Turner D¹, Huang Y², Martín-de-Carpi J³, Aloi M⁴, Focht G¹, Kang B⁵, Zhou Y², Sanchez C⁶, Kappelman MD⁷, Uhlig HH⁸, Pujol-Muncunill G³, Ledder O¹, Lionetti P⁹, Dias JA¹⁰, Ruemmele FM¹¹, Russell RK¹²; Paediatric IBD Porto group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2020 Mar 31. doi: 10.1097/MPG.0000000000002729. [Epub ahead of print]

Author information

1 Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Israel.

2 Department of Gastroenterology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.

3 Hospital Sant Joan de Déu, Barcelona, Spain.

4 Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Italy.

5 Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

6 Pediatric Gastrointestinal Unit H.G.U. Gregorio Maranon, Madrid, Spain.

7 Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

8 Translational Gastroenterology Unit, University of Oxford, Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Biomedical Research Center Oxford, UK.

9 Departement NEUROFARBA- University of Florence - Meyer children's Hospital- Florence, Italy.

10 Pediatric Gastroenterology, Centro Hospitalar Universitário S. João, Porto, Portugal.

11 Université Paris Descartes, Sorbonne Paris Cité, APHP, Hôpital Necker Enfants Malades, Paris, France.

12 Department of Paediatric Gastroenterology, The Royal Hospital for Sick Children, Edinburgh.

Abstract

INTRODUCTION: With the current COVID-19 pandemic, concerns have been raised about the risk to children with inflammatory bowel diseases (IBD). We aimed to collate global experience and provide provisional guidance for managing paediatric IBD (PIBD) in the era of COVID-19.

METHODS: An electronic reporting system of children with IBD infected with SARS-CoV-2 has been circulated among 102 PIBD centres affiliated with the Porto and Interest-group of ESPGHAN. A survey has been completed by major PIBD centres in China and South-Korea to explore management during the pandemic. A third survey collected current practice of PIBD treatment. Finally guidance points for practice have been formulated and voted upon by 37 PIBD authors and Porto group members.

RESULTS: Eight PIBD children had COVID-19 globally, all with mild infection without needing hospitalization despite treatment with immunomodulators and/or biologics. No cases have been reported in China and South Korea but biologic treatment has been delayed in 79 children, of whom 17 (22%) had exacerbation of their IBD. Among the Porto group members, face-to-face appointments were often replaced by remote consultations but almost all did not change current IBD treatment. Ten guidance points for clinicians caring for PIBD patients in epidemic areas have been endorsed with consensus rate of 92-100%.

CONCLUSIONS: Preliminary data for PIBD patients during COVID-19 outbreak are reassuring. Standard IBD treatments including biologics should continue at present through the pandemic, especially in children who generally have more severe IBD course on one hand, and milder SARS-CoV-2 infection on the other.