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  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JPHN</journal-id>
      <journal-title-group>
        <journal-title>Journal of Pediatric Health And Nutrition</journal-title>
      </journal-title-group>
      <issn pub-type="epub">2691-5014</issn>
      <publisher>
        <publisher-name>Open Access Pub</publisher-name>
        <publisher-loc>United States</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="doi">10.14302/issn.2691-5014.jphn-20-3295</article-id>
      <article-id pub-id-type="publisher-id">JPHN-20-3295</article-id>
      <article-categories>
        <subj-group>
          <subject>in-brief</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Clinical Landmarks of COVID-19 in Newborn, Children and Teenagers </article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Stefan</surname>
            <given-names>Bittmann</given-names>
          </name>
          <xref ref-type="aff" rid="idm1843151932">1</xref>
          <xref ref-type="aff" rid="idm1843244900">*</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Elisabeth</surname>
            <given-names>Luchter</given-names>
          </name>
          <xref ref-type="aff" rid="idm1843151932">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Gloria</surname>
            <given-names>Villalon</given-names>
          </name>
          <xref ref-type="aff" rid="idm1843151932">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Elena</surname>
            <given-names>Moschüring-Alieva</given-names>
          </name>
          <xref ref-type="aff" rid="idm1843151932">1</xref>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Anne</surname>
            <given-names>Weissenstein</given-names>
          </name>
          <xref ref-type="aff" rid="idm1843151932">1</xref>
        </contrib>
      </contrib-group>
      <aff id="idm1843151932">
        <label>1</label>
        <addr-line>Department of Pediatrics, Ped Mind Institute (PMI), Gronau, Germany</addr-line>
      </aff>
      <aff id="idm1843244900">
        <label>*</label>
        <addr-line>Corresponding author</addr-line>
      </aff>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Andrea</surname>
            <given-names>Martins da Silva</given-names>
          </name>
          <xref ref-type="aff" rid="idm1843273444">1</xref>
        </contrib>
      </contrib-group>
      <aff id="idm1843273444">
        <label>1</label>
        <addr-line>Rua Franklin Machado Santana 847 14340000 Brodowski SÃ£o Paulo Brazil </addr-line>
      </aff>
      <author-notes>
        <corresp>Stefan Bittmann, MD, MA, Head of the Department of Pediatrics and Ped Mind Institute (PMI), Hindenburgring 4, D-48599 Gronau, Germany. Tel: <phone>++49-2565-97325</phone>. Fax: <fax>++49-2565-97324</fax>. Email: <email>stefanbittmann@gmx.de</email></corresp>
        <fn fn-type="conflict" id="idm1843266500">
          <p>The authors have declared that no competing interests exist.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub" iso-8601-date="2020-04-07">
        <day>07</day>
        <month>04</month>
        <year>2020</year>
      </pub-date>
      <volume>1</volume>
      <issue>3</issue>
      <fpage>1</fpage>
      <lpage>2</lpage>
      <history>
        <date date-type="received">
          <day>30</day>
          <month>03</month>
          <year>2020</year>
        </date>
        <date date-type="accepted">
          <day>06</day>
          <month>04</month>
          <year>2020</year>
        </date>
        <date date-type="online">
          <day>07</day>
          <month>04</month>
          <year>2020</year>
        </date>
      </history>
      <permissions>
        <copyright-statement>© </copyright-statement>
        <copyright-year>2020</copyright-year>
        <copyright-holder>Stefan Bittmann, et al.</copyright-holder>
        <license xlink:href="http://creativecommons.org/licenses/by/4.0/" xlink:type="simple">
          <license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. </license-p>
        </license>
      </permissions>
      <self-uri xlink:href="http://openaccesspub.org//jphn/article/1312">This article is available from http://openaccesspub.org//jphn/article/1312</self-uri>
      <abstract>
        <p>This review catalogs clinical landmarks of COVID‑19 across newborns, children, and adolescents, including MIS‑C, risk factors, and considerations for vaccination and school policies.</p>
      </abstract>
      <kwd-group>
        <kwd>COVID-19</kwd>
      </kwd-group>
      <counts>
        <fig-count count="0"/>
        <table-count count="0"/>
        <page-count count="2"/>
      </counts>
    </article-meta>
  </front>
  <body>
    <sec id="idm1842994188">
      <title>Short Communication</title>
      <p>The outbreak of coronavirus infection             SARS-CoV-2 was reported in December 2019 in Wuhan, China <xref ref-type="bibr" rid="ridm1841724452">1</xref><xref ref-type="bibr" rid="ridm1841788308">2</xref><xref ref-type="bibr" rid="ridm1841734508">3</xref><xref ref-type="bibr" rid="ridm1841828340">4</xref>. Globally, the WHO classified the outbreak as a pandemic, which will spread rapidly around the world in March 2020. More than 462,684 cases of COVID-19 infection have been reported by the WHO worldwide, including 20834 deaths (date 26/03/20). 2401 deaths worldwide were registered by the WHO in the last 24 hours (25/3-26/3/2020), indicating the            aggressive and devastating potential of the virus.  SARS Cov-2 infection leads to loss of life and economic             disruption <xref ref-type="bibr" rid="ridm1841724452">1</xref><xref ref-type="bibr" rid="ridm1841828340">4</xref>. In the "Coronavirus Infection            Pneumonia Treatment Plan", the National Health            Commission stated that children and infants also suffer from the disease (March 2020) <xref ref-type="bibr" rid="ridm1841565068">8</xref>. Initial reports             provide information on cases in newborns and            children, mostly published by Chinese doctors and           researchers <xref ref-type="bibr" rid="ridm1841724452">1</xref><xref ref-type="bibr" rid="ridm1841788308">2</xref><xref ref-type="bibr" rid="ridm1841734508">3</xref><xref ref-type="bibr" rid="ridm1841828340">4</xref><xref ref-type="bibr" rid="ridm1841569844">5</xref><xref ref-type="bibr" rid="ridm1841569196">6</xref><xref ref-type="bibr" rid="ridm1841572004">7</xref>. Only a few reports describe the first small series of SARS-CoV-2 infections in pregnant  women who gave birth to SARS-CoV-2 negative           babies <xref ref-type="bibr" rid="ridm1841569844">5</xref><xref ref-type="bibr" rid="ridm1841569196">6</xref>. By early March 2020, 285 children with SARS-CoV-2 pneumonia and 10 newborns had been diagnosed in China <xref ref-type="bibr" rid="ridm1841569844">5</xref><xref ref-type="bibr" rid="ridm1841569196">6</xref>. Epidemiological studies              suggest that people are generally susceptible to            SARS-CoV-2 and some children have a clear family          history <xref ref-type="bibr" rid="ridm1841788308">2</xref><xref ref-type="bibr" rid="ridm1841734508">3</xref>. The symptoms of some children and  newborns are varying and manifest in a few cases as vomiting and diarrhoea and other gastrointestinal  symptoms, or only as mental retardation and shortness of breath <xref ref-type="bibr" rid="ridm1841565068">8</xref><xref ref-type="bibr" rid="ridm1841561828">9</xref>. Children with mild symptoms showed only low fever, mild fatigue and often no pneumatic signs <xref ref-type="bibr" rid="ridm1841565068">8</xref><xref ref-type="bibr" rid="ridm1841561828">9</xref>. Moreover, children with high fever are known. In a correspondence letter to „The New England Journal of Medicine“ published online on April 2020 by, 171 children were ruled out <xref ref-type="bibr" rid="ridm1841542468">13</xref>. They had a median range of 6.7 years with a male preponderance of 60.8 per cent. 64.9 per cent had pneumonia, 19.3 per cent upper respiratory tract infection and 15.8 per cent an asymptomatic infection. Age distribution showed 24.6 per cent 11-15y, 33.9 per cent 6-10 y, 23.4 percent 1-5 y and 18.1 per cent younger than 1 year old child. A family cluster infection was found in 90.1 per cent (139. The symptoms found were cough in 48.5 per cent,           fever in 41.5 per cent, pharyngeal erythema in 46.2 per cent. Diarrhea was present in 8.8. per cent, fatigue in 7.6 per cent, vomiting in 6.4 per cent. Tachypnoea was present in 28.7 per cent, tachycardia in 23 percent <xref ref-type="bibr" rid="ridm1841542468">13</xref>. CT revealed ground-glass opacity in 32.7 percent of children, local patchy shadowing in 18.7 percent of    cases, bilateral patchy shadowing in 12.3 percent.           Interstitial abnormalities were found in 2 patients (1.2 per cent) <xref ref-type="bibr" rid="ridm1841542468">13</xref>. In an observational study from China, 36 children were found to have higher levels of                procalcitonin, D-dimer and creatine kinase isoenzyme MB, suggesting a myocardial role in COVID-19 disease in children <xref ref-type="bibr" rid="ridm1841572004">7</xref>. In children and neonates, a possible explanation for the mild clinical course of COVID-19 could be immature angiotensin II receptors, the primary docking site of the spike protein of the SARS CoV-19 virus <xref ref-type="bibr" rid="ridm1841558804">10</xref>. More than 80% of angiotensin II receptors in children belong to the AT2 subtype, with less severe cases being assumed in children <xref ref-type="bibr" rid="ridm1841545772">12</xref>. The hypothesis could be that more AT1 receptor binding of COVID-19 is found as in adults, the more severe case. More than 80% of pulmonary ACE2 receptors are positioned on type II alveolar epithelial cells that produce pulmonary surfactant. A lack of surfactant due to impaired               surfactant synthesis in type II cells should be further analyzed. Until the end of March 2020, three months after the onset of the disease, clinical studies led to the conclusion that the clinical course of newborns, children and adolescents follows the algorithm "the older the more severe" <xref ref-type="bibr" rid="ridm1841569196">6</xref><xref ref-type="bibr" rid="ridm1841572004">7</xref><xref ref-type="bibr" rid="ridm1841565068">8</xref><xref ref-type="bibr" rid="ridm1841561828">9</xref>. Children can play an important role as asymptomatic transmitter of COVID-19.</p>
    </sec>
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