19, during a critical period of intervention before progression to more severe 19. clinical manifestations. Nutrition must also be considered during the rehabilitation of COVID-19 survivors with post-ventilation-acquired dysphagia and ICU-acquired weakness. Vitamin D 2-Apr-20 Evidence That Nutrients Review This article reviews the role of vitamin D in reducing the risk of respiratory Based on literature Grant WB, Lahore H, supplementa- Vitamin D tract infections, namely influenza, through mechanisms like inducing related to Vitamin D McDonnell SL, et al. Evidence tion, Vitamin C, Supplementation cathelicidins and defensins that can lower viral replication rates and supplementation and that Vitamin D ascorbic acid, Could Reduce Risk reducing concentrations of pro-inflammatory cytokines that produce the influenza, authors Supplementation Could cathelicidin, of Influenza and cytokine storm. Evidence supporting the role of vitamin D in reducing risk of recommend Vitamin D Reduce Risk of Influenza and prevention, COVID-19 Infections COVID-19 includes that the outbreak occurred in winter, a time when 25- supplementation to COVID-19 Infections and

influenza and Deaths hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of reduce risk for COVID- Deaths. Nutrients. cases in the Southern Hemisphere near the end of summer are low; that 19 infection. RCTs and 2020;12(4):E988. Published 75 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication vitamin D deficiency has been found to contribute to acute respiratory large population 2020 Apr 2. distress syndrome; and that case-fatality rates increase with age and with studies must be doi:10.3390/nu12040988 chronic disease comorbidity, both of which are associated with lower conducted to evaluate 25(OH)D concentration. To reduce risk of infection, it is recommended that these people at risk of influenza and/or COVID-19 consider Vitamin D recommendations. supplementation. Higher doses may be useful for treatment as well. Pediatrics, 2-Apr-20 Detection of Covid- New England Correspondence Authors conducted a retrospective analysis of 366 hospitalized children (≤16 Findings from this Liu W, Zhang Q, Chen J, et al. detection, 19 in Children in Journal of years) at three branches of Tongji Hospital in Wuhan, from January 7 to retrospective analysis Detection of Covid-19 in China Early January 2020 Medicine January 15, 2020. The most frequently detected pathogens in children were indicate that SARS- Children in Early January

in Wuhan, China. influenza A virus (in 23 patients [6.3%]) and influenza B virus (in 20 [5.5%]). CoV-2 infections in 2020 in Wuhan, China. N Engl SARS-CoV-2, the virus that causes Covid-19, was detected in 6 patients children were J Med. 2020;382(14):1370– (1.6%). All six children had previously been completely healthy. Laboratory occurring early in the 1371. investigations showed that the levels of lymphocytes, white cells, and epidemic. doi:10.1056/NEJMc2003717 neutrophils were below the normal range in six, four, and three patients, respectively. Four of the six patients had pneumonia, as assessed radiographically by CT scan. One child was admitted to the pediatric intensive care unit and received pooled immune globulin from healthy donors. All the patients were treated empirically with antiviral agents, antibiotic agents, and supportive therapies. All patients recovered after hospitalization for a median of 7.5 days Vertical 2-Apr-20 Vertical Fetal and Review Authors reviewed the risk of vertical transmission of COVID-19 by using data This review of current Karimi-Zarchi M, transmission, Transmission of Pediatric from published articles or official websites up to March 4, 2020. A total of 31 literature on vertical Neamatzadeh H, Dastgheib pregnancy, Coronavirus Disease Pathology infected pregnant mothers with COVID-19 from Iran and China were transmission suggests SA, et al. Vertical neonatal 19 (COVID-19) From reported. No COVID-19 infection was detected in their neonates or a lack of evidence for Transmission of Coronavirus infection Infected Pregnant placentas. Two mothers died from COVID-19-related respiratory intrauterine Disease 19 (COVID-19) from Mothers to complications after delivery. Based on currently limited data, there is no transmission. Infected Pregnant Mothers to

Neonates: A Review evidence for intrauterine transmission of COVID-19 from infected pregnant Neonates: A Review women to their fetuses. Mothers may be at increased risk for more severe [published online, 2020 Apr respiratory complications. 2]. Fetal Pediatr Pathol. 2020;1–5. doi:10.1080/15513815.2020. 1747120 COVID-19, 1-Apr-20 COVID-19: Pacific Commentary There is limited scientific evidence on the severity of COVID-19 in pregnant Given a lack of Goris JM. COVID-19: SARS-CoV-2, PREGNANCY AND Journal of women, but most reports indicate that pregnant women experience similar evidence that SARS- PREGNANCY AND breastfeeding BREASTFEEDING Medical clinical outcomes as non-pregnant women who have progressed to COVID- CoV-2 is transmitted BREASTFEEDING. Pacific Sciences 19 pneumonia. Further, no evidence has shown that SARS-CoV-2 infection through breast milk, Journal of Medical Sciences. during pregnancy has a negative impact on the fetus. Similarly, there is no the author argues that 2020;20(2):17-20. evidence of transmission of the virus from mother to fetus during breastfeeding should pregnancy. Given that there is additionally no evidence of vertical continue to be a transmission of mother to infant via intra-uterine contact or breast milk, the priority for infants. benefits of breastfeeding outweigh the potential risks. The authors Especially in low- and recommend mothers wash hands thoroughly and use a face mask while middle-income breastfeeding. Further, mother and infant should maintain physical distance countries, from other people. If the mother is too ill to breastfeed, families should be breastfeeding is encouraged and supported to express breastmilk for feeding. Exclusive critical for infant breastfeeding for the first 6 months of life is essential for healthy growth development and and development of infants and for maternal health. Thus, it is important 76 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication that health professionals, especially in low- and middle-income countries, should be continued are reminded of the importance to continue to protect, promote and given the minute risks. support breastfeeding. COVID-19, 1-Apr-20 Expert consensus International Special Article The authors present recommendations for the care and management of The authors present Chen D, Yang H, Cao Y, et al. patient for managing Journal of COVID-19 in pregnancy based on discussions from a multidisciplinary recommendations for Expert consensus for management, pregnant women Gynecology teleconference consisting of maternal-fetal medicine and other experts in or the care and managing pregnant women pregnancy, and neonates born and from China and the USA on February 5, 2020. The following 10 management of and neonates born to China, USA to mothers with Obstetrics recommendations were made: (1) standardized screening, admission, and pregnant women with mothers with suspected or suspected or management of pregnant women with COVID-19 in accordance to local, COVID-19. These confirmed novel coronavirus confirmed novel federal, and international guidelines; (2) determine the travel history of include measures (COVID-19) infection. Int J coronavirus pregnant women to endemic areas and screen them for clinical symptoms of involving standardized Gynaecol Obstet. 2020 (COVID-19) COVID-19 pneumonia; (3) lung imaging and diagnostic testing for pregnant care, multidisciplinary May;149(2):130-136. doi: infection women with suspected COVID-19; (4) encouragement of pregnant women to management, and 10.1002/ijgo.13146. Epub report suspected and/or confirmed COVID-19 infection and the set-up of measures to prevent 2020 Apr 1. Erratum in: Int J appropriate facilities to accommodate them; (5) routine antenatal cross-infection by Gynaecol Obstet. 2020 examination for pregnant women with confirmed COVID-19, with safety strict adherence to Jul;150(1):136. PMID: guidelines being followed by medical staff; (6) individualized timing of birth, safety and sanitation 32196655. with mode of delivery based on obstetrical indications; (7) multidisciplinary protocols. planning of birth with the anesthesiology team; (8) multidisciplinary team management with neonatologists for newborns of mothers with COVID-19 pneumonia; (9) joint management of pregnant women with COVID-19 by staff, obstetricians, neonatologists, and critical care specialists with protocols to prevent cross-infection; (10) COVID-19 infection control training for all staff engaged in obstetrics. MERS-CoV, 1-Apr-20 Middle East Travel Letter to the The author provides a comparison of MERS-CoV, SARS, and SARS-CoV-2 In this letter to the Al-Tawfiq JA. Middle East SARS, C- Respiratory Medicine editor infection during pregnancy. There was no difference in the age group of the editor, the author Respiratory Syndrome section, ICU, Syndrome and patients, however, the gestational age was lower among MERS-CoV than provides a comparison Coronavirus (MERS-CoV) and comparison, Coronavirus (MERS- Infectious COVID-19 patients. Of the MERS-CoV cases in pregnancy, 63.6% required ICU of MERS-CoV, SARS, COVID-19 infection during pregnancy CoV) and COVID-19 Disease admission, and this is comparable to 50% of SARS pregnant women. The and SARS-CoV-2 pregnancy [published infection during case fatality rate in MERS-pregnant patients was approx. 35%, and this was infection during correction appears in Travel pregnancy not statistically different when compared to the overall MERS case fatality pregnancy. These Med Infect Dis. 2020 Jul- rate. In the MERS cases, 40% had a C-section, and this is much lower than comparisons may Aug;36:101717]. Travel Med the 100% C-section rate in cases of COVID-19. There was a fetal demise rate allow health care Infect Dis. 2020;36:101641. of 30% among pregnant women with MERS compared to 0% among COVID- providers and public doi:10.1016/j.tmaid.2020.101 19. Therefore, similar to the difference in the clinical presentation and health authorities to 641 course among SARS, MERS-CoV and COVID-19, there are also differences in better advise pregnant the outcome and course of pregnant women with these coronaviruses’ women. infection. Pregnancy, 1-Apr-20 An Uncomplicated New England Correspondence A 34-year-old woman presented to the labor and delivery unit with a 3-day This case describes an Iqbal SN, Overcash R, uncomplicated Delivery in a Patient Journal of history of fever, chills, dry cough, and myalgia. She reported decreased fetal uncomplicated, Mokhtari N, et al. An delivery, with Covid-19 in the Medicine movements during the past day. Chest radiographs showed reticular vaginal delivery of a Uncomplicated Delivery in a neonate, United States interstitial opacities, and laboratory tests were unremarkable except for healthy neonate in a Patient with Covid-19 in the United States lymphopenia. Tests for COVID-19 were determined to be positive 21 hours woman with COVID- United States [published after samples were obtained. On hospital day 3, she had an uncomplicated 19. Skin-to-skin online, 2020 Apr 1]. N Engl J spontaneous vaginal delivery. Delayed cord clamping was not performed, contact was not Med. 2020. and skin-to-skin contact between the mother and infant was not permitted. allowed. The neonate doi:10.1056/NEJMc2007605 There was no evidence of neonatal or intra-amniotic infection. The neonate was isolated following 77 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication was moved to a separate room and remained there until discharge. The delivery and fed with neonate was fed with formula and expressed breast milk. formula and expressed breast milk. Hepatitis A 1-Apr-20 Can Hepatitis A Experimental Review Based on numbers of total confirmed cases, it seems that the global COVID- Asymptomatic cases Sarialioglu F, Belen Apak FB, vaccine, Vaccine Provide and Clinical 19 pandemic has spared some countries like India, Pakistan, countries of the of COVID-19 could Haberal M. Can Hepatitis A seroprevalence, Protection Against Transplantati African continent, and South America. Although many confounding factors indirectly indicate Vaccine Provide Protection cross-reactivity, COVID-19? on can affect these results, a main difference among these countries may be protection due to HAV Against COVID-19?. Exp Clin infants, another infectious agent, which can cause high seroprevalence among seropositivity. Infants Transplant. 2020;18(2):141– maternal populations in countries that have endemic disease or are vaccinated affected with severe 143. antibodies routinely, such as hepatitis A virus (HAV), another RNA virus. In contrast with COVID-19 may have doi:10.6002/ect.2020.0109 low-income countries, overall HAV seroprevalence was shown to be 19% in weakened immune the English population, similar to other high-income countries where HAV systems due to waning has become uncommon. In consideration of children, greater severity of maternal anti-HAV COVID-19 in young infants may be explained by the waning of maternal anti- antibodies. Further HAV antibodies towards the end of the first year of life. The HAV vaccine is studies must confirm highly immunogenic and may protect against COVID-19 infection through the use of HAV vaccine the possibility of adaptive immune cross-reaction. to cross-protect against COVID-19. Nutritional 1-Apr-20 Impact of Nutrition Journal of Editorial The nutrition community must consider certain nutrients and food patterns While this article Kalantar-Zadeh K, Moore LW. supplementa- and Diet on COVID- Renal that could prevent COVID-19 infection or mitigate its severity. Meta-analyses focuses primarily on Impact of Nutrition and Diet tion, vitamin C, 19 Infection and Nutrition suggest a consistent and statistically significant benefit of vitamin C to dietary interventions on COVID-19 Infection and chronic kidney Implications for prevent the common cold and support respiratory defense mechanisms. to support patients Implications for Kidney disease Kidney Health and Fava beans contain chemical compounds similar to quinine-based with CKD, it also Health and Kidney Disease Kidney Disease antimalarial medications, which are being used in COVID-19 infected supports Management [published Management persons. For patients with chronic kidney disease (CKD), in particular, supplementation of online, 2020 Apr 1]. J Ren adequate protein and calorie intake, enterally or parenterally, is antioxidants to Nutr. 2020. recommended. Studies in patients with CKD have shown positive outcomes promote immune doi:10.1053/j.jrn.2020.03.006 from dietary intervention with omega-3, calcitriol for patients with vitamin D function in patients deficiency, melatonin, beta-glucan, and cholecalciferol. with COVID-19. Children, 1-Apr-20 COVID-19 Virus and Archives de Editorial As of March 3, 2020, there are more than 900 confirmed pediatric cases, but Based on existing Morand A, Fabre A, Minodier asymptomatic, Children: What Do Pédiatrie currently no child under 10 years of age has died; only one individual knowledge around P, et al. COVID-19 virus and clinical We Know? between 10 and 19 years of age died, and only one child under 1 year old COVID-19 in children, children: What do we know?. characteristics, was reported to have a severe form of the disease. The number of this article raises the Arch Pediatr. breastfeeding confirmed pediatric cases is very low, and the severity and mortality rates question of whether 2020;27(3):117–118. are even lower, compared to adults. There is no systematic sampling series children represent less doi:10.1016/j.arcped.2020.03 in asymptomatic persons, and the age distribution of asymptomatic patients severe cases, are less .001 is not detailed in the literature. Do children represent less severe cases, are infected, or are being they less infected, or are they being underdiagnosed as less symptomatic? underdiagnosed as Symptoms in children include fever, pneumonia, and upper respiratory signs. asymptomatic? Symptomatic care is often sufficient, but antibiotic treatment of bacterial Breastfeeding is superinfection may be necessary. A higher risk of preterm birth is reported encouraged with in pregnant women, and maternal infection could be involved in neonatal appropriate hygiene distress; one neonate died, but his specimens tested negative for COVID-19 precautions. by RT-PCR. Breastfeeding, with proper hygiene precautions, should be encouraged. If a mother is too tired to breastfeed, milk should be expressed using breast pumps so that a healthy caregiver may feed the infant.

78 COVID-19, Maternal and Child Health, Nutrition – Literature Repository April 2020

Key Terms Date Title Journal / Type of Summary & Key Points Specific Observations Full Citation Published Source Publication Neonatal 1-Apr-20 Novel coronavirus Infectious Case Report A 15-day-old neonate was admitted with fever, lethargy, cutaneous This case report adds Kamali Aghdam M, Jafari N, infection, in a 15-day-old Diseases mottling, and respiratory distress without cough. His mother had symptoms to literature on early- Eftekhari K. Novel sepsis, family neonate with of Novel coronavirus. RT-PCR assay was performed, and the neonate's onset SARS-CoV-2 in coronavirus in a 15-day-old cluster clinical signs of pharyngeal sample tested positive for SARS-CoV-2. Blood, urine, and stool neonates, with neonate with clinical signs of

sepsis, a case report cultures were negative. The newborn was isolated and subjected to exposure from sepsis, a case report supportive care. Antibiotic and antiviral treatment was initiated. Eventually, parent(s). [published online, 2020 Apr the neonate was discharged in good general condition. 1]. Infect Dis. 2020;1–3. doi:10.1080/23744235.2020. 1747634 NICU, donor 1-Apr-20 U.S. NICUs and The Lancet Reflections On March 28, 2020, the first infant death of the U.S. outbreak was This article discusses Furlow, B. US NICUs and milk bank, Donor Milk Banks Child & announced in Illinois. The U.S. CDC recommends separating newborns from concerns related to donor milk banks brace for

breastfeeding, Brace for COVID-19 Adolescent mothers with suspected or confirmed COVID-19. Disruptions in breastfeeding, donor COVID-19. Lancet Child & skin-to-skin Health breastfeeding could increase babies' risk of developing necrotizing milk supply, and skin- Adol Health. 2020. contact, United enterocolitis (NEC), a life-threatening gastrointestinal emergency that can to-skin touch during https://doi.org/10.1016/S235 States, CDC, lead to gut perforation and sepsis. Hospital visitor restrictions have further the COVID-19 2-4642(20)30103-6 WHO reduced newborns' opportunities for skin-to-skin touch and holding. In pandemic. The author contrast with the CDC, WHO guidance on breastfeeding suggests that notes that human milk women with COVID-19 should breastfeed their newborns if they want to do lowers risk for so, while emphasizing respiratory hygiene (mask wearing, handwashing). newborn necrotizing Pasteurized donor milk is a vital resource for babies in NICUs whose mothers enterocolitis thus cannot provide breast milk, but donor supplies have become a concern as disruptions in states and cities issue stay-at-home orders. Hospitals have begun breastfeeding may precautionary rationing, allocating donor milk to the smallest and most at- lead to GI risk preterm infants to prevent NEC. emergencies. Infant, isolation 1-Apr-20 Environment and Annals of Letter SARS-CoV-2 is suspected to spread from an infected person to a susceptible Findings suggest that Yung CF, Kam KQ, Wong MSY, room, personal Personal Protective Internal host primarily through droplets and possibly direct contact. The roles of SARS-CoV-2 positive et al. Environment and protective Equipment Tests for Medicine transmission by indirect contact (fomites) or by long-range airborne route infants with no Personal Protective equipment, SARS-CoV-2 in the are uncertain. In this letter, authors investigate environmental respiratory symptoms, Equipment Tests for SARS- breastfeeding, Isolation Room of contamination and potential for transmission from a 6-month-old infant can contaminate CoV-2 in the Isolation Room hygiene an Infant With with COVID-19, admitted for isolation. The isolation environment and PPE of nearby environments. of an Infant With Infection

precautions Infection. a health care worker were sampled and tested using PCR. The infant's Hand hygiene when [published online, 2020 Apr bedding, cot rail, and table (where baby formula and wipes were placed) caring for infants with 1]. Ann Intern Med. situated 1 meter away were found to be positive for SARS-CoV-2, confirming COVID-19 is important 2020;M20-0942. that an infant with COVID-19 but without respiratory symptoms can to reduce doi:10.7326/M20-0942 contaminate the environment through crying or drooling. There was a environmental downward trend of viral load with increasing distance from the infant. contamination. Despite close physical contact with the infant during feeding, no evidence of SARS-CoV-2 was detected on the health care worker's gown.

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