COVID-19 in Newborns and Infants—Low Risk of Severe Disease: Silver Lining or Dark Cloud?

Rawat, Munmun; Chandrasekharan, Praveen; Hicar, Mark D.; Lakshminrusimha, Satyanarayana

doi:10.1055/s-0040-1710512

Cited by 68 publications

(82 citation statements)

References 33 publications

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“…50 Rawat et al speculate on why neonates have been spared of COVID-19 serious symptomatology, but also caution that they can be carriers for transmission of the virus to vulnerable adults. 55 In addition to that, there is scarce information about the short-and long-term effects of infection on neonates. Therefore, it is vital to prevent infection in the neonates.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review

2020

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Objective Novel coronavirus disease 2019 (COVID-19) seems to affect adults and pediatric patients differently. While neonates are a special population, little is known about the neonatal outcomes. This study aimed to investigate the outcomes in COVID-19 positive neonates and incidence of vertical transmission of the virus by reviewing available literature. Study Design This study is a narrative review of available literature on “COVID-19 in neonates,” for which PubMed and Google Scholar were used to search the published articles. Results We summarized the data from 39 published studies that are comprised of 326 COVID-19 positive peripartum mothers with respective neonatal outcomes. Twenty-three neonates have been reported to be COVID-19 positive. Male neonates were affected significantly more (79%) than female neonates. Approximately 3% neonates acquired infection through suspected vertical transmission. Strict infection prevention measures during the perinatal time can significantly reduce the chance of horizontal transmission of the virus. Overall, neonates were asymptomatic or mildly symptomatic regardless of gestational age at birth and required only supportive measures. There was 0% mortality in COVID-19 positive neonates. Conclusion From available published data to date, we can conclude that the prognosis of COVID-19 positive neonates is good with no mortality. There appears to be minimal vertical transmission of the infection. Key Points

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Section: Discussionmentioning

confidence: 99%

Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review

2020

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“…In adults with severe respiratory failure from SARS-CoV-2 infection, who typically experience clinical deterioration about 1 week following illness onset, a dysregulated immune system is thought to drive disease manifestations, as opposed to direct cellular injury from viral infection (Stage II-pulmonary phase). Children appear to have less severe pulmonary manifestations compared to adults, possibly due to lower gene expression of the angiotensin converting enzyme (ACE)-2 receptor (the target of SARS-CoV-2) [12,13]. Immune dysregulation in adults with respiratory disease is characterized by lymphopenia (specifically NK cells, CD4 T lymphocytes and B lymphocytes) and sustained production of pro-inflammatory cytokines, such as tumor necrosis factor (TNF)-α and interleukin (IL)-6 [14].…”

Section: Relationship Of Mis-c To Covid-19 and Pathogenesismentioning

confidence: 99%

Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management

et al. 2020

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may result in the multisystem inflammatory syndrome in children (MIS-C). The clinical presentation of MIS-C includes fever, severe illness, and the involvement of two or more organ systems, in combination with laboratory evidence of inflammation and laboratory or epidemiologic evidence of SARS-CoV-2 infection. Some features of MIS-C resemble Kawasaki Disease, toxic shock syndrome, and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. The relationship of MIS-C to SARS-CoV-2 infection suggests that the pathogenesis involves post-infectious immune dysregulation. Patients with MIS-C should ideally be managed in a pediatric intensive care environment since rapid clinical deterioration may occur. Specific immunomodulatory therapy depends on the clinical presentation. The relationship between the immune response to SARS-CoV-2 vaccines in development and MIS-C requires further study.

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“…In this view, a previous “contact” with these viruses might provide at least a partial/basal immunization (through the production of neutralizing antibodies) shielding humans also against the circulating SARS-CoV-2. Recently, other authors have agreed with this hypothesis in which a cross-immunity can be induced by seasonal infections by human coronaviruses especially in children [9] , [21] , [22] . This may explain their modest involvement both in the number and severity of the infection.…”

Section: Consequences Of the Hypothesis And Discussionmentioning

confidence: 73%

“…Another possibility may be related to higher numbers of CD4 cells (due to the thymus activity) and to lower numbers of CD8 T lymphocytes in children compared to adults [3] , [9] . This may be protective because it has been reported that SARS-CoV-2 infection is related to a decrease in CD4 cells in older men when compared with younger men and women’s higher CD4 cell numbers [3] .…”

Section: Introductionmentioning

confidence: 99%

Why do children seem to be more protected against COVID-19? A hypothesis

Sposato

Scalese

2020

Medical Hypotheses

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Today it remains unclear why children seem to be less likely to get infected by COVID-19 or why they appear to be less symptomatic after infections. All individuals, especially children, are exposed to various viruses including human coronavirus (CoVs) that can generally lead to respiratory infections. We hypothesize that recurrent CoVs exposure may induce an effective antiviral B and T-cell-mediated adaptive immune response, which could also be protective against COVID-19. Based on the high-homology between the Spike protein epitopes of taxonomically-related coronaviruses, we theorize that past/recurrent contact with CoVs might shield children also against the circulating COVID-19 through a possible neutralizing antibody response previously CoVs-induced. This would open up possible lines of research for the development of live-attenuated virus vaccines from CoVs. Future research is desirable to confirm or disprove such hypothesis.

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COVID-19 in Newborns and Infants—Low Risk of Severe Disease: Silver Lining or Dark Cloud?

Cited by 68 publications

References 33 publications

Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review

Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review

Multi-System Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Review of Clinical Presentation, Hypothetical Pathogenesis, and Proposed Management

Why do children seem to be more protected against COVID-19? A hypothesis

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