COVID-19 infections in infants

Abstract

The study aimed to analyse the clinical course of COVID-19 in 300 infants, selected from 1283 children diagnosed with COVID-19 between March and December 2020, registered in the SARSTerPED multicenter database. Most of the infants were registered in October and November 2020. 44% of the group were girls, and 56% were boys. At diagnosis, the most common symptoms were fever in 77% of the children, cough in 40%, catarrh in 37%. Pneumonia associated with COVID-19 was diagnosed in 23% of the children, and gastrointestinal symptoms in 31.3%. In 52% of the infants, elevated levels of D-dimers were observed, and in 40%, elevated levels of IL-6 serum concentration were observed. During the second wave of the pandemic, 6 times more infants were hospitalized, and the children were statistically significantly younger compared to the patients during the first wave (3 months vs 8 months, p < 0.0001 respectively). During the second wave, the infants were hospitalized for longer. COVID-19 in infants usually manifests as a mild gastrointestinal or respiratory infection, but pneumonia is also observed with falls in oxygen saturation, requiring oxygen therapy. Gastrointestinal symptoms are common in infants infected with SARS-CoV-2, and infant appetite disorders may lead to hospitalization. The clinical course of the disease differed significantly between the first and second wave of the pandemic. It seems that infants may play a role in the transmission of SARS-COV-2 infections in households, despite mild or asymptomatic courses; eating disorders in infants should be an indication for COVID-19 testing.

The Seroprevalence of SARS-CoV-2 IgG Antibodies in Children Hospitalized for Reasons Other Than COVID-19

“…Co-morbidities, including birth defects, epilepsy, prematurity, atopic dermatitis, bronchopulmonary dysplasia, and immunodeficiency, were reported in 12% of the hospitalized infants. According to the authors, the actual incidence of COVID-19 in children is underestimated due to the lack of diagnoses of mild and asymptomatic courses [11].…”

“…Patients also report diarrhea, abdominal pain, vomiting, fatigue, headache, loss of smell and taste, muscle aches, and shortness of breath [9,10]. About 15% of infected children develop severe COVID-19 with pneumonia, while 5% of patients develop thrombosis, septic shock, and multiorgan failure due to a cytokine storm resulting from an abnormal immune system response [11]. The group of children at risk of severe COVID-19 is made up of newborns, children with obesity, and coexisting chronic diseases (such as congenital diseases of the heart, lungs, and respiratory tract, malnutrition, and cancer) [12,13].…”

SARS-CoV-2 seroprevalence in children worldwide: a systematic review and meta-analysis

“…While evidence suggested milder or even asymptomatic SARS-CoV-2 infections in children and adolescents (0–19 years of age; referred to hereafter as “children”) pre-Omicron, 6 , 7 , 8 more adverse health outcomes from COVID-19, including pneumonia, thrombosis, septic shock, MIS-C, and multiorgan failure, were documented then. 9 , 10 , 11 , 12 , 13 , 14 The lower risk of disease in children “pre-Omicron”, combined with concerns about vaccine safety and parental hesitancy, led to limited vaccine uptake and slow implementation of vaccination in children globally (particularly for children of <12 years of age). 15 , 16 Vaccines for children were also largely inaccessible in many parts of the world that were lagging behind in the vaccination of adults, particularly in low and middle-income countries (LMICs).…”

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

“…A recent report from Poland showed that during the second COVID-19 wave, 30% of affected children were infants, which increased from 10% during the first wave. Around 98% of the infants had mild disease, and none had severe disease [ 15 ]. A nationwide American study reported outcomes for under-5 children affected by the Omicron variant compared to those infected by the Delta variant.…”

“…In contrast to adult data, epidemiologic studies in neonates and children have shown that over 90% of those affected have asymptomatic or mild disease [ 8 , 9 , 10 ]. Despite a recent surge in pediatric and neonatal cases reported, relevant outcomes such as mortality, need for respiratory support, and hospitalization rates have remained lower compared to adults [ 11 , 12 , 13 , 14 , 15 , 16 ].…”