Table 5.
Summary and quality of the evidence and recommendations on the prevention of COVID-19 in the paediatric population.
| Quality of evidence | Summary of the evidence | Recommendations | |
|---|---|---|---|
| Effectiveness of masks (surgical/FFP2, N95 or similar) in reducing the risk of SARS-CoV-2 transmission in children | |||
| Low | Clinical trials have found no evidence of effectiveness (RR, 0.96; 95% CI, 0.82%–1.14%). However, observational studies have found a significant protective effect (RR, 0.35; 95% CI, 0.27%–0.45%). | Weak in support | Use of a surgical, FFP2, N95 o similar mask in adherence with current policy is recommended: mandatory for children aged more than 6 years and recommended for children aged 3–5 years. |
| Effectiveness of nonmedical masks in reducing the risk of SARS-CoV-2 transmission in children | |||
| Very low | There is evidence on the efficacy of nonmedical face masks is scarce and heterogeneous. | Weak in support | Use of nonmedical masks as recommended by the WHO or, in Spain, masks with UNE 0064-2:2020 or UNE 0065 specifications or any other tested in accredited laboratories and in adherence with current policy, is expected in individuals aged 6 years and older (and recommended from years) that are not infected by SARS-CoV-2. |
| Adverse effects of masks | |||
| Very low | The most frequent side effect is discomfort during use. There have been no reports of adverse events. | ||
| Risk of neonatal infection in infants born to SARS-CoV-2-positive mothers | |||
| Low | Vertical transmission of SARS-CoV-2 is very rare, and it has not been possible to establish the timing of transmission (intrauterine, intrapartum or postnatal). | ||
| Influence of the type of delivery in the vertical transmission of SARS-CoV-2 to newborns of positive mothers | |||
| Low | There is no difference in the SARS-CoV-2 infection status of newborns delivered vaginally versus those delivered by caesarean section. | Strong in support | Taking into account the costs and benefits, the lack of evidence on the advantages of caesarean delivery and the preference of families, it is recommended that the decision whether to have a caesarean or vaginal delivery be made based on obstetric criteria and not seeking to modify the risk of transmission. |
| Is it possible to breastfeed newborns of SARS-CoV-2-positive mothers? | |||
| Low | The scarce evidence available does not suggest that SARS-CoV-2 is transmitted through breast milk. | Strong in support | The promotion and maintenance of breastfeeding in newborns of mothers with SARS-CoV-2 infection is strongly recommended. |
| Use of preventive measures in the perinatal period to prevent transmission of SARS-CoV-2 to the newborn | |||
| Very low | The scarce evidence available does not allow estimation of the efficacy of preventive measures meant to reduce transmission of SARS-CoV-2 to newborns. | Weak in support | Taking into account the costs and benefits, the lack of evidence on the advantages and safety of not implementing preventive measures and the preference of families, in the case of SARS-CoV-2-positive mothers, contemplate maintaining the routine preventive measures that are currently recommended: rooming-in keeping a safe distance except when the infant is being breastfed, handwashing, and use of face masks while the mother remains infectious. |
| Schools and activities | |||
| Low | There is evidence of low quality that schools are not an important source of transmission and there is no certainty that their closure would decrease the incidence of disease in the general population or in the population under 18 years, or that it would have a significant impact on the percentage of severe cases (requiring ICU admission) or overall mortality due to COVID-19. | Weak against | Closure of schools and childcare centres as a preventive measure to decrease the incidence and severity of COVID-19 in the general population is not recommended. |
CI, confidence interval; RR, relative risk; WHO, World Health Organization.