SARS-CoV-2 Infections in Children; From Newborns to Adolescents – Whether to Remain on Anti-Rheumatic Therapy for Children with Rheumatic Diseases
2020 Volume 32 Issue 2 Pages 98-107
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2020 Volume 32 Issue 2 Pages 98-107
In children, COVID-19-related diseases are less frequent and less aggressive. However, precise analysis has revealed that children in paediatric ICUs included many infants and young children with such severe symptoms as respiratory distress and multiple organ failure. In the United States, 74 children admitted to paediatric ICUs were estimated to be a reflection of the 176, 190 children globally infected with SARS-CoV-2.
For us paediatricians, there is a strong concern whether SARS-CoV-2 has a potential for intrauterine vertical transmission. After caesarean delivery, newborns were free from SARS-CoV-2 infections because samples taken from neonates proved to be sterile. However, neonates with confirmed SARS-CoV-2 infections were then infected after birth via exposure to coughs or microdroplets from their mothers. Thus, neonates born from COVID-19-positive mothers should be separated as soon as possible after delivery, and then fed formula exclusively.
Children with chronic rheumatic diseases under treatment with anti-rheumatic therapy―especially biologics ― are supposedly sensitive to SARS-CoV-2. On the other hand, hydroxychloroquine and tocilizumab were quite effective for patients progressing to ARDS/multiple organ dysfunction due to a cytokine storm. It will be beneficial to maintain undergoing therapy for chronic rheumatic diseases in the setting of the COVID-19 pandemic because stopping the therapy could cause inflammatory relapses to occur and there might not then be a way to suppress the inflammation.
In the course of COVID-19 infections, some cases were diagnosed with Kawasaki disease. However, in East Asia, Japan, and Korea ― the most prevalent areas of incidences of Kawasaki disease ― there still seem to be no reports suggesting a relationship between COVID-19 and Kawasaki disease. Thus, we must remain vigilant and keep on the lookout for the time being as more information is gathered about COVID-19’s characteristics.
