COVID-19

The consequences of gestational coronavirus disease 2019(COVID-19) exposure on neonatal immunity are incompletely understood. While vertical transmission to the fetus is rare, maternal COVID-19 exposure can adversely impact the neonate by inducing placental pathology, or indirectly, via neonatal immune programming. To investigate the latter, Gilley et al. analyzed cytokine levels in cord blood mononuclear cells (CBMCs) obtained from neonates exposed to chorioamnionitis, gestational COVID-19, and unexposed controls. They observed that fetal exposure to maternal inflammation, by either SARS-CoV-2 infection or chorioamnionitis, exaggerated the pro-inflammatory cytokine response to neonatal bacterial pathogens in cultured CBMCs. While both chorioamnionitis and COVID-19 exposure exaggerated cytokine expression, there were differences in immune cell populations and cell-type specific responses. These interesting findings indicate that fetal exposure to inflammatory stimuli, even without fetal infection, results in changes in the neonatal immune cell phenotype and function leading to heightened immune activation. The results of this study differ from a trend towards a muted pro-inflammatory response seen in pediatric COVID-19, which is attributed to cause decreased disease severity. The mechanisms underlying neonatal immune programming, the timing and severity of maternal exposure in relationship to immune programming and long-term health consequences need to be explored in future studies.

Pediatric mental health has been poorly addressed and access to quality psychiatric care is limited in many countries around the world including wealthy nations. The novel coronavirus disease 2019 (COVID-19) pandemic caused a strain on pediatric mental health resources across the globe. This was primarily due to the stress of lockdowns, loss of caregivers, and school interruptions, which further exacerbated the mental health needs of children. Despite their unreadiness, emergency departments have been utilized to address those needs. Kostopoulou et al. reported that, although emergency departments’ pediatric visits have decreased earlier during the pandemic, mental health visits increased during the same period.

The COVID-19 pandemic has emphasized the way different communities have been affected dependent on ethnic or social background. In this paper, the social determinants of COVID-19 will be considered with a review of the current literature and the opportunities for future research. There has been very little written about this approach to the infection and its consequences. Although children are not as affected as adults, the measures to control the pandemic may have significant consequences for children’s mental and physical well-being, as well as long-term challenges for their education. Research in pediatrics and child health should address this challenge going forward.