COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease?

Donà, Daniele; Montagnani, Carlotta; Chiara, Costanza Di; Venturini, Elisabetta; Galli, Luisa; Vecchio, Andrea Lo; Denina, Marco; Olivini, Nicole; Bruzzese, Eugenia; Campaña, Andrea; Giacchero, Roberta; Salvini, Filippo; Meini, Antonella; Ponzoni, Matteo; Trapani, Sandra; Rossi, Elena; Lombardi, Mary Haywood; Badolato, Raffaele; Pierri, Luca; Pruccoli, Giulia; Rossin, Sara; Colomba, Claudia; Cazzato, Salvatore; Pacati, Ilaria; Nicolini, Giangiacomo; Pierantoni, Luca; Bianchini, Sonia; Krzysztofiak, Andrzej; Garazzino, Silvia; Giaquinto, Carlo; Gattinara, Guido Castelli

doi:10.3390/v14102256

Cited by 15 publications

(36 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The majority of admitted neonates and children in this study were COVID-19-positive and without co-morbidities, similar to findings from Ghana, Italy and India [ 9 , 12 , 62 ]. In addition, children were typically admitted with moderate-to-severe disease rather than asymptomatic or mild disease.…”

Section: Discussionsupporting

confidence: 87%

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

et al. 2023

View full text Add to dashboard Cite

There are concerns with excessive antibiotic prescribing among patients admitted to hospital with COVID-19, increasing antimicrobial resistance (AMR). Most studies have been conducted in adults with limited data on neonates and children, including in Pakistan. A retrospective study was conducted among four referral/tertiary care hospitals, including the clinical manifestations, laboratory findings, the prevalence of bacterial co-infections or secondary bacterial infections and antibiotics prescribed among neonates and children hospitalized due to COVID-19. Among 1237 neonates and children, 511 were admitted to the COVID-19 wards and 433 were finally included in the study. The majority of admitted children were COVID-19-positive (85.9%) with severe COVID-19 (38.2%), and 37.4% were admitted to the ICU. The prevalence of bacterial co-infections or secondary bacterial infections was 3.7%; however, 85.5% were prescribed antibiotics during their hospital stay (average 1.70 ± 0.98 antibiotics per patient). Further, 54.3% were prescribed two antibiotics via the parenteral route (75.5%) for ≤5 days (57.5), with most being ‘Watch’ antibiotics (80.4%). Increased antibiotic prescribing was reported among patients requiring mechanical ventilation and high WBCs, CRP, D-dimer and ferritin levels (p < 0.001). Increased COVID-19 severity, length of stay and hospital setting were significantly associated with antibiotic prescribing (p < 0.001). Excessive antibiotic prescribing among hospitalized neonates and children, despite very low bacterial co-infections or secondary bacterial infections, requires urgent attention to reduce AMR.

show abstract

Section: Discussionsupporting

confidence: 87%

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Dona et al reported the outcomes of 216 infants less than 90 days old affected with COVID-19 disease from 35 Italian institutions. Only 2.3% of infants needed intensive care unit admission, and all infants recovered from the illness [ 27 ]. A population-based study from the UK reported 66 neonates with confirmed SARS-CoV-2 infection (incidence 5.6 per 10,000 live births) required hospital admission.…”

Section: Epidemiology Of Covid-19mentioning

confidence: 99%

“…The actual incidence of COVID-19 in neonates and infants continues to be underestimated, mainly due to asymptomatic cases and a lack of testing. Studies reporting higher morbidity and mortality in neonates and infants have not accounted for pre-existing comorbidities or used an arbitrary definition for diagnosing severe disease [ 27 ]. Epidemiologic data seems promising to propose that neonates and young children may continue to evade severe COVID-19 disease during the upcoming period.…”

Section: Epidemiology Of Covid-19mentioning

confidence: 99%

COVID-19 Disease in Under-5 Children: Current Status and Strategies for Prevention including Vaccination

et al. 2023

View full text Add to dashboard Cite

Since the coronavirus disease (COVID-19) pandemic hit the globe in early 2020, we have steadily gained insight into its pathogenesis; thereby improving surveillance and preventive measures. In contrast to other respiratory viruses, neonates and young children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have a milder clinical presentation, with only a small proportion needing hospitalization and intensive care support. With the emergence of novel variants and improved testing services, there has been a higher incidence of COVID-19 disease reported among children and neonates. Despite this, the proportion of young children with severe disease has not increased. Key mechanisms that protect young children from severe COVID-19 disease include the placental barrier, differential expression of angiotensin-converting enzyme 2 (ACE-2) receptors, immature immune response, and passive transfer of antibodies via placenta and human milk. Implementing mass vaccination programs has been a major milestone in reducing the global disease burden. However, considering the lower risk of severe COVID-19 illness in young children and the limited evidence about long-term vaccine safety, the risk–benefit balance in children under five years of age is more complex. In this review, we do not support or undermine vaccination of young children but outline current evidence and guidelines, and highlight controversies, knowledge gaps, and ethical issues related to COVID-19 vaccination in young children. Regulatory bodies should consider the individual and community benefits of vaccinating younger children in their local epidemiological setting while planning regional immunization policies.

show abstract

“…Coronavirus Disease-19 (COVID-19) is caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) [ 1 ]. However, information about pediatric patients, especially those under 90 days of age, remains fragmented, scarce, and often contradictory [ 2 , 3 , 4 ]. Knowledge of these young patients has been extrapolated from older pediatric cases, with a limited number of research and case series publications during the ongoing pandemic [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The potential risk factors for community-acquired COVID-19 in very young individuals are unclear, with speculation about whether immature immune systems pose a risk or play a protective role [ 2 , 5 , 6 , 7 , 8 ]. Several risk stratification scores for COVID-19 in young infants have been proposed but often show conflicting results, and the percentage of infants experiencing severe COVID-19 varies widely across different studies [ 1 , 3 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Bellini,

Brisca,

Orfanos

et al. 2024

Healthcare

View full text Add to dashboard Cite

Aim: To provide a comprehensive description of the clinical features, biochemical characteristics, and outcomes of infants up to 90 days old with COVID-19. Moreover, to assess the severity of the disease and propose an effective management pathway. Methods: Retrospective single-center study spanning three years. Patient data includes age, sex, symptoms, comorbidities, blood and urine test results, cultures, admission, length of stay, therapies, intensive care unit admission, and mortality. Results: A total of 274 patients were enrolled in the study, comprising 55% males. Among them, 60 patients (22%) were under the age of 29 days, while 214 (78%) fell within the 29 to 90 days age range. The overall incidence of SARS-CoV-2 infections was 0.28 per 10,000 Pediatric Emergency Department admissions. Blood inflammatory markers showed no significant abnormalities, and there were no recorded instances of positive blood cultures. Less than 1% of infants showed urinary tract infections with positive urine cultures, and 1.5% of patients had a concurrent RSV infection. Hospitalization rates were 83% for neonates and 67% for infants, with a median length of stay (LOS) of 48 h for both age groups. None of the patients required admission to the Pediatric or Neonatal Intensive Care Unit, and only one required High Flow Nasal Cannula (HFNC). No secondary serious bacterial infections were observed, and all hospitalized patients were discharged without short-term sequelae. No deaths were reported. Discussion and Conclusions: Infants with COVID-19 generally exhibit milder or asymptomatic forms of the disease, making home management a viable option in most cases. Blood tests, indicative of a mild inflammatory response, are recommended primarily for children showing symptoms of illness. Hospitalization precautions for infants without apparent illness or comorbidities are deemed unnecessary. Given the evolving nature of experiences with COVID-19 in infants, maintaining a high level of clinical suspicion remains imperative.

show abstract

COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease?

Cited by 15 publications

References 26 publications

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

Antibiotic Overprescribing among Neonates and Children Hospitalized with COVID-19 in Pakistan and the Implications

COVID-19 Disease in Under-5 Children: Current Status and Strategies for Prevention including Vaccination

Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Contact Info

Product

Resources

About