Covid-19 in neonates, and paediatrics: March 2021 A selection of recent guidelines and evidence.

NB. separate bulletin available on request on Covid-19 vaccines.

General Covid-19 in neonates Covid-19 in pregnancy/birth ➢ Vertical Transmission Covid-19 in paediatrics Maternal Mental Health Child Mental Health Domestic Abuse

General Preventive measures for accompanying caregivers of children in paediatric health care during the COVID-19 pandemic—walking an ethical tightrope. Clinical Microbiology and , Jan 2021. Hanna Schmid, Ulrich Heininger, Danielle Vuichard-Gysin, Andreas Widmer, Julia Bielicki,

Covid-19 in neonates

Have 2019 (COVID-19) Community Lockdowns Reduced Rates? Obstetrics and gynecology; Mar 2021; vol. 137 (no. 3); p. 399-402 Goldenberg, Robert L; McClure, Elizabeth M.

Prolonged fever and hyperferritinaemia: a puzzling diagnosis of neonatal virus infection during COVID-19 pandemic. (UK) BMJ case reports; Mar 2021; vol. 14, no. 3. Badawy, Mohammed Kamal; Hurrell, Sophie; Baldwin, Catherine; Hassan, Heba.

Perinatal COVID-19 Resources

EL. 3.3.2021 BAPM, updated 25 Mar 2021. A collection of perinatal specific resources specifically about COVID-19. Links to related resources from eg RCPCH, RCOG and the BPSU study on Neonatal complications of coronavirus disease (COVID-19)

BAPM - COVID-19: Frequently asked questions within neonatal services RCPCH, 26 Mar 2021. Compilation from perinatal professionals and guidance from RCPCH and RCOG.

Covid-19 in pregnancy/birth

COVID-19: Pregnancy issues and antenatal care UpToDate, 26 Mar 2021 The latest evidence summary.

COVID-19: Labor, delivery, and postpartum issues and care UpToDate, 1 Mar 2021 The latest evidence summary.

Update to living systematic review on covid-19 in pregnancy. BMJ (Clinical research ed.); Mar 2021; vol. 372 ; p. n615 This update includes 192 studies (64 676 pregnant and recently pregnant women), 115 of which were new additions to the review. The prevalence of covid-19 in pregnant and recently pregnant women remained unchanged between this update and the original version of the living systematic review. Pregnant women continue to be at increased risk of severe covid-19. […]

Coronavirus disease 2019 (COVID-19): pregnancy-related complications [scroll down] BMJ Best Practice, updated 26 Mar 2021.

Pregnancy and neonatal outcomes of COVID‐19: co‐reporting of common outcomes from PAN‐COVID and AAP SONPM registries. Ultrasound Obstet Gynecol. 23 February 2021. Mullins, E. et al. Reports the outcome of infected from a collaboration formed early during the pandemic between the investigators of two registries in the UK and the US.

Comparative study of clinical symptoms, laboratory results and imaging features of coronavirus and virus, including similarities and differences of their pathogenesis Pakistan Journal of Medical and Health Sciences; Jul 2020; vol. 14 (no. 3); p. 1405-1411. Karimian P.; Delavar M.A. One of the challenges physicians face is the similarities between the symptoms of COVID19 and influenza infection. Both viruses cause severe infection of lungs, but influenza virus has different types and some types are highly pathogenic; even more than coronavirus. Children and pregnant women are more vulnerable to influenza virus and children may experience harsher symptoms. COVID-19 symptoms on the other hand are milder in pregnant women and children. […] At the present study, comparative study of clinical and laboratory symptoms and imaging features of coronavirus and influenza virus and also similarities and differences in their pathogenesis is carried out.

Association between the COVID-19 pandemic and the risk for adverse pregnancy outcomes: a cohort study.

EL. 3.3.2021 BMJ open; Feb 2021; vol. 11 (no. 2); p. e047900. Du, Min; Yang, Jie; Han, Na; Liu, Min; Liu, Jue.

Successful use of CPAP in a pregnant patient with COVID-19 pneumonia. Case Report. BMJ case reports; Mar 2021; vol. 14, no. 3. Reindorf, Maxine; Newman, Joseph; Ingle, Tejas.

The lived experiences of pregnant women during COVID-19 pandemic: a descriptive phenomenological study. BMC pregnancy and childbirth; Mar 2021; vol. 21 (no. 1); p. 193 Mortazavi, Forough; Ghardashi, Fatemeh.

Healthcare Workers: Pregnancy and Coronavirus (Letter) Journal of occupational and environmental medicine; Feb 2021; vol. 63 (no. 2) Belingheri M.; Paladino M.E.; Riva M.A.

The effect of COVID-19 on general anaesthesia rates for . A cross-sectional analysis of six hospitals in the north-west of England. Anaesthesia; Mar 2021; vol. 76 (no. 3); p. 312-319 Bhatia, K. et al.

COVID-19 Infection During Pregnancy and Risk of Neurodevelopmental Disorders in Offspring: Time for Collaborative Research. (Letter with refs) Biological psychiatry; Mar 2021; vol. 89 (no. 5); p. e29 López-Díaz, Álvaro et al.

The metabolic and immunological characteristics of pregnant women with COVID-19 and their neonates. European journal of clinical microbiology & infectious : official publication of the European Society of Clinical Microbiology; Mar 2021; vol. 40 (no. 3); p. 565-574 Zhou, Jingjiao et al.

New report examines impact of first wave of COVID-19 on maternal deaths. HSIB, 25 Feb 2021 This report offers crucial learning from maternal death investigations undertaken during the first peak of the COVID-19 pandemic, in particular it reinforces the increased risk of COVID-19 to women from Black, Asian and minority ethnic backgrounds.

Vertical Transmission

Perinatal Transmission of 2019 Coronavirus Disease-Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry? Clinical infectious diseases : an official publication of the Infectious Diseases Society of America; Mar 2021; vol. 72 (no. 5); p. 862-864. Fan C. et al. Presents 2 cases of coronavirus disease 2019 (COVID-19)– associated severe respiratory syndrome coronavirus 2 (SARSCoV-2) infection during the third trimester of pregnancy. Both mothers and newborns had excellent outcomes. Study failed to identify SARS-CoV-2 in all of the products of conception and the newborns. This report provided evidence of low risk of intrauterine infection by vertical transmission of SARS-CoV-2.

EL. 3.3.2021 Management of Viral Complications of Pregnancy: Pharmacotherapy to Reduce Vertical Transmission. Review. Obstetrics and gynecology clinics of North America; Mar 2021; vol. 48 (no. 1); p. 53-74 Rogan, Sarah C; Beigi, Richard H.

Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis. (Authors' reply/letter with refs.) BJOG : an international journal of obstetrics and gynaecology; Mar 2021; vol. 128 (no. 4); p. 769 Walker, Kate F. et al.

Severe Acute Respiratory Syndrome Coronavirus 2 Vertical Transmission from an Asymptomatic Mother. The Pediatric infectious disease journal; Mar 2021; vol. 40 (no. 3); p. e115 Carbayo-Jiménez, Tania et al.

Frequency of congenital infection UpToDate, updated 26 Mar 2021. The latest evidence summary within COVID-19: Pregnancy issues and antenatal care Or Search for “vertical” or “transmission” in the text using the Find tool top right.

Covid-19 in paediatrics

COVID-19: clinical manifestations and diagnosis in children UpToDate, last updated 24 Mar 2021. The latest evidence summary.

Coronavirus disease 2019 (COVID-19)/complications: paediatric inflammatory multisystem syndrome [scroll down] BMJ Best Practice, updated 26 Mar 2021. A rare, but severe condition, reported in children and adolescents approximately 2 to 4 weeks after the onset of COVID-19, likely due to a post-infectious inflammatory process.

COVID-19 resources RCPCH, Mar 2021 Guidance about the COVID-19 pandemic - on paediatric services, staffing and rotas, education and training, research and surveillance and information for families.

Coronaviruses in children: A review of potential mechanisms of childhood protection Acta Paediatrica, International Journal of Paediatrics; Mar 2021; vol. 110 (no. 3); p. 765-772 Rabi F.A.; Al Zoubi M.S.; Al-Iede M.M.; Badran E.F.; Kasasbeh G. Aim: The 2019 coronavirus disease (COVID-19) has spread worldwide and the number of cases continues to rise exponentially. Epidemiologic reports indicate that severity of illness increases with age. However, the reasons behind the relative protection of children and are unclear. Whether the rationale is host- related or virus dependent is important to determine since the latter could change with viral mutations. We review factors that could affect the susceptibility of children to the novel coronavirus. Method(s): We search publications indexed on PUBMED. Result(s): Descriptions of the pathophysiology of current and previous coronavirus suggest several viral targets and immunomodulatory pathways affecting the severity of illness. There is limited evidence to suggest age-variability of viral cell receptors and transmembrane co- factors required for coronavirus entry and replication. However, the ensuing cytokine storm and the effect of

EL. 3.3.2021 higher melatonin in children are age-dependent and could explain decreased disease variability in children. Conclusion(s): We believe that current evidence suggests host factors can play a role in disease severity in children and thus may remain protective despite potential virus mutation in the future. However, we recognise and discuss avenues of future research that can further illuminate the reasons children are protected from severe COVID-19 illness.

Pediatric emergency medicine literature 2020 [Review] American Journal of Emergency Medicine; May 2021; vol. 43 ; p. 123-133 Petruzella F.; Easter J.S. Most children are treated at general Emergency Departments (EDs) and not specialized pediatric EDs. […]We selected ten studies that we found impactful, robust, and relevant for practicing general emergency physicians. This review includes studies of status epilepticus, cardiac arrest, asthma, fever, wound care, rapid sequence intubation, coronavirus, and trauma. At the peak of the COVID-19 lockdown period in the UK [1] and especially in April 2020, the neurosurgical team at Alder Hey Children’s Hospital noticed a significant decrease in acute referrals. In our neurosurgical unit, we act as the regional tertiary referral centre for the northwest, and even a supra regional referral centre for some craniofacial and vascular pa thologies. We decided to audit the referrals which we keep the records of on a prospective referral documentation system, and we decided to compare the period from March to May between 2019 and 2020.

[Consequences of the SARS-CoV-2 Pandemia on the Early Childhood Examinations] in German. Blankenstein, Oliver et al. Klinische Padiatrie; Mar 2021; vol. 233 (no. 2); p. 94-95. Abstract: Seit Mitte Mai wird berichtet, dass die Maßnahmen oder die Angst vor einer Infektion mit SARS- CoV-2 zu einem sekundären Gesundheitsrisiko führen könnten, weil Diagnosen, z. B. von Krebs- oder Herz- Kreislauferkrankungen, verspätet gestellt und Therapien, z. B. komplizierte operative Eingriffe mit Intensivpflege, verzögert durchgeführt werden (COVIDSurg Collaborative, Br J Surg 2020; DOI: 10.1002/bjs.11746; Kuhlen R et al., Dtsch Arztebl Int 2020; 117: 488-489). In der Kinder- und Jugendmedizin stehen die Fragen und Probleme des Schulunterrichts, der fehlenden sozialen Kontakte innerhalb der peer group und der häuslichen Gewalt im Vordergrund der Fragen zur Auswirkung der Pandemie auf die Gesundheit (Wade M et al., Psychiatry Res 2020; 290:113-143). Mögliche Auswirkungen auf die Umsetzung der Richtlinie des Gemeinsamen Bundesausschuss (G-BA) über die Früherkennung von Krankheiten bei Kinder (Vorsorge-Untersuchungen U1-U9) sind bislang nicht bekannt. Im Rahmen der SARS-CoV2 Kontaktbeschränkungen hatte der G-BA die Toleranzzeiten (Abrechnungsfristen) für die Vorsorge- Untersuchungen U6-U9 bis zum Ablauf von 3 Monaten nach Beendigung einer epidemischen Lage von nationaler Tragweite aufgehoben (BAnz AT 29.05.2020 B6).

COVID-19 lockdown presented a chance to evaluate emergency referrals to paediatric neurosurgical unit: a prospective cohort study. Letter Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery; Mar 2021; vol. 37 (no. 3); p. 729-732 Aly, Ahmed; Pettorini, Benedetta.

COVID-19 FAQs in paediatric and congenital cardiology: AEPC position paper. Cardiology in the young; Mar 2021; vol. 31 (no. 3); p. 344-351 Sendzikaite, Skaiste; Heying, Ruth; Milanesi, Ornella; Hanseus, Katarina; Michel-Behnke, Ina As the challenging battle with COVID-19 continues, professionals from the Association for the European Paediatric and Congenital Cardiology receive many questions regarding COVID-19 in a Paediatric and Congenital Cardiology setting. The aim of this paper is to present the AEPC position on frequently asked questions based on the most recent scientific data, as well as to frame a discussion on how to take care of

EL. 3.3.2021 our patients during this unprecedented crisis. As the times are changing quickly and information regarding COVID-19 is very dynamic, continuous collection of evidence will help guide constructive decision-making.

Acute covid-19 and multisystem inflammatory syndrome in children. (Clinical Update) BMJ (Clinical research ed.); Mar 2021; vol. 372 ; p. n385 Rubens, Jessica H; Akindele, Nadine Peart; Tschudy, Megan M; Sick-Samuels, Anna C.

[Treatment of SARS-CoV-2 in paediatrics : what is the evidence to date?] Revue medicale suisse; Feb 2021; vol. 17 (no. 726); p. 344-348. Fougère, Yves; Rohr, Marie; Vetter, Pauline; Wagner, Noémie. Although SARS-CoV-2 infects individuals of all ages, children show less severe symptoms. Nevertheless, the very rare COVID-19 severe cases in paediatrics require our full attention. Much research has been conducted and is still ongoing on effective treatments. On the antiviral front, no molecule has been proven effective yet and the results of several studies on the benefit of monoclonal antibodies and convalescent plasma are pending. On the side of immunomodulators, the benefit of steroids has been demonstrated for patients severely ill. Other molecules are being investigated. However, all these studies focused on adults and paediatric data are warranted.

The Impact of COVID-19 Pandemic on Adult and Pediatric Allergy & Immunology Services in the UK National Health Service. The journal of allergy and clinical immunology. In practice; Feb 2021; vol. 9 (no. 2); p. 709 Krishna, Mamidipudi Thirumala et al. There are no published data regarding the impact of coronavirus disease 2019 pandemic on Allergy & Immunology services in the UK National Health Service. Data showed reduction in face-to-face consultations, increase in remote consultations, reduced access to allergy testing, and increase in self-administration of omalizumab and immunoglobulin replacement therapy. CONCLUSIONS. The pandemic had a significant impact on A&I services, leading to multiple unplanned pragmatic amendments in service delivery. There is an urgent need for prospective audits and strategic planning in the medium and long-term to achieve equitable, safe, and standardized health care.

Maternal Mental Health Maternal mental health during a pandemic: a rapid evidence review of Covid-19's impact Centre for Mental Health, 2021. A rapid literature review of existing published and grey literature about the impact of Covid-19 on maternal mental health and perinatal mental health services, including within the voluntary and community sector, across all four nations of the UK.

Maternal mental health House of Commons Library Research Briefing, 2021. Concerns have been raised about the impact of the Covid-19 pandemic on maternal mental health. There is evidence that new mothers have experienced poor maternal mental health during the pandemic.

The prevalence and risk factors of depression in prenatal and postnatal women in China with the outbreak of Corona Virus Disease 2019 Journal of Affective Disorders; Mar 2021; vol. 282 ; p. 1203-1209 Li C.; Wang W.; Zhang X.; Huo L.; Wang R.; Qi L.; Zhou X.; Zhou Y.

EL. 3.3.2021 The lived experiences of pregnant women during COVID-19 pandemic: a descriptive phenomenological study. BMC pregnancy and childbirth; Mar 2021; vol. 21 (no. 1); p. 193. Mortazavi, Forough; Ghardashi, Fatemeh.

Psychopathology associated with coronavirus disease 2019 among pregnant women Letter with refs. American Journal of Obstetrics & Gynecology MFM, Volume 3, Issue 1, 2021, Article 100289. Margaret Olabisi Ogunbiyi.

Child Mental Health Child mental health RCPCH, 15 Oct 2020 Role of paediatricians in supporting children and young people's mental health - position statement.

Preventing Toxic Childhood Stress in the COVID Era: A Role for Telemedicine Telemedicine journal and e-health: the official journal of the American Telemedicine Association, Aug 2020. Bottino C.J. The coronavirus pandemic has resulted in unprecedented stress for families and children. Curve-flattening measures have disrupted the relational networks of millions. Stress in the absence of protective relationships can quickly become toxic, harming mental and physical health. If toxic stress is characterized by an absence of protective relationships, telemedicine may have a role in collective prevention efforts by enabling and preserving patient-provider continuity. Through virtual visits and check-ins, trusted health care providers can serve as a source of emotional support and psychosocial buffering for families under stress. By leveraging technology to deliver care remotely, telemedicine lets patients and providers connect, relate, and engage. Connection enables the conveyance of compassion and empathy. Telemedicine may thus serve as an important conduit for fostering protective relationships, buffering toxic stressors, and promoting safety and healing. Telemedicine will not resolve the needs created by the pandemic, but it may be one component for addressing them.

Domestic Abuse

Remote Examination and Screening for Domestic Abuse. Comment on "Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges". (Comment on article below) Journal of medical Internet research, Feb 2021; vol. 23 (no. 2); p. e23295. Grimes, Hannah Lee; Uppal, Ramnik.

Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges. Journal of medical Internet research, July 2020;22(7):e19916. Wu H, Sun W, Huang X, Yu S, Wang H, Bi X, Sheng J, Chen S, Akinwunmi B, Zhang CJP, Ming W. Reports how the COVID-19 pandemic brings not only opportunities for the development and popularization of online antenatal care programs but also challenges.

Domestic abuse: get help during the coronavirus (COVID-19) outbreak Home Office, last updated 12 Feb 2021. Includes sources of help for children. [Click on Get help if you, or someone you know, is a victim and scroll down to Get help for children and young people]. EL. 3.3.2021