SARS-CoV-2 Among Infants &amp;lt;90 Days of Age Admitted for Serious Bacterial Infection Evaluation

Paret, Michal; Lalani, Karim; Hedari, Carine; Jaffer, Annum; Narayanan, Nisha; Noor, Asif; Lighter, Jennifer; Madan, Rebecca Pellett; Shust, Gail F.; Ratner, Adam J.; Raabe, Vanessa

doi:10.1542/peds.2020-044685

Cited by 19 publications

(29 citation statements)

References 35 publications

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“…It is thought that the difference in severity from SARS-CoV-2 infection between age groups relates to distinct immune responses and expression in receptors of angiotensin-converting enzyme-2 (ACE-2) in younger children [ 30 ]. However, consistent with previous studies, we found that amongst infants, neonates aged <1 month were at increased risk for hospitalization [ 9 , 10 , 13 , 15 , 31 ]. Although a low threshold for admission in infants aged less than 6 to 12 weeks who present with fever may impact hospitalization rates, a larger proportion of neonates aged <1 month admitted for COVID-19 have also required respiratory support compared to older infants, including 5 who required mechanical ventilation [ 23 ].…”

Section: Discussionsupporting

confidence: 92%

Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada

et al. 2022

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Background There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2. Methods This is a national, prospective study of infants with SARS-CoV-2 from April 8th 2020 to May 31st 2021 using the infrastructure of the Canadian Paediatric Surveillance Program. Infants <1 year of age with microbiologically confirmed SARS-CoV-2 infection from both inpatients and outpatients seen in clinics and emergency departments were included. Cases were classified as either: 1) Non-hospitalized patient with SARS-CoV-2 infection; 2) COVID-19-related hospitalization; or 3) non-COVID-19-related hospitalization (e.g., incidentally detected SARS-CoV-2). Case severity was defined as asymptomatic, outpatient care, mild (inpatient care), moderate or severe disease. Multivariable logistic regression was performed to identify characteristics associated with hospitalization. Results A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions (aOR = 4.53, 2.06–9.97), and infants <1 month had higher odds of hospitalization then infants aged 1–3 months (aOR = 3.78, 1.97–7.26). In total, 20 infants (3.8%) met criteria for severe disease. Conclusions We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group was found to be uncommon. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.

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Section: Discussionsupporting

confidence: 92%

Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada

et al. 2022

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“…The implications of coinfection with viruses and atypical bacteria on clinical features, laboratory and radiological examinations, treatments and outcomes are still unclear ( 58 ). Given that young children have the highest frequency of coinfections (notably with RSV and PIV or ADV), one must anticipate a future increment of coinfections with common respiratory viruses and SARS-CoV-2 ( 11 , 59 , 60 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on viral respiratory infection epidemiology in young children: A single-center analysis

Shen

Vermeulen

Debeer

et al. 2022

Front. Public Health

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BackgroundThe COVID-19 pandemic impacts different health aspects. Concomitant with the adoption of non-pharmaceutical interventions (NPIs) to reduce the spread of SARS-CoV-2, global surveillance studies reported a reduction in occurrence of respiratory pathogens like influenza A and B virus (IAV & IBV) and respiratory syncytial virus (RSV). We hypothesized to observe this collateral benefit on viral respiratory infection epidemiology in young children.MethodsRespiratory samples of children aged below 6 years, presenting at the outpatient clinic, emergency department, or pediatric infectious diseases department of the University Hospitals Leuven, between April 2017 and April 2021 were retrospectively analyzed. The occurrence (positivity rate), and seasonal patterns of viral respiratory infections were described. Chi-squared or Fisher's exact test (and Bonferroni correction) were used to explore differences in occurrence between 2020-2021 and previous 12-month (April to April) periods.ResultsWe included 3020 samples (453 respiratory panels, 2567 single SARS-CoV-2 PCR tests). IAV and IBV were not detected from March and January 2020, respectively. For IAV, positivity rate in 2020–2021 (0%, n = 0) was significantly different from 2018-2019 (12.4%, n = 17) (p < 0.001) and 2019-2020 (15.4%, n = 19) (p < 0.001). IBV positivity rate in 2020-2021 (0%, n = 0) was not significantly different from previous periods. RSV occurrence was significantly lower in 2020–2021 (3.2%, n = 3), compared to 2017-2018 (15.0%, n = 15) (p = 0.006), 2018–2019 (16.1%, n = 22) (p = 0.002) and 2019-2020 (22.8%, n = 28) (p < 0.001). The RSV (winter) peak was absent and presented later (March-April 2021). Positivity rate of parainfluenza virus 3 (PIV-3) was significantly higher in 2020-2021 (11.8%, n = 11) than 2017-2018 (1%, n = 1) (p = 0.002). PIV-3 was absent from April 2020 to January 2021, whereas no clear seasonal pattern was distinguished the other years. For the other viruses tested, no significant differences in occurrence were observed between 2020-2021 and previous periods. From March 2020 onwards, 20 cases (0.7%) of SARS-CoV-2 were identified.ConclusionThese findings reinforce the hypothesis of NPIs impacting the epidemiology of influenza viruses and RSV in young children. Compared to previous periods, no IAV and IBV cases were observed in the 2020-2021 study period, and the RSV peak occurred later. Since the pandemic is still ongoing, continuation of epidemiological surveillance, even on a larger scale, is indicated.

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“…Therefore, it has been suggested that infants should be tested for COVID-19, especially in periods when there is a history of exposure and the number of cases is high [ 8 , 12–15 ]. The most common complaints in COVID-19 (+) infants are fever, cough, vomiting, rhinorrhea, irritability and nasal congestion [ 16–18 ]. To our knowledge, no study has compared COVID-19-positive and -negative patients in febrile infants evaluated as FWS.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Infection in Well-Appearing 30- to 90-Day-Old Infants with Fever without a Source

Güngör

Bodur

Göktüğ

et al. 2022

Journal of Tropical Pediatrics

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Fever without a source (FWS) is common clinical status in the young infants. The aim of this study was to evaluate the clinical and laboratory findings of coronavirus disease (COVID-19) infection in well-appearing infants with FWS. Well-appearing febrile infants between 30 and 90 days who were evaluated as FWS in the pediatric emergency department and tested for COVID-19 were divided into two groups: COVID-19 (+) and (−). The clinical and laboratory findings of the patients were compared. The study included 95 febrile infants with FWS, and the mean age was 59.62 ± 16.82 days. The nasopharyngeal COVID-19 polymerase chain reaction test results of 29/95 (30.5%) patients were positive, while 66/95 (69.5%) were negative. The complaints of irritability and nasal congestion were found to be significantly more common in COVID-19-positive patients (p = 0.04 and p = 0.041, respectively). The hospitalization rate (p = 0.009), length of hospital stay (p = 0.026), initiation of antibiotic treatment (p < 0.001) and duration of antibiotic treatment (p = 0.036) were significantly lower in the COVID-19 (+) patients. The C-reactive protein (CRP, p < 0.001), absolute neutrophil count (ANC, p < 0.001), absolute lymphocyte count (ALC, p = 0.015), white blood cell (WBC, p < 0.001) and systemic immune-inflammation index (SII, p < 0.001) were found to be significantly lower in the COVID-19 (+) patient group. There was no significant difference between the groups in terms of neutropenia, lymphopenia or leukopenia. COVID-19 infection may present as an FWS. During the pandemic period, testing for COVID-19 among infants who were evaluated as FWS may reduce unnecessary hospitalizations and antibiotic treatments, and shorten hospital stays and duration of antibiotics.

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SARS-CoV-2 Among Infants <90 Days of Age Admitted for Serious Bacterial Infection Evaluation

Cited by 19 publications

References 35 publications

Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada

Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada

Impact of COVID-19 on viral respiratory infection epidemiology in young children: A single-center analysis

COVID-19 Infection in Well-Appearing 30- to 90-Day-Old Infants with Fever without a Source

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