W ith the rapidly evolving severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) pandemic, the knowledge about the disease manifestations and severity has also evolved quickly. Due to its resemblance to SARS, influenza, and other respiratory viruses, children were initially thought to be more susceptible than adults. However, less than 5% of total coronavirus disease (COVID-19) cases belong to the pediatric age group, and the severity has been milder as compared to adults [3,4]. Information regarding clinical manifestations and outcomes of COVID-19 in adults is available due to a huge number of reported cases, but the scenario for the pediatric population is different as our knowledge about clinical and laboratory characteristics as well as prognosis of COVID-19 is very limited. Due to this difference in the manifestations of COVID-19 among pediatric patients from adults, there is a need to clarify the disease manifestations and course among children. We performed this systematic review to synthesize the information on clinical manifestations, laboratory findings, and outcome of COVID-19 among the pediatric population.

Background Studies in animal models and humans with type 1 diabetes mellitus (T1DM) have shown that probiotic supplementation leads to decreased pro‐inflammatory cytokines (responsible for damaging β‐cells of the pancreas), improved gut barrier function, and induction of immune tolerance. Objective To study the effect of supplementation of probiotics in children with T1DM on glycemic control, insulin dose, and plasma C‐peptide levels. Methods A single‐centered, double‐blinded, and randomized placebo‐controlled pilot trial was conducted in children (2–12 years) with new‐onset T1DM. Ninety‐six children were randomized and allocated to Placebo or Intervention groups. The intervention included high dose (112.5 billion viable lyophilized bacteria per capsule) multi‐strain probiotic De Simone formulation (manufactured by Danisco‐Dupont) sold as Visbiome® in India. The probiotic was supplemented for 3 months and HbA1c, fasting C‐peptide, blood sugar records, and insulin dose was recorded at baseline and 3 months. Results A total of 90 patients (45 in each group) were analyzed for outcome parameters. We found a significant decrease in HbA1c (5.1 vs. 3.8; p = 0.021) and a significant decline in total and bolus insulin dose (U/kg/day; p = 0.037 and 0.018, respectively) in the intervention group when compared with the placebo group. A significantly higher (p = 0.023) number of children achieved remission in the treatment group. We did not notice adverse effects in either of the study groups. Conclusion Children with newly diagnosed T1DM managed with standard treatment along with probiotics showed better glycemic control and a decrease in insulin requirements; however, more extensive studies are further warranted.

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Objectives To describe the epidemiological and clinical characteristics and outcome of hospitalized children with COVID-19 during the initial phase of the pandemic. Methods This was a cross-sectional descriptive study conducted at the dedicated COVID-19 hospital of a tertiary care referral center in North India. Consecutive children aged 14 y or younger who tested positive for SARS-CoV-2 by RT-PCR from nasopharyngeal swab between 1 April 2020 and 15 July 2020 were included. Results Of 31 children with median (IQR) age of 33 (9-96) mo, 9 (29%) were infants. About 74% (n = 23) had history of household contact. Comorbidities were noted in 6 (19%) children. More than half (58%) were asymptomatic. Of 13 symptomatic children, median (IQR) duration of symptoms was 2 (1-5.5) d. Fever (32%) was most common followed by cough (19%), rapid breathing (13%), diarrhea (10%) and vomiting (10%). Severe [n = 4, 13%] and critical [n = 1, 3%] illnesses were noted more commonly in infants with comorbidities. Three (10%) children required PICU admission and invasive ventilation; one died. Median (IQR) length of hospital stay was 15 (11-20) d. Follow up RT-PCR before discharge was performed in 17 children and the median (IQR) duration to RT-PCR negativity was 16 (12-19) d. Conclusions In the early pandemic, most children with COVID-19 had a household contact and presented with asymptomatic or mild illness. Severe and critical illness were observed in young infants and those with comorbidities.

Background The majority of the children with SARS-CoV-2 infection present with respiratory symptoms, hence various chest imaging modalities have been used in the management. Knowledge about the radiological findings of coronavirus disease (COVID-19) in children is limited. Hence, we systematically synthesized the available data that will help in better management of COVID-19 in children. Methods Four different electronic databases (MEDLINE, EMBASE, Web of Science and CENTRAL) were searched for articles reporting radiological findings in children with COVID-19. Studies reporting thoracic radiological findings of COVID-19 in patients aged <19 years were included. A random-effect meta-analysis (wherever feasible) was performed to provide pooled estimates of various findings. Results A total of 1984 records were screened of which forty-six studies (923 patients) fulfilled the eligibility criteria and were included in this systematic review. A chest computed tomography (CT) scan was the most frequently used imaging modality. While one-third of the patients had normal scans, a significant proportion (19%) of clinically asymptomatic children had radiological abnormalities too. Unilateral lung involvement (55%) was frequent when compared with bilateral and ground-glass opacities were the most frequent (40%) definitive radiological findings. Other common radiological findings were non-specific patchy shadows (44%), consolidation (23%), halo sign (26%), pulmonary nodules and prominent bronchovascular marking. Interstitial infiltration being the most frequent lung ultrasound finding. Conclusion CT scan is the most frequently used imaging modality for COVID-19 in children and can detect pneumonia before the appearance of clinical symptoms. Undefined patchy shadows, grand-glass opacities and consolidation are commonly observed imaging findings in COVID-19 pneumonia.