Mild COVID‐19 in hospitalised infants younger than 90 days

Servidio, Alessia Giuseppina; Visentin, Giacomo; Conti, Rosaura; Cozzi, Giorgio; Bua, Jenny; Barbi, Egidio; Amaddeo, Alessandro

doi:10.1111/apa.16624

Cited by 4 publications

(13 citation statements)

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“…The majority of hospitalized children were healthy, with no underlying clinical conditions, and were admitted primarily due to concerns related their young age, as reported in other case series [ 2 , 3 , 6 , 17 , 18 , 19 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 89%

“…Although it is often associated with fever or URT symptoms, poor feeding can be the only symptom observed. Thus, COVID-19 should also be considered in infants with inadequate milk intake [ 9 , 17 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Five infants presented a coinfection with RSV and required oxygen supplementation, and one patient developed acute bronchiolitis with respiratory distress, requiring respiratory support with HFNC. This highlights the importance of considering alternative diagnoses beyond COVID-19, especially in cases of respiratory failure or the need for respiratory support, and the possibility of coinfections with more aggressive respiratory viruses [ 19 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our data suggest that children <90 days old with COVID-19 are in good health, do not require hospitalization or specific care, and can, therefore, be easily managed at home [ 1 , 28 , 29 ]. Moreover, COVID-19 in infants under 90 days of age is milder than other acute viral illnesses in the same age group regarding the risk of developing bronchiolitis and/or the need for oxygen supplementation [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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

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“…[8][9][10][11] Data on SARS-CoV-2 infection in infants suggest that in most cases it presents as a mild disease. 12 In particular, a multicentre international study showed that only 3% of infants testing positive for SARS-CoV-2 developed symptoms consistent with bronchiolitis. 3 In the same study, SARS-CoV-2-related bronchiolitis mostly had a mild clinical course, but the number of affected infants was considerably limited.…”

Section: Original Researchmentioning

confidence: 99%

SARS-CoV-2-related bronchiolitis: a multicentre international study

et al. 2023

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BackgroundBronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited.ObjectiveTo describe the main clinical characteristics of infants with SARS-CoV-2-related bronchiolitis in comparison with infants with bronchiolitis associated with other viruses.Setting, patients, interventionsA multicentre retrospective study was conducted in 22 paediatric emergency departments (PED) in Europe and Israel. Infants diagnosed with bronchiolitis, who had a test for SARS-CoV-2 and were kept in clinical observation in the PED or admitted to hospital from 1 May 2021 to 28 February 2022 were considered eligible for participation. Demographic and clinical data, diagnostic tests, treatments and outcomes were collected.Main outcome measuresThe main outcome was the need for respiratory support in infants testing positive for SARS-CoV-2 compared with infants testing negative.Results2004 infants with bronchiolitis were enrolled. Of these, 95 (4.7%) tested positive for SARS-CoV-2. Median age, gender, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative infants. Human metapneumovirus and respiratory syncytial virus were the viruses most frequently detected in the group of infants negative for SARS-CoV-2.Infants testing positive for SARS-CoV-2 received oxygen supplementation less frequently compared with SARS-CoV-2-negative patients, 37 (39%) vs 1076 (56.4%), p=0.001, OR 0.49 (95% CI 0.32 to 0.75). They received less ventilatory support: 12 (12.6%) high flow nasal cannulae vs 468 (24.5%), p=0.01; 1 (1.0%) continuous positive airway pressure vs 125 (6.6%), p=0.03, OR 0.48 (95% CI 0.27 to 0.85).ConclusionsSARS-CoV-2 rarely causes bronchiolitis in infants. SARS-CoV-2-related bronchiolitis mostly has a mild clinical course.

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

Cimolai

2024

Clin Exp Pediatr

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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.

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Mild COVID‐19 in hospitalised infants younger than 90 days

Cited by 4 publications

References 5 publications

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

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

SARS-CoV-2-related bronchiolitis: a multicentre international study

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

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