COVID-19 among infants: key clinical features and remaining controversies

Abstract

Infants aged <1 year represent a seemingly more susceptible pediatric subset for infections. Despite this, coronavirus disease 2019 (COVID-19) infection has not been proven as more serious in this age group (outside the very early neonatal period) than in others. Indeed, a considerable number of asymptomatic infections have been recorded, and the symptoms and morbidity associated with COVID- 19 differ minimally from those of other respiratory viral infections. Whether due to an abundance of caution or truly reduced susceptibility, infections in infants have not raised the same profile as those in other age groups. In addition to direct severe acute respiratory syndrome coronavirus 2 diagnostic tests, laboratory markers that differentiate COVID-19 from other viral infections lack specificity in infants. Gastrointestinal presentations are common, and the neurological complications of infection mirror those of other respiratory viral infections. There have been relatively few reports of infant deaths. Under appropriate precautions, breastfeeding in the context of maternal infections has been associated with tangible but infrequent complications. Vaccination during pregnancy provides protection against infection in infants, at least in the early months of life. Multi-inflammatory syndrome in children and multi-inflammatory syndrome in neonates are commonly cited as variants of COVID-19; however, their clinical definitions remain controversial. Similarly, reliable definitions of long COVID in the infant group are controversial. This narrative review examines the key clinical and laboratory features of COVID-19 in infants and identifies several areas of science awaiting further clarification.

Retrospective Analysis of Clinical Characteristics and Disease Outcomes in Children and Adolescents Hospitalized Due to COVID-19 Infection in Tunisia

“…Studies have reported that among infants, although COVID-19 is symptomatically mild, even the low risk of severe infection would require prevention. The presence of comorbid conditions can heighten the risk of infections and their complications in infants [33]. Therefore, it is imperative to focus on protecting the infants from COVID-19 infections.…”

“…As infants under 6 months of age are ineligible for any existing COVID-19 vaccines, maternal vaccination is the only available option in preventing disease in early infancy. It is noted that infants acquire immunity via the placenta from their mothers [33,34]. A recent study conducted in the US reported that the incidence of hospitalization for COVID-19 was considerably lower for infants aged < 6 months if their mothers were vaccinated compared with infants of unvaccinated mothers (21/100,000 person-years vs. 100/100,000 person-years) [34].…”

Admission diagnostics for SARS‐CoV‐2 and other respiratory viruses

“…Purposeful screening of asymptomatic patients or having a large fraction of such patients out of the total so tested adds another layer of diagnostic bias. Asymptomatic infection has been known to be commonplace in presumed paediatric SARS‐CoV‐2 infections, but the veritable frequency of the same can be challenged 3 . As for the potential bias in the current study, the influence of variable laboratory diagnostics can also affect other viral amplification diagnostics.…”