A Multicentered Study on Epidemiologic and Clinical Characteristics of 37 Neonates With Community-acquired COVID-19

Abstract

Background: Coronavirus disease 2019 (COVID-19) primarily affects adults and spares children, whereas very little is known about neonates. We tried to define the clinical characteristics, risk factors, laboratory, and imagining results of neonates with community-acquired COVID-19. Methods: This prospective multicentered cohort study included 24 neonatal intensive care units around Turkey, wherein outpatient neonates with COVID-19 were registered in an online national database. Full-term and premature neonates diagnosed with COVID-19 were included in the study, whether hospitalized or followed up as ambulatory patients. Neonates without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were excluded. Results: Thirty-seven symptomatic neonates were included. The most frequent findings were fever, hypoxemia, and cough (49%, 41%, 27%, respectively). Oxygen administration (41%) and noninvasive ventilation (16%) were frequently required; however, mechanical ventilation (3%) was rarely needed. Median hospitalization was 11 days (1–35 days). One patient with Down syndrome and congenital cardiovascular disorders died in the study period. C-reactive protein (CRP) and prothrombin time (PT) levels were found to be higher in patients who needed supplemental oxygen (0.9 [0.1–8.6] vs. 5.8 [0.3–69.2] p = 0.002, 11.9 [10.1–17.2] vs. 15.2 [11.7–18.0] p = 0.01, respectively) or who were severe/critical (1.0 [0.01–8.6] vs. 4.5 [0.1–69.2] p = 0.01, 11.7 [10.1–13.9] vs. 15.0 [11.7–18.0] p = 0.001, respectively). Conclusions: Symptomatic neonates with COVID-19 had high rates of respiratory support requirements. High CRP levels or a greater PT should alert the physician to more severe disease.

Clinical characteristics of COVID-19 in neonates and young infants

“…Accumulating evidence with regard to treatment of COVID-19 in early life indicates that very few neonates require additional treatment, with antiviral agents, azithromycin, or a-interferon which reflects the current uncertainties regarding specific treatment options [3,9,12]. All our patients were, rapidly improved without any specific treatment, providing further evidence that additional treatment is not necessary for a favor outcome of community-acquired COVID-19 in neonates and very young infants.…”

“…Neutropenia and/or monocytosis was detected in 10 infants (71.4%) while none of them experienced lymphopenia which has consistently been reported in adults and has been associated with increased disease severity [9]. The lack of lymphopenia, possibly attributed to the high thymic output in early life, in association with the relative immaturity of monocytes which results in diminished cytokine responses, could be a smart way of the neonatal immune system to response to SARS-CoV-2 without excessive inflammation associated with severe lung disease [10].…”

COVID-19 in Children with Brain-Based Developmental Disabilities: A Rapid Review Update

“…Nine studies 21, 24, 27, 29, 31, 33, 36, 39, 42 included children with brain-based disabilities, and the remaining 20 included children at risk of developing a brain-based disability (premature infants and infants with congenital heart diseases in most studies) (Table 2). Most studies were published in the United States and the majority of studies were case reports or case series (23/29, 79%).…”

COVID-19 as cause of viral sepsis: A Systematic Review and Meta-Analysis

“…Of the 104 included studies, mainly observational retrospective, 42 were reporting results from China (19-60), 19 from the U.S.A (61-79), 5 from the U.K (80-84), 24 across Europe, mainly Italy, Spain, France and the Netherlands (85-109), 10 from other countries (110-119) and 3 were international (120-122). All studies reported data on hospitalized patients due to COVID-19 and 35 of them included data for ICU nnnnnn(20, 25, 33, 36, 37, 41, 44, 45, 48, 52, 53, 56, 58, 66, 72, 73, 81-84, 86-89, 95, 96, 98, 101, 103, 106, 107, 109, 111, 119). Eight studies were pediatric (59, 60, 78, 79, 83, 84, 118, 119).…”

“…All studies reported data on hospitalized patients due to COVID-19 and 35 of them included data for ICU nnnnnn(20, 25, 33, 36, 37, 41, 44, 45, 48, 52, 53, 56, 58, 66, 72, 73, 81-84, 86-89, 95, 96, 98, 101, 103, 106, 107, 109, 111, 119). Eight studies were pediatric (59, 60, 78, 79, 83, 84, 118, 119). The majority of articles included patients without any selection criteria (all-comers), whereas forty-five focused on specific subgroups, such as critically ill, cancer or rheumatologic patients, patients on mechanical ventilation etc.…”