A retrospective review of severe acute respiratory syndrome-coronavirus-2 infection in children with acute leukemia-from a tertiary hospital in Northern India Running Title: SARS-CoV2 infection in children with acute leukemia from Northern India To the Editor, Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is thought to cause milder infections in children; however various risk groups for severe coronavirus disease (COVID-19) have been identified. Few reports have highlighted poorer outcomes in children with Cancer. 1]Hematological malignancies have been found to have increased mortality by 37%. 2] The highest risk of COVID-19 infection has been noted with acute lymphoblastic leukemia (ALL), at a higher risk of viral and fungal infections. However, reported data is scarce in the literature. 3] Identifying the differences with which SARS CoV2 behaves in an immunocompromised patient would assist in prognostication and resource allocation for this vulnerable section. The present retrospective study assessed the demographic and clinical characteristics and outcomes of children admitted with acute leukemia at our tertiary care referral center in Northern India with COVID 19 infection. Chart review of children aged 12 years or younger, with an underlying diagnosis of acute leukemia, admitted for acute COVID-19 care between October 1, 2020, and March 31, 2021was done. All children were positive for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction (RT-PCR) from the combined nasopharyngeal and oropharyngeal swab. The severity of COVID-19 was categorized as mild, moderate, severe, and critical based on the latest operational guidelines . 4] Children who quickly progressed to acute respiratory distress syndrome or respiratory failure and had life-threatening organ dysfunction including shock, encephalopathy, myocardial injury or heart failure, coagulation dysfunction, and acute kidney injury were classified as having a critical illness. Baseline laboratory parameters were recorded. Information regarding demographic and clinical details, including age, sex, leukemia treatment, clinical features, and laboratory investigations, were A c c e p t e d A r t i c l e Key message Question: What are the demographic, clinical characteristics, and outcome of SARS-CoV2 in children undergoing chemotherapy with acute leukemia? Finding: Mild clinical illness was predominant, fever being the most common. Raised inflammatory markers were noted irrespective of severity. Severe and critical illnesses were infrequently observed. All patients recovered well except 2, who died. Meaning: Children with acute leukemia on chemotherapy infected with SARS-CoV2 do not have adverse outcomes. Footnotes Conflicts of interestNo potential conflict of interest relevant to this article was reported. Ethics statementThe institutional ethics committee approved the study. Ethics clearance was obtained (IEC /VMMC/SSJH/Project/ 2021-05/CC-143).

were born prematurely were more likely to have a lower weight than those that were full term. No significant difference was observed for the other factors, such as gender, age at treatment start, and the duration of propranolol treatment.Our study showed that oral propranolol at a dose of 2.0 mg/ kg/day affected weight development in pediatric patients with IHs during treatment; however, the influence disappeared by 2 years after the cessation of treatment. These results do not conflict with a previous study. 5 Weight development varied among the three measurement time points, and we hypothesize that this was, in large part, due to the occasional occurrence of slight propranolol-induced diarrhea, which may have resulted in poor nutritional status. However, the influence of propranolol was temporary. With its cessation, children's nutritional status likely returned to normal, and physical growth also returned to normal. Our data revealed that infants were more likely to be underweight at the end of treatment if they were born prematurely. We hypothesize that the reduced absorption of nutrients caused by propranolol treatment and their premature birth accounts for propranolol's negative influence on their physical development. Thus, parents should be instructed to ensure that their child is fed regularly, especially if premature, to prevent prolonged malnutrition during treatment.The results of this study are limited by its retrospective nature and the lack of a comparative control group. Additionally, this study had a small sample size and a high amount of patient variability. Larger and longer term prospective studies should be performed to fully determine the influence of propranolol on patients' physical development.