LETTER TO THE EDITORDear Editor, Coronavirus disease 2019 arrived in Singapore in January 2020 as imported cases, followed by local transmission predominantly involving dormitories, with later spread within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of a total of over 200,000 cases. Only 0.034% of children younger than 12 years old needed oxygen supplementation, intensive care, or died. 1,2 A few possible reasons have been postulated: firstly, children may have more robust innate responses to viral infections; secondly, angiotensin-converting enzyme 2 receptors may be immature or less expressed in the respiratory tract of a child; and thirdly, children may have increased mucociliary clearance. 3 In 2021, with the emergence of the Delta variant, rising local transmission, and children <12 years old remaining unvaccinated, we started to experience the fuller spectrum of paediatric SARS-CoV-2 infection. We describe the first Singapore cases known to the authors of vertically transmitted COVID-19, and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, in the setting of a tertiary paediatric unit in National University Hospital in Singapore. The unit has about 109 paediatric inpatient beds and an intensive/high dependency care capacity of 18 beds.Vertically transmitted COVID-19 in a newborn. In our centre, mothers with active COVID-19 infection are offered the option of rooming separately from their newborn after delivery, especially if they are deemed highly infectious by being early in illness with a low cycle threshold (CT) value. Active COVID-19 infection is defined as duration of the illness and infectivity is generally taken to be 10 days if the woman is fully vaccinated and 14 days if she is unvaccinated. Breast milk is the preferred feeding option regardless of whether the newborn is separated from the mother or rooming with her. Investigation-wise, cord blood is sent for SARS-CoV-2 serology at birth. Initially, nasopharyngeal swabs for SARS-CoV-2 RNA polymerase chain reaction (PCR) were performed in neonates after birth, and on days 1 and 2 of life, with accompanying stool samples sent for PCR. This has since been rationalised to only on days 1 and 2 of life. If the neonate

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