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Objectives The aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes. Methods This was a retrospective, single-center, observational study conducted in a pediatric intensive and high-dependency care unit (PICU, HDU) in an urban hospital in Paris. All patients, aged from 1 month to 18 years, admitted for confirmed or highly suspected SARS-CoV-2 were included. Results We analyzed the data of 27 children. Comorbidities (n = 19, 70%) were mainly neurological (n = 7), respiratory, (n = 4), or sickle cell disease (n = 4). SARS-CoV-2 PCR results were positive in 24 children (nasopharyngeal swabs). The three remaining children had a chest CT scan consistent with COVID-19. Respiratory involvement was observed in 24 patients (89%). Supportive treatments were invasive mechanical ventilation (n = 9), catecholamine (n = 4), erythropheresis (n = 4), renal replacement therapy (n = 1), and extracorporeal membrane oxygenation (n = 1). Five children died, of whom three were without past medical history. Conclusion This study highlighted the large spectrum of clinical presentation and time course of disease progression as well as the non-negligible occurrence of pediatric life-threatening and fatal cases of COVID-19 mostly in patients with comorbidities. Additional laboratory investigations are needed to further analyze the mechanism underlying the variability of SARS-Cov-2 pathogenicity in children.

Resume Le syndrome de Guillain-Barre (SGB) est rare dans l’enfance, et le diagnostic des formes atypiques est difficile dans cette tranche d’âge. Les principaux diagnostics differentiels incluent les neuropathies congenitales hereditaires. Nous rapportons le cas d’un garcon de 8 mois, qui s’est presente avec une hypotonie acquise due a une paralysie musculaire progressive d’evolution descendante associee a une neutropenie. Le SGB a ete diagnostique grâce a l’association d’une dissociation albumino-cytologique dans le liquide cephalo-rachidien et d’une polyneuropathie sensitivomotrice demyelinisante a l’electrophysiologie. La guerison a ete complete un an apres traitement. Une hypotonie acquise chez un nourrisson doit faire evoquer un SGB et motiver la realisation d’une ponction lombaire. Le suivi medical a la fois clinique et electrophysiologique est important, en particulier chez les nourrissons, afin d’identifier d’eventuelles rechutes qui pourraient etre le symptome d’une neuropathie genetique ou d’une maladie inflammatoire chronique.

Guillain-Barré Syndrome (GBS) is rare in infancy, and the diagnosis of atypical forms is difficult in this age range. The main differential diagnoses include congenital neuropathy. Biological and electrophysiological investigations remain important to confirm diagnosis and start treatment quickly. We report the case of an 8-month-old boy who presented with acquired hypotonia due to progressive descending limb paralysis, predominant in the upper limbs, associated with unexplained severe neutropenia. GBS was diagnosed thanks to the association of albuminocytologic dissociation on cerebrospinal fluid and demyelinating sensomotor polyradiculoneuropathy on electroneuromyography. Only one cycle of treatment with intravenous immunoglobulins was sufficient to achieve complete recovery after 1 year. Physicians should know that atypical forms of GBS exist in infants, in order to recognize the syndrome, rule out differential diagnoses, and start treatment as soon as possible. Medical follow-up remains important before and after remission, especially in infants, to identify relapses, which might be the symptom of a genetic neuropathy or a chronic inflammatory disease.

The disulfonimide (R)-1 enables enantio-differentiation of a large scope of chiral O-heterocycles, thanks to the formation of diastereomeric adducts. The underlying H-bond has been investigated by NMR. (R)-1 has been used as a chiral solvating agent (CSA) to determine the stereochemical purity of D/L lactide by (1)H NMR.