COVID-19 in Neonates, Infants and Children

Impact of Novel Coronavirus 2019 on Neonates, Infants and Children

Available data suggests COVID-19 much more mild in paediatric population 

  • Of 44,672 confirmed cases, 0.9% were 0-10 years and 1.2% were 10-19 years(1)

  • Small cohort studies indicate critical illness occurred in <1% of children(2,3,4)

  • Case reports in neonates describe mild presentations(5) and there is no evidence currently of vertical transmission(6)

  • Report of one death <20 years in China, no further details about their age(7).  Verbal reports from Italy claim there have been no deaths <19 years(2). However, sadly a 13 year old boy is known to have died in the UK.

  • A case series of 171 children found 15.8% were asymptomatic, 19.3% presented with an URTI and 64.9% had pneumonia(8)

Demographics

From the case series of 171

  • Age: 18.1% were <1 yr, 23.4% 1-5 yrs, 33.9% 6-10 yrs, 24.6% 11-15 yrs.

  • 60.8% were male

How does it present?

  • Symptoms of respiratory infection - cough, nasal congestion, rhinorrhea, sore throat, fever(7)

  • gastrointestinal symptoms including abdominal discomfort, nausea, vomiting, abdominal pain, and diarrhea can also occur in children(9)

  • Can be asymptomatic in children(4)

What do we know about transmission?

  • The majority of paediatric cases have had a close family contact with COVID-19(10)

  • Modelling data suggests transmission most likely around 12 hours before symptom onset(2)

  • Children may secrete novel coronavirus 2019 in stool for several weeks after becoming asymptomatic(11)

How is it managed? 

  • Advice from RCPCH is extensive and covers how to manage patients in different clinical areas, as well as guidance on isolation and practical considerations 

  • This article provides clinical categories and detailed management advice

Further reading from the Don’t forget the bubbles team

References: 

1.Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 17;41(2):145-151. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003. [Epub ahead of print]

2. Don’t Forget The Bubbles & UK Paediatricians. DFTB COVID PEM UK meeting [Webinar]. 10-11am on 17th March 2020.  

3. Wang et. al. Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces (autonomous region) of northern China. Zhonghua Er Ke Za Zhi. 2020 Mar 2;58(4):E011. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32118389 [Epub ahead of print, accessed 19.3.20]

4. Wang et. al. Retracted: Clinical and epidemiological characteristics of 34 children with 2019 novel coronavirus infection in Shenzhen. Zhonghua Er Ke Za Zhi. 2020 Feb 17;58(0):E008. doi: 10.3760/cma.j.issn.0578-1310.2020.0008. [Epub ahead of print, accessed 19.3.20] 

5. Wang et. al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis. 2020 Mar 12. pii: ciaa225. doi: 10.1093/cid/ciaa225. [Epub ahead of print, accessed 19.3.20]

6.Chen et. al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020 Mar 7;395(10226):809-815. doi: 10.1016/S0140-6736(20)30360-3. [Epub ahead of print, accessed 19.3.20]

7.Centres for Disease Control and Prevention. COVID-19 Guidance for Paediatric Care Providers. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html [Accessed 19.3.20]

8. Xiaoxia et. al. Correspondance: SARS-CoV-2 Infection in Children. New Eng J Med. March 18, 2020. DOI: 10.1056/NEJMc2005073.

9. Shen et. al.Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr. 2020 Feb 7. doi: 10.1007/s12519-020-00343-7. [Epub ahead of print, accessed 19.3.20]

10. Li-Na et. al. Clinical features of pediatric patients with COVID-19: a report of two family cluster cases. World J Pediatr. 2020 Mar 16. doi: 10.1007/s12519-020-00356-2. [Epub ahead of print]. 

11. Tang et. al. Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China. Emerg Infect Dis. 2020 Jun 17;26(6). doi: 10.3201/eid2606.200301. [Epub ahead of print, accessed 19.3.20]

This page was written by Dr Rachel Coles, paediatric trainee and first published on 19th March 2020.

Updated by the author on 20.3.20

Contact covid@medshr.net with questions, feedback and resources.

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