key: cord-0861407-wpnaxe7p authors: Shen, Kun-Ling; Yang, Yong-Hong title: Diagnosis and treatment of 2019 novel coronavirus infection in children: a pressing issue date: 2020-02-05 journal: World J Pediatr DOI: 10.1007/s12519-020-00344-6 sha: d384d03b65a3c246bbbb26befadeec2d86f1551f doc_id: 861407 cord_uid: wpnaxe7p nan characteristics, and with further wide-use of pathogen tests, the number of pediatric patients will increase. Based on the collected data, infected children have relatively milder clinical symptomsthan infected adults; and no deaths have been reported in pediatric patients. The age of onset ranged from 1 month to 17 years in the 28 confirmed pediatric patients. All were family clusters or with a close contact history. The clinical features are variable in pediatric patients. Several patients displayed no obvious clinical symptoms at diagnosis, and they were found by screening because of close contacts with confirmed patients; and further chest imaging suggested pneumonia. Several gradually presented with fever, fatigue, dry cough, accompanied by other upper respiratory symptoms including nasal congestion, runny nose, and seldom gastrointestinal symptoms such as nausea, vomiting and diarrhea. Laboratory examination in pediatric patients showed that blood routine was often normal, and C-reactive protein was normal or transiently elevated. Lung imaging examination revealed mild increase of lung markings or ground-glass opacity or pneumonia. Most pediatric patients had mild symptoms, without fever or pneumonia. They had good prognosis and recovered within 1-2 weeks after disease onset. Only a few patients had lower respiratory tract infections. Although no severe cases or deaths have been reported in the pediatric population up to now, the potential risk of death should be highlighted. During severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) epidemics, ARDS and death also occur in pediatric cases [2] [3] [4] . The current clinical features are defined only based on the 28 pediatric patients. Clinical features in pediatric patients will be further defined with increased number of confirmed patients. We should attach importance to differential diagnosis with other viral infections in pediatric patients. Winter and Spring are peak seasons of other viral infections such as influenza, respiratory syncytial virus. While screening 2019-nCoV, clinicians should also consider common viruses for differential diagnosis and identifying co-infections. Interferon (IFN) is a group of low-molecular glycoproteins with similar structure and function, which is produced by host cells through antiviral response when the body is infected by virus. IFN is the first-line innate immune defense of the body against viral infection. Based on different gene and protein structures, IFN is divided into IFN-α, IFN-β, and so on. Interferon mainly plays antiviral effects through two ways: (1) inducing production of antiviral effector proteins, thereby inhibiting viral replication in the cells to protect normal cells from viral invasion; (2) activating cellular immunity by promoting proliferation and activation of cytotoxic T lymphocytes (CTL), activating natural killer (NK) cells and macrophages to clear the virus. The body's endogenous IFN deficiency or insufficiency may lead to reduced antiviral activity. Children are susceptible to viral infections because of their immature immune function and relatively low levels of specific humoral and cellular immunity and IFN secretion. In 1973, Merigan et al. [5] from the British Medical Research Center firstly confirmed that IFN could prevent and treat respiratory virus infections. Thereafter, many researches have been carried out to approve the findings. Multi-center clinical studies in children from China [6] [7] [8] [9] have also revealed that IFN-α atomization can reduce the viral load, alleviate symptoms and shorten disease duration in treating viral infections including bronchiolitis, viral pneumonia, acute upper respiratory tract infection and hand, foot and mouth disease. Our team also found that topical use of recombinant human IFN-α2b spray in the mouth and nose can alleviate symptoms and shorten disease course of upper respiratory tract infections in children [10] . During the SARS outbreak in 2003, an animal study revealed that recombinant human IFN-α2b spray can prevent SARS-CoV infection in Rhesus monkey model by inhibiting virus infection and replication [11] . Further population study revealed that recombinant human IFN-α2b spray can effectively reduce the infection rate of respiratory syncytial virus, influenza virus, adenovirus and SARS-CoV [12, 13] . The Novel Coronavirus Infection Pneumonia Diagnosis and Treatment Standards (the fourth edition) and Diagnosis, treatment and prevention of 2019 novel coronavirus infection in children: experts' consensus statement also listed IFN-α atomization as a choice of treatment for 2019-nCoV pneumonia [14] . In summary, the efficacy and safety of interferon in the treatment of children with 2019-nCoV need to be further confirmed. Current number of infected pediatric patients is low. However, for better understanding of 2019-nCoV infection in children and improving the level of diagnosis and treatment, National Respiratory Diseases Clinical Research Center and Respiratory Diseases Group of Chinese Pediatric Association initiated a study on clinical features of 2019-nCoVinfected pediatric patients. This study will be helpful for early recognition, early diagnosis and early treatment of infected children. The Chinese government is taking strong measures to mobilize the whole society to fight against the epidemic. We are fully confident to win the battle against the epidemic. Pediatricians in China will stay in line with the Chinese government make all-out efforts to prevent and control the epidemic and protect children's lives and health. 1/a53e6 df293 cc4ff 0b5a1 6ddf7 b6b2b 31.shtml . 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