key: cord-0873007-1hwcp09t authors: Lu, Qi; Shi, Yuan title: Coronavirus disease (COVID‐19) and neonate: What neonatologist need to know date: 2020-03-12 journal: J Med Virol DOI: 10.1002/jmv.25740 sha: 95000c60c92a70799da860a76ad5e75e50ec58a0 doc_id: 873007 cord_uid: 1hwcp09t Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) cause china epidemics with high morbidity and mortality, the infection has been transmitted to other countries. About three neonates and more than 230 children cases are reported. The disease condition of the main children was mild. There is currently no evidence that SARS‐CoV‐2 can be transmitted transplacentally from mother to the newborn. The treatment strategy for children with Coronavirus disease (COVID‐19) is based on adult experience. Thus far, no deaths have been reported in the pediatric age group. This review describes the current understanding of COVID‐19 infection in newborns and children. Since December 2019, patients with fever, dry cough, normal, or decreased white blood cell counts who were initially diagnosed as "Fever of Unknown Origin with pneumonia" have been continuously increasing in Wuhan. 1 The causative agent of this unexplained infected pneumonia was identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which not only has a strong human-to-human transmission but also causes severe pneumonia to death. 2 CoV-2 is so aggressive that the infection has been transmitted to other countries and is seriously imperiling human life. World Health Organization has declared this disease to constitute a Public Health Emergency of International Concern on 30 January 2020. 3 SARS-CoV-2 is single-stranded RNA viruses, belongs to subgenus Sarbecovirus of the genus Betacoronavirus. 5 15, 16 According to existing complete data, amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six newborn babies delivered by infected mothers were tested for SARS-CoV-2, and all samples tested negative for the virus. 17 The incubation periods of COVID-19 were 1 to 14 days, and the mean has been estimated to be 5. nucleic acid from nasopharyngeal swab was recorded in three children, 9 days in two patients, 12 days in one patient. 19 Thus far, no deaths have been reported in the children which are similar to SARS. 19, 20 Three newborns have been diagnosed up to date who mainly belonged to family cluster cases. One 17 days old neonate diagnosed as COVID-19 infection had a fever, cough, and vomiting milk. In his family, the housemaid was the earliest case, subsequently, the mother was infected. 21 The second newborn appeared fever on 5 days after birth whose mother also confirmed infected. The third one who was born by the infected mother was silent and diagnosed on 30 hours after birth by the viral nucleic acid test. Short breath, vomiting milk, cough, and fever were present in neonates. The vital signs of those neonates were stable, there is no severe emergency case until now. 19, [21] [22] [23] The diagnosis of COVID-19 is based on comprehensive contact and travel history and precise laboratory tests. Current diagnostic tools were the nucleic acid or virus gene tests. Samples included nasopharyngeal swab, sputum, secretion of the lower respiratory tract, blood, and feces. The nasopharyngeal swab is the most common specimens, however, its detection positive rate is less than 50%. Repeated detection is necessary for improving the positive rate. The positive rate of bronchoalveolar lavage fluid was high, but it is not suitable for most of the patients due to increased risk of crossinfection. 24 puerperant. If the puerperant is positive for SARS-CoV-2, the neonate must be isolated, then detected SARS-CoV-2. 26 Early identification and early isolation are imperative for COVID-19 control. COVID-19 neonates should be placed in negative pressure rooms or in rooms in which room exhaust is filtered through high-efficiency particulate air filters with reference to MERS management. 16 No visiting is allowed for neonates of COVID-19. Treatment mainly depends on adult patients' clinical experience due to few cases in children. There is no specific drug treatment for SARS-CoV-2 being similar to MERS-CoV and SARS-CoV. 19, 26 Symptomatic and supportive treatment is the mainstay of therapy for patients of SARS-CoV-2 infection including the supply of oxygen, the maintenance of water-electrolyte, and acid-base balance. The supplement of water and electrolyte should be appropriate, so as to avoid aggravating the pulmonary edema and reduced oxygenation. 27 For newborns with severe acute respiratory distress syndrome, high-dose pulmonary surfactant, inhaled nitric oxide, high-frequency oscillatory ventilation, and extracorporeal membrane lung may be useful. In the United States, patients' conditions were improved apparently after the treatment with nucleoside analog-remdesivir, but there was just one case, the efficacy needs further verification. 28 Interferon-α2b nebulization were be applied in MERS-CoV and SARS-CoV, so it could be considered to use in SARS-CoV-2 infection. 29, 30 In addition, three potential drug combinations (sirolimus plus dactinomycin, mercaptopurine plus melatonin, and toremifene plus emodin) are candidate repurposable drugs. 31 Moreover, convalescent sera from SARS-CoV-2-recovered patients may be useful for SARS-CoV-2 infection, because of a significant reduction in the mortality following convalescent sera from SARS-recovered patients treatment. 32 7 | CONCLUSIONS COVID-19 can result in asymptomatic to severe illness, fortunately, children without underlying diseases appeared to have mild disease. The disease condition of the neonates was also minor. Though this new virus comes out without specific antiviral drugs treatment, neonatologist needs to more virological, epidemiological, and clinical data to treat and manage COVID-19. The authors declare that there are no conflict of interests. 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