A systematic review of SARS-infected pregnant females, newborns, children and adolescents_Chinese Journal of Evidence-Based Medicine

Authors：

LI Wenxing ^1,2 ,  TANG Jun ^1,2 , ZENG Yan ^1,2 , YUE Yan ^1,2 , HE Yang ^1,2 , ZHANG Meng ^1,2 , HU Peng ^1,2 , XIONG Tao ^1,2 , MU Dezhi ^1,2 ,  LI Youping ³

1. Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, P.R.China;
3. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

TANG Jun, Email: tj1234753@sina.com; LI Youping, Email: yzmylab@hotmail.com

Keywords：

Severe acute respiratory syndrome (SARS); SARS-CoV; Children; Infants; Newborns; Adolescent; Pregnant women; Systematic review

DOI：

10.7507/1672-2531.202002027

Video：

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Objectives To systematically review the clinical characteristics of pregnant females, newborns, children and adolescents with SARS infection.Methods The clinical characteristics of patients with SARS infection were searched using PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases. Descriptive analysis was performed to analyze the clinical characteristics of the patients, clinical manifestations, treatment and prognosis.Results A total of 13 studies including 19 pregnant females, 14 newborns, and 81 children and adolescents were identified. The ratio of male to female was 1 to 1.2 in children and adolescents patients aged 56 days to 17.5 years. Children under 12 years old accounted for 58.3% (28/48). Of the child patients, 34.0% (16/47) had close contact with patients with SARS. Fever (93.8%, 76/81) and cough (49.4%, 40/81) were the most common symptoms in children and adolescents with SARS infection, and 17.5% (11/63) occurred with shortness of breath or dyspnea. The positive ratio of nucleic acid detection for SARS-CoV was 9.2% (14/48), and the positive ratio of serum antibody was 92.9% (13/14). Peripheral blood lymphocyte reduction was approximately 65.7% (44/67). Approximately 70.8% (51/72) unilateral and 29.2% (21/72) bilateral lesions were found by thoracic X-ray or CT scan. No child fatalities were reported. As of maternal patients, aged 23 to 44 years, 10 cases (52.6%) were infected during early and middle pregnancy, and 9 cases (47.4%) during late pregnancy. Fever (100.0%, 19/19) and cough (78.9%, 15/19) were the main clinical symptoms, and shortness of breath/dyspnea occurred in 36.8% (7/19) of infected pregnant females. The positive ratio of nucleic acid detection for SARS-CoV was 50.0% (8/16), whereas the positive ratio of serum antibody was 93.3% (14/15). The ratios of thrombocytopenia, lymphopenia, and liver enzymes abnormalities were 38.9% (7/18), 61.1% (11/18) and 50.0% (3/6). All patients were identified for lesions by thoracic X-ray or CT scan examination. Seven cases were severe (36.8%). Five patients were treated with mechanical ventilation (26.3%). Three patients died (15.8%). Four patients were spontaneous abortion (40.0%, 4/10). Nine patients were cesarean sectioned (75.0%, 9/12). Six fetuses (46.2%, 6/13) with fetal distress, 7 cases (53.8%, 7/13) with premature delivery were identified. Three fetuses (23.1%) had intrauterine growth retardation. None of the fourteen newborns was diagnosed as SARS infection.Conclusions The clinical symptoms such as fever and cough in children and adolescents with SARS infection are similar to that of adult patients. However, children and adolescents are usually manifested as mild infection without reported death. There is no evidence to support that SARS-CoV could transmit vertically from infected mother to their fetuses.

Citation： LI Wenxing, TANG Jun, ZENG Yan, YUE Yan, HE Yang, ZHANG Meng, HU Peng, XIONG Tao, MU Dezhi, LI Youping. A systematic review of SARS-infected pregnant females, newborns, children and adolescents. Chinese Journal of Evidence-Based Medicine, 2020, 20(4): 426-436. doi: 10.7507/1672-2531.202002027 Copy

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10.	陆普选, 周伯平, 胡毅文, 等. 五例严重急性呼吸综合征患儿的临床和胸部 X 线表现特点. 中华儿科杂志, 2003, 41(9): 9-11+85.
11.	Chiu WK, Cheung PC, Ng KL, et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med, 2003, 4(3): 279-283.
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13.	Tsou IY, Loh LE, Kaw GJ, et al. Severe acute respiratory syndrome (SARS) in a paediatric cluster in Singapore. Pediatr Radiol, 2004, 34(1): 43-46.
14.	Bitnun A, Read S, Tellier R, et al. Severe acute respiratory syndrome-associated coronavirus infection in Toronto children: a second look. Pediatrics, 2009, 123(1): 97-101.
15.	Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol, 2004, 191(1): 292-297.
16.	张建平, 王蕴慧, 陈雷宁, 等. 妊娠中晚期合并重症急性呼吸综合征的临床分析. 中华妇产科杂志, 2003, 38(8): 516-520.
17.	Robertson CA, Lowther SA, Birch T, et al. SARS and pregnancy: a case report. Emerg Infect Dis, 2004, 10(2): 345-348.
18.	Yudin MH, Steele DM, Sgro MD, et al. Severe acute respiratory syndrome in pregnancy. Obstet Gynecol, 2005, 105(1): 124-127.
19.	Shek CC, Ng PC, Fung GP, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics, 2003, 112(4): e254.
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22.	Thabet F, Chehab M, Bafaqih H, et al. Middle East respiratory syndrome coronavirus in children. Saudi Med J, 2015, 36(4): 484-486.
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25.	Guan W, Ni Z, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China. medRxiv, 2020. DOI: 10.1101/2020.02.06.20020974.
26.	赵林清, 钱渊, 朱汝南, 等. 北京地区部分儿童严重急性呼吸综合征的血清学研究. 中华儿科杂志, 2006, 44(4): 262-266.
27.	Yu CC, Li AM, So RC, et al. Longer term follow up of aerobic capacity in children affected by severe acute respiratory syndrome (SARS). Thorax, 2006, 61(3): 240-246.
28.	Yu CC, Li AM, Au CT, et al. Follow up of aerobic capacity in children affected by severe acute respiratory syndrome. Respirology, 2012, 17(3): 513-518.
29.	Shen K, Yang Y, Wang T, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. World J Pediatr, 2020, DOI: 10.1007/s12519-020-00343-7.
30.	庄思颖, 郭娟娟, 曹羽明, 等. 围产期新型冠状病毒感染一例. 中华围产医学杂志, 2020, 23(2): 85-90.
31.	Favre G, Pomar L, Musso D, et al. SARS-CoV-2 epidemic: what about pregnancies? Lancet, 2020, DOI: 10.1016/S0140-6736(20)30311-1.
32.	Zhu H, Wang L, Fang C, et a1. Clinical analysis of 10 neonates born to mothers with SARS-CoV-2 pneumonia. Transl Pediatr, 2020, DOI: 10.21037/tp.2020.02.06.
33.	新生儿出生 30 小时确诊感染新冠病毒专家: 或存母婴垂直传播. Available from: http://www.cnr.cn/hubei/yuanchuang/20200205/t20200205_524961963.shtml.

1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 2020, DOI: 10.1056/NEJMoa2001017.
2. Gorbalenya AE, Baker SC, Baric RS, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses-a statement of the Coronavirus Study Group. BioRxiv, 2020, DOI: 10.1101/2020.02.07.937862.
3. World Health Organization. WHO Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. Available from: https://www.who.int/dg/speeches/detail.
4. 儿童 2019 新型冠状病毒感染的诊断与防治建议(试行第一版). 中华儿科杂志, 2020, DOI: 10.3760/cma.j.issn.0578-1310.2020.0004.
5. World Health Organization. SARS (severe acute respiratory syndrome). Disease outbreaks. Available from: https://www.who.int/csr/sars/country/table2004_04_21/en/.
6. World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). Available from: https://www.who.int/emergencies/mers-cov/en/.
7. Leung C, Kwan Y, Ko P, et al. Severe acute respiratory syndrome among children. Pediatrics, 2004, 113(6): e535-e543.
8. Yang GG, Lin SZ, Liao KW, et al. SARS-associated coronavirus infection in teenagers. Emerg Infect Dis, 2004, 10(2): 382-383.
9. 曾其毅, 刘丽, 曾华松, 等. 广州地区 33 例儿童严重急性呼吸综合征临床特点和治疗转归. 中华儿科杂志, 2003, 41(6): 12-16.
10. 陆普选, 周伯平, 胡毅文, 等. 五例严重急性呼吸综合征患儿的临床和胸部 X 线表现特点. 中华儿科杂志, 2003, 41(9): 9-11+85.
11. Chiu WK, Cheung PC, Ng KL, et al. Severe acute respiratory syndrome in children: experience in a regional hospital in Hong Kong. Pediatr Crit Care Med, 2003, 4(3): 279-283.
12. Sit SC, Yau EKC, Lam YY, et al. A young infant with severe acute respiratory syndrome. Pediatrics, 2003, 112(4): e257-e260.
13. Tsou IY, Loh LE, Kaw GJ, et al. Severe acute respiratory syndrome (SARS) in a paediatric cluster in Singapore. Pediatr Radiol, 2004, 34(1): 43-46.
14. Bitnun A, Read S, Tellier R, et al. Severe acute respiratory syndrome-associated coronavirus infection in Toronto children: a second look. Pediatrics, 2009, 123(1): 97-101.
15. Wong SF, Chow KM, Leung TN, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol, 2004, 191(1): 292-297.
16. 张建平, 王蕴慧, 陈雷宁, 等. 妊娠中晚期合并重症急性呼吸综合征的临床分析. 中华妇产科杂志, 2003, 38(8): 516-520.
17. Robertson CA, Lowther SA, Birch T, et al. SARS and pregnancy: a case report. Emerg Infect Dis, 2004, 10(2): 345-348.
18. Yudin MH, Steele DM, Sgro MD, et al. Severe acute respiratory syndrome in pregnancy. Obstet Gynecol, 2005, 105(1): 124-127.
19. Shek CC, Ng PC, Fung GP, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics, 2003, 112(4): e254.
20. 王蕴慧, 张睿, 张建平, 等. SARS 感染对妊娠结局及胎、婴儿的影响. 中华围产医学杂志, 2004, 7(3): 155-158.
21. Kuypers J, Martin ET, Heugel J, et al. Clinical disease in children associated with newly described coronavirus subtypes. Pediatrics, 2007, 119(1): e70-e76.
22. Thabet F, Chehab M, Bafaqih H, et al. Middle East respiratory syndrome coronavirus in children. Saudi Med J, 2015, 36(4): 484-486.
23. Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci, 2020. DOI: 10.1007/s11427-020-1637-5.
24. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020, DOI: 10.1016/S0140-6736(20)30211-7.
25. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China. medRxiv, 2020. DOI: 10.1101/2020.02.06.20020974.
26. 赵林清, 钱渊, 朱汝南, 等. 北京地区部分儿童严重急性呼吸综合征的血清学研究. 中华儿科杂志, 2006, 44(4): 262-266.
27. Yu CC, Li AM, So RC, et al. Longer term follow up of aerobic capacity in children affected by severe acute respiratory syndrome (SARS). Thorax, 2006, 61(3): 240-246.
28. Yu CC, Li AM, Au CT, et al. Follow up of aerobic capacity in children affected by severe acute respiratory syndrome. Respirology, 2012, 17(3): 513-518.
29. Shen K, Yang Y, Wang T, et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts’ consensus statement. World J Pediatr, 2020, DOI: 10.1007/s12519-020-00343-7.
30. 庄思颖, 郭娟娟, 曹羽明, 等. 围产期新型冠状病毒感染一例. 中华围产医学杂志, 2020, 23(2): 85-90.
31. Favre G, Pomar L, Musso D, et al. SARS-CoV-2 epidemic: what about pregnancies? Lancet, 2020, DOI: 10.1016/S0140-6736(20)30311-1.
32. Zhu H, Wang L, Fang C, et a1. Clinical analysis of 10 neonates born to mothers with SARS-CoV-2 pneumonia. Transl Pediatr, 2020, DOI: 10.21037/tp.2020.02.06.
33. 新生儿出生 30 小时确诊感染新冠病毒专家: 或存母婴垂直传播. Available from: http://www.cnr.cn/hubei/yuanchuang/20200205/t20200205_524961963.shtml.

Chinese Journal of Evidence-Based Medicine

A systematic review of SARS-infected pregnant females, newborns, children and adolescents

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