Neonates with SARS-CoV-2 infection: spectrum of disease from a prospective nationwide observational cohort study

Abstract

BACKGROUND: Coronavirus disease 2019 (COVID-19) can be more severe in infants than in older children. To date, only a few case series have reported data on neonates with COVID-19, including mostly asymptomatic neonates who were tested because of exposure to maternal SARS-CoV-2 infection. This study summarises nationwide epidemiological data, clinical characteristics, treatment and outcomes of neonates presenting with symptomatic SARS-CoV-2 infection. METHODS: Data were prospectively collected through the Swiss Paediatric Surveillance Unit from hospitalised neonates with laboratory-confirmed SARS-CoV-2 infection (positive polymerase chain reaction on a respiratory sample) from 1 March 2020 to 31 September 2021. All 29 paediatric hospitals in Switzerland reported cases. RESULTS: In total, 73 neonates were included; 7 (10%) were preterm. The median age at presentation was 17 days (interquartile range [IQR] 11–23); 40 (55%) were female. The majority of neonates (64, 88%) were admitted from home. Nine (12%) had a pre-existing medical condition. Overall, the most common symptom recorded was fever in 52 (71%), followed by rhinorrhoea or nasal congestion in 32 (44%) and respiratory distress in 19 (26%). Twenty (27%) neonates presented with fever without a source. Seven (10%) neonates were admitted to an intensive care unit (5 for respiratory failure and 2 for monitoring). One (1%) neonate required inotropic support. The median length of hospital stay in term neonates was 4 days (IQR 3–5). Two (3%) were treated with corticosteroids and 1 (1%) with remdesivir. In total, 60 (82%) neonates had contact with a known or suspected SARS-CoV-2 index case. All of the 71 neonates for whom data were available were discharged to their homes without symptoms. CONCLUSION: In neonates, COVID-19 mainly presents with fever, and symptoms of upper and lower respiratory tract infection. The clinical course is mostly mild, requiring a short period of hospitalisation. COVID-19 needs to be added as a differential diagnosis in neonates who present with fever without a source. However, the presence of SARS-CoV-2 should not deter from the search for a serious bacterial infection. Further data from surveillance studies are needed to better understand COVID-19 in neonates, guide therapy and to evaluate whether the clinical spectrum is changing with new SARS-CoV-2 variants.

Epidemiology and Clinical Features of COVID-19 among 4,015 Neonates in Iran: Results of the National Study from the Iranian Maternal and Neonatal Network

“…These data were similar to other studies from Iran, including that by Mohagheghi et al [50] who found that respiratory distress was the most frequent presenting finding in hospitalized neonates with COVID-19. Our results are interesting in view of other neonatal studies, including that of Zimmerman et al [24] from Switzerland in which the most frequent presenting features of infected neonates were fever (71%), rhinorrhea or nasal congestion (44%) and respiratory distress (26%). The study by Devin et al [27] identified tachypnea as the most frequent presenting symptom of infection in both non-severe and severely affected neonates, followed by fever and hypoglycemia.…”

“…This has resulted in a significant decrease in child and maternal mortality rates [15]. The epidemiological features of COVID-19 in neonates has now been described from multiple reports [24,27,28]. A recent report of greater than one million neonatal clinical encounters derived from 109 health systems in the United States found that COVID-19 infection was diagnosed in 0.1% of newborns, and that 7.7% of infected neonates developed serious disease [27].…”

The characteristics of SARS‐CoV‐2‐positive children in Australian hospitals: a PREDICT network study

“…In our study, 58% of the children who presented to hospitals were under six years of age, including 25 infants less than one month old admitted to hospital (but none to intensive care). In a recent Swiss study, five of 73 hospitalised neonates with COVID‐19 were admitted to intensive care with respiratory failure 14 . In general, the possibility of rapid deterioration means that the threshold for admitting infants for observation or empiric intravenous antibiotic therapy is low.…”

The changing clinical presentation of COVID‐19 in children during the course of the pandemic

“…Children admitted due to, and with, SARS‐CoV‐2 infection were included. All 29 paediatric hospitals in Switzerland entered cases on a monthly basis and completed a detailed electronic clinical report form, using REDCap (Vanderbilt University, Tennessee, USA) 13–15 …”

“…All 29 paediatric hospitals in Switzerland entered cases on a monthly basis and completed a detailed electronic clinical report form, using REDCap (Vanderbilt University, Tennessee, USA). [13][14][15] This study includes data collected between 01 March 2020 and…”