COVID-19 Disease in Infants Less Than 90 Days: Case Series

Abstract

The objective of this study is to describe the clinical presentations, radiological and laboratory findings, and outcomes of COVID-19 disease in infants ≤ 90 days of age at presentation. We conducted a retrospective study of infants in this age group who were found to be SARS-CoV-2 positive. Asymptomatic infants who were identified through routine testing following delivery to COVID-19-positive mothers were excluded. We classified infants according to their presentation: asymptomatic, mildly symptomatic, moderately symptomatic, and severely/critically symptomatic. A total of 36 infants were included. Of them, two were asymptomatic and four had severe/critical presentation. Of the severely symptomatic infants, two were considered as multisystem inflammatory syndrome in children (MIS-C) and there was one death. One infant in the severe symptomatic group presented with cardiac failure, with the possibility of congenital infection. Another infant presented with cardiogenic shock. None of these infants received antiviral medication. The study found that infants ≤ 90 days can present with a severe form of COVID-19 disease. Multisystem inflammatory syndrome in children, although rarely reported in infants, is a possible complication of COVID-19 disease and can be associated with significant morbidity and mortality.

Clinical features and outcomes of coronavirus disease 2019 in early infants in Japan: A case series and literature review

“…Thus far, only a few case series of early infants with COVID-19 have been available, and risk factors for severity remain unclear. A case series from Saudi Arabia suggested that infants ≤90 days old can develop more severe COVID-19 disease than older children [ 4 ].…”

“…Early infants with severe COVID-19 described in this review included those with severe pre-existing medical conditions (cyanotic heart disease, immunodeficiency, or extreme prematurity), MIS-C, or co-infection [ 3 , 4 , 9 ]. Our cases did not involve severe comorbidities or MIS-C.…”

“…One systematic review of early infants with COVID-19 reported that admission to the intensive care unit (ICU) and respiratory support were required in approximately 20%–30% of the patients [ 3 ]. A few case series showed various degrees of severity of COVID-19 in early infants [ 4 , 5 ]. Risk factors for severe illness remain unclear.…”

SARS-CoV-2 Positivity in Early Infancy: A National Cohort From Saudi Arabia

“…In a case series, Shaiba et al ( 17 ) reported that most (94%) infants of ≤ 90 days old presented to a local hospital for SARS-CoV-2 testing were symptomatic. This is almost similar to what was observed in this study where 85% of all infants presented with symptoms (42, 85, and 90% in early, late and post neonatal groups, respectively).…”

Multisystem Inflammatory Syndrome of a Neonate From a COVID-19-Infected Mother: A Case Report

“…Furthermore, the COVID-19 infection is not as common below one year of age; thereby, the projected incidence rate among this age group was 12%-18% [3]. The disease has a milder course in children than adults and may present with non-specific symptoms, especially in neonates that are not clearly explained [4][5][6][7]. However, multiple studies reported that the issue is possibly associated with the low availability of angiotensin-converting enzyme 2 (ACE2) receptors among children below one year of age [8][9][10].…”