COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features
COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features
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DOI：
10.1097/inf.0000000000002700
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发表时间：
2020-06-01
影响因子：
3.6
通讯作者：
Curtis, Nigel
中科院分区：
文献类型：
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作者：
Zimmermann, Petra;Curtis, Nigel
新型严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）大流行在地球仪迅速蔓延。与最初的报告相反，最近的研究表明，儿童与成年人一样可能感染病毒，但症状较少，病情较轻。在这篇综述中，我们总结了迄今为止在儿科病例系列中报告的儿童感染SARS-CoV-2的流行病学和临床特征。我们还总结了妊娠期感染SARS-CoV-2的妇女所生新生儿的围产期结局。我们发现了11个病例系列，共333名婴儿和儿童。总体而言，83%的儿童有积极的接触史，主要是与家庭成员。潜伏期在2至25天之间，平均为7天。病毒可从鼻咽分泌物中分离长达22天，从粪便中分离超过30天。在高达79%的儿童中报告了合并感染（主要是支原体和流感）。高达35%的儿童无症状。最常见的症状是咳嗽（48%;范围19%-100%），发热（42%; 11%-100%）和咽炎（30%; 11%-100%）。其他症状包括鼻塞、流涕、呼吸急促、喘息、腹泻、呕吐、头痛和疲劳。实验室测试参数仅发生最低限度的改变。影像学表现无特异性，包括单侧或双侧浸润伴磨玻璃影或实变伴周围晕征。儿童很少需要进入重症监护室（3%），迄今为止，全球仅报告了少数儿童死亡。9个病例系列和2个病例报告描述了65名妇女和67名新生儿妊娠期间母体SARS-CoV-2感染的结局。两名母亲（3%）被送进重症监护室。30%的孕妇报告胎儿窘迫。37%的妇女早产。新生儿并发症包括呼吸窘迫或肺炎（18%）、弥散性血管内凝血（3%）、窒息（2%）和2例围产儿死亡。据报道，尽管在分娩和母婴分离期间采取了严格的感染控制和预防措施，但仍有4名新生儿（3名患有肺炎）呈SARS-CoV-2阳性，这意味着不能排除垂直传播。
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has spread rapidly across the globe. In contrast to initial reports, recent studies suggest that children are just as likely as adults to become infected with the virus but have fewer symptoms and less severe disease. In this review, we summarize the epidemiologic and clinical features of children infected with SARS-CoV-2 reported in pediatric case series to date. We also summarize the perinatal outcomes of neonates born to women infected with SARS-CoV-2 in pregnancy. We found 11 case series including a total of 333 infants and children. Overall, 83% of the children had a positive contact history, mostly with family members. The incubation period varied between 2 and 25 days with a mean of 7 days. The virus could be isolated from nasopharyngeal secretions for up to 22 days and from stool for more than 30 days. Co-infections were reported in up to 79% of children (mainly mycoplasma and influenza). Up to 35% of children were asymptomatic. The most common symptoms were cough (48%; range 19%-100%), fever (42%; 11%-100%) and pharyngitis (30%; 11%-100%). Further symptoms were nasal congestion, rhinorrhea, tachypnoea, wheezing, diarrhea, vomiting, headache and fatigue. Laboratory test parameters were only minimally altered. Radiologic findings were unspecific and included unilateral or bilateral infiltrates with, in some cases, ground-glass opacities or consolidation with a surrounding halo sign. Children rarely needed admission to intensive care units (3%), and to date, only a small number of deaths have been reported in children globally. Nine case series and 2 case reports described outcomes of maternal SARS-CoV-2 infection during pregnancy in 65 women and 67 neonates. Two mothers (3%) were admitted to intensive care unit. Fetal distress was reported in 30% of pregnancies. Thirty-seven percent of women delivered preterm. Neonatal complications included respiratory distress or pneumonia (18%), disseminated intravascular coagulation (3%), asphyxia (2%) and 2 perinatal deaths. Four neonates (3 with pneumonia) have been reported to be SARS-CoV-2 positive despite strict infection control and prevention procedures during delivery and separation of mother and neonates, meaning vertical transmission could not be excluded.