Objective To summarize the epidemiological, clinical characteristics and discharge outcomes of children with COVID-19 and to provide evidence to guide the prevention and treatment of COVID-19. MethodsConfirmed COVID-19 cases of children aged from 1 month to 18 years were included. We excluded articles on SARS-CoV-2 nucleic acid detection reagents and molecular diagnosis and those from which children's data could not be extracted. Literature was searched in the database of PubMed, CBM and CNKI from January 1st, 2019 to March 11th, 2020 and a supplementary search was performed in the WHO COVID-19 literature database and references of the included literature. Risk of bias assessment was conducted by the associate chief physician of Department of Infectious Disease in Children's Hospital of Fudan University. Literature evaluation and data extraction were instructed and reviewed by professionals from Center for Clinical Guideline Development and Evaluation in Children's Hospital of Fudan University. ResultsA total of 18 literature was included according to the eligibility criteria with 13 in Chinese and 5 in English. Among them, there are 10 case reports and 8 case series reports, 3 of which had acceptable risk of bias. One hundred and twenty-seven children with COVID-19 were identified including 47 of mild type, 78 of common type and 2 of critical type. They were at the age of 1 day to 17 years with 66 males (52%) and were all tested positive for SARS-CoV-2 nucleic acid. The number of cases with history of residence or travel in Hubei Province or contact with people from Hubei Province, and cases of family clustering accounted for 58%（74/127）and 75%（79/105）respectively. Of 11 literature mentioning the time for diagnosis, 9 described it as 1-3 days. Seventy-two cases had fever and specific body temperature values with 43 cases at 37.3-39℃, and 6 cases at >39 ℃. Of 10 literature mentioning fever duration, 7 described it as 1 day. Coughing, nasal congestion/runny nose/sneezing, diarrhea and vomiting, and asymptomatic children were respectively identified in 11 literature (47 cases), 6 literature (14 cases), 4 literature (10 cases with 1 critical illness and 4 of first symptoms) and in 7 literature (26 cases with 15 of pneumonia by imaging) . A total of 16 literature (105 cases) reported routine blood test results with WBC 3.2-16.71 (×109·L-1) and 2 of decrease in absolute lymphocytes. Imaging examinations were performed in 126 cases from 17 literature. Four of 11 cases of chest X-ray showed inflammatory exudation at one side and there were 80 cases (70%) with signs of pneumonia and 35 cases (30%) without that in 115 cases undergoing chest CT. Among the 80 children with CT signs of pneumonia, there were 57 for ground-glass shadows (71%), 42 for small nodules/consolidation shadows (52%) (coexisting with ground-glass shadows), 4 for grid shadows and 3 for bronchopneumonia-like changes. Seventy-three cases (57%) received antiviral therapy including interferons, peramivir/oseltamivir, ribavirin, Kaltera (lopinavir/ritonavir), arbidol, darunavir/cobicistat, etc. ; 11 cases were treated with Chinese patent medicine and 3 cases did not receive any treatment. Forty-six children were discharged or tested negative for SRAS-CoV-2 by nasopharyngeal swabs after 5 to 22 days. The longest disease duration was 30 days that nucleic acid test by stools still remained positive at the 30th day of observation. ConclusionChildren with COVID-19 were more common in family clusters. They were featured by mild and common types with short fever duration, mild respiratory symptoms, short intervals between the onset of symptoms and diagnosis and a good prognosis.
Objective To compare the pregnancy outcomes of pregnant women infected with SARS-CoV-1, MERS-CoV and SARS-CoV-2 and their impacts on newborns so as to provide evidence to guide the prevention and treatment of COVID-19. MethodsNeonates delivered by pregnant women diagnosed with coronavirus (SARS-CoV-1, MERS-CoV and SARS-CoV-2) infections through nucleic acid tests were included. Literature on pregnant women with SARS, MERS and COVID-19 and their neonates was searched in the database of PubMed, CBM and CNKI from January 1st, 2000 to March 9th, 2020 and a supplementary search was performed in the WHO COVID-19 literature database and references of the included literature. The literature was screened by reading the abstract and the full text according the eligibility criteria. Literature evaluation and data extraction were instructed and reviewed by professionals from Center for Clinical Guideline Development and Evaluation in Children's Hospital of Fudan University. ResultsA total of 42 pregnant women diagnosed with coronavirus infections and 36 live births were included for statistical analysis. There were 13 cases of SARS-CoV-1 infected pregnant women. Among them, 3 died (23%) and 4 of 10 surviving cases had a spontaneous abortion in the first trimester (40%), and the remaining 6 cases gave birth to 6 neonates (4 premature and 2 full-term) without SARS-CoV-1 infection. Two pregnant women were diagnosed with MERS-CoV infection. Both of them survived and 2 live-born neonates were born (1 premature and 1 full-term) without MERS-CoV infection. There were 27 confirmed cases of pregnant women with SARS-CoV-2 infection without deaths and 28 live births (1 twins) were delivered. Three of the newborns were tested positive for the nucleic acid test of SARS-CoV-2 through nasopharyngeal swabs with one severe case with congenital atrial septum defect and two mild cases. Close contact between mother and baby or family members after birth existed and no evidence of vertical placental transmission was found. There was no breastfeeding. All were cured and discharged. ConclusionThough the epidemiological and clinical characteristics of pregnant women infected by SARS-CoV-1 and MERS-CoV and their newborns were insufficiently reported in the literature, it was still of certain reference value for the prevention, diagnosis and treatment of SARS-CoV-2 infection in this population. Despite the high risk of bias in the literature, the outcomes of pregnant women with SARS-CoV-2 infection and their newborns at discharge were good.
ObjectiveTo explore the diagnosis and treatment of neonatal SARS-CoV-2 infection, the transmission ability of SARS-CoV-2, and the safety of transport. MethodsThe epidemiological history, transport process, treatment methods and the outcome of a neonate with SARS-CoV-2 infection were analyzed. ResultsThe newborn, male, 22 days old, was transported to the Children's Hospital Affiliated of Zhengzhou University on February 22, 2020 due to the intermittent fever for 17 days by a negative-pressure ambulance from Xinyang Central Hospital. On January 22, his father and mother (37+3 weeks pregnant) returned to the home of his maternal grandparents in Henan Province from Wuhan, Hubei Province to prepare for the birth and later the mother, father and maternal grandparents had fever and other symptoms one after another. After the cesarean section on January 31, the mother and newborn lived in the same ward. On February 1, the mother was diagnosed with COVID-19 and his father and maternal grandparents were diagnosed with COVID-19 successively. On February 5, the newborn had fever and was diagnosed with COVID-19 the next day with chest X-ray showing diffuse consolidation. After 17-day isolation treatment in Xinyang Central Hospital, his temperature was 37.5 ℃ and a nasal cannula was still needed for inhaling oxygen. Healthcare providers under the tertiary personal protection spent 4.5 hours transporting him to our hospital by a negative-pressure ambulance. In our hospital, he was put in an incubator and given artificial feeding and a nasal cannula with FiO2 40% and a flow rate of 1 L·min-1 and interferon α-1b was sprayed into the nasal cavity. Bedside cardiac color Doppler ultrasound showed an atrial septal defect (6.9 mm), 1 950 pg·mL-1 for NT-proB-type Natriuretic Peptide (BNP) blood test and manifestations of cardiac insufficiency, and a balanced fluid intake was given. On February 28, the newborn's nasopharyngeal swabs were tested negative for SARS-CoV-2. On March 1, his nasopharyngeal swabs and stools were tested negative and the chest CT showed most shadow at the lower right lung disappeared. On March 6, the newborn was discharged. ConclusionA long-distance transport of a severe neonatal COVID-19 case was possible under effective safety protection measures when there was a need. This case did not support vertical transmission from mother to neonates and there were no adults infected by the newborn. Fluid management should be paid more attention when heart disease is combined.
ZHU Yan-ping, JIANG Si-yuan, WANG Xiao-kang, LI Ming-xia, YANG Chen-hao, CAO Yun, LIANG Yi-fei, Reduction of Infection in Neonatal Intensive Care Unit Using the Evidence-based Practice for
Objective:To investigate the incidence of retinopathy of prematurity (ROP) in the premature infants less than 34 weeks' gestation in 25 neonatal intensive care units (NICU) in China. Methods:The data were from the clinical database of preterm infants established by a cluster randomized control study of "REduction of Infection in Neonatal intensive care units using the Evidencebased Practice for Improving Quality (REINEPIQ)" . All preterm infants with less than 34 weeks' gestation who received at least one ROP screening during hospitalization in 25 tertiary Chinese NICUs from May 2015 to April 2018 were enrolled. Results:A total of 14, 015 preterm infants <34 weeks' gestation received ROP screening during hospitalization during the study period. Overall 2, 304 infants (16.4%) were diagnosed with ROP. Incidence of stage 1, stage 2 and stage 3 or above were 7.8%, 7.2% and 1.5%, respectively. Among infants with gestational age <28 weeks, the incidence of ROP and stage 3 or above ROP were 56.5% and 9.6%, respectively. Among infants with birth weight <1, 000 g, the incidence of ROP and stage 3 or above ROP were 54.2% and 9.6%, respectively. Among infants with birth weight from 1, 000 g to 1, 499 g, the incidence of ROP and stage 3 or above were 22.1% and 1.5%, respectively. Among all infants with ROP, 8.2% (188) received treatment with 62% (117) receiving intraocular medicine injection. Significant variations of ROP incidence existed among the included NICUs. Conclusion:The incidence of ROP among infants <34 weeks' gestation was 16.4% in 25 tertiary Chinese NICUs with relatively high proportion of treatment and significant variations among different NICUs.
Abstract Objective:NFKB1 deficiency will result in a variety of clinical and immunological features. EpsteinBarr virusinduced disease is a rare phenotype. We report the case to expand the spectrum of this disease. Methods:We analyzed clinical manifestations and physical signs of one patient with NFKB1 deficiency and performed immunological evaluation, Lymphocyte subpopulation, Whole exome sequencing (WES), Sanger sequencing, Realtime PCR and Western blot. Results:The patient is a 12year-old female. She suffered from a recurrent fever for six months. She was diagnosed with dysfunction of blood clotting, hepatic function damage, hepatosplenomegaly and lymphadenopathy accompanied with high titer of EBV and significantly increased NK cell. WES showed that she carried the NFKB1 gene de nove mutation: c.2430 dupA. Its site had not been reported before. Different from previous reports, the mutation was located in the death domain of the protein, which may lead to an early termination of amino acid. Functional experiment showed decreased p50 expression and unstable mRNA. Conclusion:NFKB1 deficiency could be diagnosed by combining clinical and immunological features with genetic phenotypes. We expanded the clinical and genetic phenotypes of this disease.
Abstract Objective:To investigate the characteristics of auditory brainstem response (ABR) in children with global developmental delay (GDD) to assist in early diagnosis of GDD. Methods:GDD refers to the delay in two or more developmental indicators or milestones. Children aged 1 to 4 years who met the GDD diagnostic criteria and received ABR test were enrolled from July 2015 to August 2019 and separated into a GDD group (the developmental quotient of each energy region in Gesell development scale ≤75) and a control group (the developmental quotient of all energy regions＞85). The interval between the test of ABR and Gesell scale should not exceed 2 weeks. The GDD group and the control group are both divided into two subgroups: 1 to 2 years old (≥ 1 year but <3 years) and 3 to 4 years old (≥ 3 years but <5 years).Compare the ABR parameters between the GDD and control group as well as the changes of the ABR parameters between the two age groups. Results:There were 129 children in the GDD group, 83 for 1 to 2 years old and 46 for 3 to 4 years old and 58 in the control group, 45 for 1 to 2 years old and 13 for 3 to 4 years old. Peak latency Ⅲ, Ⅴ and inter-peak latency Ⅲ-Ⅴ, Ⅰ-Ⅴof the GDD group was prolonged when compared with the control group (P<0.05). In the 1-2yr subgroup, peak latency Ⅲ, Ⅴ and inter-peak latency Ⅲ-Ⅴ, Ⅰ-Ⅴof the GDD group was prolonged when compared with the control group (P<0.05). In the 34yr subgroup, interpeak latency Ⅰ-Ⅴof the GDD group was prolonged when compared with the control group (P<0.05). WaveⅤamplitude of the GDD group was reduced when compared with the control group(P<0.05). In the 12yr subgroup, waveⅤamplitude of the GDD group was reduced when compared with control group (P<0.05). In the 3-4yr subgroup, there were no amplitude differences between the GDD and control group. In the GDD group, peak latency Ⅲ, Ⅴand inter-peak latency Ⅰ-Ⅲ, Ⅰ-Ⅴin the 3-4yr subgroup were reduced when compared with the 1-2yr subgroup(P<0.05) and in the control group, no age differences were found in latency and amplitude. Conclusion:GDD children showed brainstem auditory processing abnormalities with prolonged ABR peak latency Ⅲ, Ⅴ, inter-peak latency Ⅲ-Ⅴ, Ⅰ-Ⅴ and reducedⅤamplitude. The younger the GDD children were, the more obvious the ABR abnormalities were. The latency and amplitude gradually caught up to the normal level from the age of 3. Therefore, the ABR test can be used as an objective method to assist in GDD diagnosis but its role in developmental monitoring will be less important with an increase in the age.
Abstract Objective:To explore the intelligence profile of preschool children with autistic spectrum disorders (ASD) and FSIQ>70, hoping to provide reference for early interventions and technological improvements in inclusive education for ASD children. Methods:ASD children aged 4-6 years who received the test of Chinese version of the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPSSI-Ⅳ(CN)) and got FSIQ>70 were selected from the database of Department of Child Health Care at Children's Hospital of Fudan University. Their intelligence structure and level were analyzed by gender. ASD children were diagnosed according to DSM-V criteria and their scores of Autism Diagnostic Observation Schedule (ADOS) met the diagnostic point of ASD. Intelligence assessment was conducted by qualified doctors who have a certificate of WPSSI-Ⅳ. Results:A total of 24 ASD children (20 boys and 4 girls) aged 49-78 (63.9±9.4) months were included. At the first diagnosis, 19 of them had completed the ADOS assessment (16 boys and 3 girls) and educational levels of 21 children's parents were collected . There were no statistically significant differences between girls and boys in age at the first diagnosis, age of wisdom assessment, ADOS scores and parental education levels, while there were statistically significant differences between boys (88.5±12.2) and girls (107.5±12.5) in FSIQ (P=0.009). Boys had strength in Visual Spatial Index (VSI), while their ability in Working Memory Index (WMI) and Processing Speed Index (PSI) was poorer (P<0.001). There were no statistically significant differences in all functional areas of girls (P=0.043). Girls performed better than boys in all the functional areas, with significant differences in verbal comprehension index (VCI), WMI and PSI (P<0.05). Conclusion:ASD girls with FSIQ>70 had higher intelligence levels than boys. Boys' performance in VSI was significantly better than that in WMI and PSI. Girls had greater advantages than boys in VCI, WMI and PSI.
Abstract Objective:To investigate the clinical characteristics and risk factors of Kawasaki disease (KD) complicated with hip joint synovitis(SH). Methods:The children admitted to the KD database of Yuying Children's Hospital Affiliated to Wenzhou Medical University from January 1st, 2013 to May 1st, 2017 were reviewed. The case group was children with SH(SHKD group) and the control group was children without SH (KD group). The possible risk factors of SH in children with KD were analyzed. Results:A total of 1,038 children with KD were included in this study, 13 in SHKD group and 1,025 in KD group. In 13 cases of SHKD, there were 6 males and 7 females, the average age of onset was (35.5 ± 15.3) months, and synovitis appeared on the 1st to 17th (9.1 ± 4.2) day. There were 9 cases of bilateral SH, 2 cases of right SH, 1 case of left SH and 1 case of synovitis of hip and knee joint. After treatment with intravenous immunoglobulin (IVIG) and aspirin, coronary artery lesion (CAL) occurred in 1 case, shock occurred in 1 case, and IVIG-resistance occurred in 3 cases. The recovery time of SH symptoms was 1-10 (4.0 ± 2.4) days. Age, D-Dimer and the incidence of IVIG-resistance were statistically significant between the two groups (P-value was 0.026, 0.003 and 0.012, respectively). Multivariate logistic regression analysis found that the increase of D-Dimer and IVIG-resistance were independent risk factors for SHKD, and OR was 1.151 (95%CI：1.021-1.297) and 12.239 (95%CI：2.476-60.485), respectively. Conclusion:The clinical manifestations of SHKD were mainly hip joint pain and limited lower limb activity, with mild symptoms and a good prognosis. The increase in D-Dimer and IVIG-resistance were independent risk factors for SHKD.
Abstract Objective:To assess the health-related quality of life(HRQoL) of children with Alport syndrome. Methods:In this case control study, the cases included children with Alport syndrome who attended the 6th Alport family meeting in China held in 2018, and the controls included children with primary nephrotic syndrome who were admitted to Division of Nephrology, Department of Pediatrics, Peking University First Hospital between October 2017 and February 2018. The demographic, clinical and social data were collected using a self-designed questionnaire. The Chinese version of Pediatric Quality of Life InventoryTM (PedsQLTM) 4. 0 Generic Core Scales were used to assess HRQoL in the participants. Parallel child self-report (5-18 years) and parent proxy-report (2-18 years) forms was included. The trained research assistants guided the questionnaire filling by the same explanatory words and instructions. Results:A total of 91 families(61 families with Alport syndrome and 30 families with primary nephrotic syndrome)were recruited in the study. There were significant differences in the duration of disease, the level of proteinuria, the condition in the last one month, hospitalization frequency, family monthly average income and the impact of disease cost on family between children with Alport syndrome and primary nephrotic syndrome. A total of 81 child self-report forms (54 from Alport syndrome and 27 from primary nephrotic syndrome) and 91 parent proxy-report forms (61 from Alport syndrome and 30 from primary nephrotic syndrome) were collected. There were no significant differences in overall scales and four dimensions between the child-self and parent-proxy reports for both Alport syndrome and primary nephrotic syndrome. Compared with children affected by primary nephrotic syndrome and their parents, no significant differences were observed in overall scales and four subscales of the child-self reports from Alport syndrome, whereas parents of children with Alport syndrome had lower scores in the social subscale. Conclusion:Compared with primary nephrotic syndrome, HRQoL of Alport syndrome was not worse in the assessment by the Chinese version of PedsQLTM 4.0 Generic Core Scales.
Abstract Objective:To evaluate the effectiveness and safety of radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in infants. Methods:Infants younger than 1 year old were evaluated retrospectively, who underwent RFCA in our institution between January 1, 2015 and June 30, 2019. Indications for RFCA included drug-refractory atrioventricular reentrant tachycardia (AVRT) or cardiomyopathy induced by APs. All procedures were performed using a modified low dose imaging protocol of fluoroscopy. Results:A total of eight infants were included, with median age of 6.5 months and weight of 7.7kg. The electrophysiology study confirmed 1 AP in each 7 patients and 2 APs in 1 patient, of which 5 were right lateral; 3 were left lateral and 1 was left posteroseptal. The AP was manifested in 4 patients with Wolff-Parkinson-White syndrome and concealed in another 4 patients. Median fluoroscopy time was 11.2 minutes and dose-area product was 15.7 μGy. m2. The acute success rate was 100%. After the median follow-up period of 15 months, no tachycardia recurred. One patient developed late mitral valve perforation, which was successfully repaired by surgery and no other complications occurred. Conclusion:RFCA could effectively cure infants with drug-refractory arrhythmias induced by APs, however, the indications should be taken seriously and proper procedural modifications might be needed to avoid ablation complications as far as possible.
