Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children

Abstract

Background: COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions.

Methods: A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic.

Results: Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens.

Conclusions: Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.

Keywords: Biobank, pediatric; Biorepository; COVID-19; Multisystem inflammatory syndrome in children (MIS-C); SARS-CoV-2; Viral susceptibility; Viral transmission.

Fig. 1

Pediatric COVID-19 Biorepository timeline of study implementation and enrollment relative to the community surge of COVID-19 cases in the state of Massachusetts [2]

Fig. 2

Schematic of the recruitment strategies used to pursue the collection of pediatric samples for the Pediatric COVID-19 biorepository (Created with BioRender.com)

Fig. 3

Overview of laboratory blood processing procedures following BSL2 containment guidelines depicting steps for a) collection of plasma, isolation of PBMC and PMN, from blood collected into an EDTA tube and b) collection of serum from an SST blood tube (Created with BioRender.com)

Fig. 4

Overview of laboratory processing procedures completed following BSL2+ containment guidelines include: a) aliquoting nasopharyngeal swabs and oropharyngeal swabs, b) aliquoting sputum/saliva samples, c) aliquoting tracheal aspirates, d) aliquoting stool samples and e) aliquoting urine from urine cotton balls collected from patient’s diaper (Created with BioRender.com)