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A year and a half after the Coronavirus pandemic wrecked our collective lives, our society has been grappling with fear and insecurity. As a result, we have seen misinformation spreading like wildfire, and many are resorting to bizarre and incorrect methods of dealing with the virus. With this column, which will be published every Sunday, we aim to address any health or vaccine-related question our readers might have about the coronavirus pandemic.

In this week’s column, Dr Rakesh Lodha, Professor, and In-charge of Pediatric Intensive Care Unit, Department of Pediatrics, AIIMS, will talk about how COVID impacts premature babies, and how the vaccine taken by pregnant mothers affect unborn children.

How will vaccinating pregnant women help their unborn children?

Pregnant women who develop COVID have a higher risk of pregnancy-related complications and neonatal complications. So, vaccinating them is important. Antibodies have been shown to be present in newborns to mothers vaccinated with COVID vaccines. These antibody levels are likely to offer protection to the baby for few months.

What kinds of preparation should hospitals take to protect children during the third wave of COVID?

Children, so far, have been less affected as compared to adults. While they get infected almost as frequently as adults, a smaller proportion is symptomatic. Most of the symptomatic children have mild illness only. However, if a large number of individuals are infected, the number of children with infection, number with the moderate and severe diseases also increases. The available data does not support the hypothesis that children will be disproportionately more affected in subsequent surges. However, one has to be prepared to face any situation. The health authorities across the country are making arrangements to meet an increased need for hospitalization in children. The COVID facilities should have dedicated wards/ isolation rooms to look after children; invariably, the parents accompany infected children, so necessary arrangements should be made. Pediatric care has specific equipment, consumables’ and medications’ requirements; these facilities need augmentation of their infrastructure. The training of healthcare workers to manage COVID in children of all age groups is being enhanced.

In addition, there is capacity building, as well as augmentation of infrastructure to deal with a post-COVID condition in children- Multi-system inflammatory syndrome (MIS-C); a majority of these children do not have acute COVID infection and are managed in normal pediatric facilities. The treatment is supportive with the need for specific medications such as steroids and intravenous immunoglobulin in children with severe disease.

The general preventive steps for children are the same as those for adults. However, young children may not be able to put on masks appropriately. Older children and adults must strictly comply with COVID-appropriate behavior. The use of teleconsultations for other common pediatric illnesses during times of surges, may reduce footfall to hospitals and decrease the risk of exposure. Adequate preventive measures (social distancing, spacing of appointments by time to reduce crowding, etc) should be taken in hospitals/ health facilities for children visiting for vaccination and consultation for illnesses for prevention of cross-infection.

What kind of LONG COVID symptoms are newborns showing post-recovery? How can parents identify those symptoms?

Long COVID symptoms in older children are similar to those in adults. However, a similar syndrome in newborns who had COVID has not been reported.

Can premature babies have COVID? If they do, is there any special kind of care needed for them?

Newborns can have COVID infection; most of the neonates are asymptomatic or have the mild disease only. Premature babies also have been reported to have COVID. The management and monitoring for them are similar to that of term neonates with COVID. Often they have to be managed in neonatal ICUs irrespective of the COVID status.

Does a foetus experience any discomfort if the mother is COVID-19 positive?

As compared to pregnant women without COVID, those with COVID have some increase in the risk of complications of pregnancy. There is also some increase in the risk of having preterm delivery and lower birth weight of newborns. About 10-15% of babies born to COVID infected mothers may test positive for COVID-19. Most of these newborns are asymptomatic or have mild symptoms. COVID-19 during pregnancy has not been reported to be associated with congenital defects in newborns.

Can non-diabetic kids also turn diabetic during their COVID-19 infection?

Diabetes is an uncommon condition in children. During the pandemic, some of the centers in the western world have reported some increase in the number of cases of newly diagnosed diabetes, as compared to the pre-pandemic period. However, the definite link with COVID is not established.

How does COVID-19 impact children’s brains?

As highlighted earlier, the majority of children with COVID are either asymptomatic or have mild disease. As with any illness/ infection, a small proportion of children may have severe manifestations; most of these are related to the involvement of the lungs. However, rarely, there may be involvement of brain leading to seizures, change in consciousness, etc. There can be impact on brain due to low oxygen in children with severe lung disease.

COVID may also have indirect effects on the overall well-being of children; being confined to homes, effect on schooling, adult members getting sick/ dying, effect on nutrition due to economic hardships in the family, all are likely to have effect on the mental health of children.

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