Severe and critical SARS‐COV‐2 delta variant infection in infants without underlying medical conditions

Abstract

We report herein a case series of infants, with no comorbidities, who developed a life‐threatening illness due to the SARS‐CoV‐2 Delta variant. We retrospectively reviewed the medical records of children, aged under 15 years, admitted to PICU, during the peak of Delta infection, between June 23 and August 16 2021, with severe and critical forms of SARS‐CoV‐2 infection, confirmed by RT‐PCR. Twenty infants were included, the median age was 47 days (IQR: 26.5–77) and sex ratio was 0.8. No underlying medical conditions were noted. Parents were not vaccinated. Respiratory involvement was the main feature observed. Eleven patients had paediatric acute respiratory distress (PARDS) with a median oxygen saturation index (OSI) of 9 (IQR: 7–11). PARDS was mild in four, moderate in five, and severe in two cases. Hemodynamic instability was observed in 4 cases. The main radiological finding was ground glass opacities in 11 cases. Seventeen patients were mechanically ventilated, and three of them were escalated to high‐frequency oscillatory ventilation. The median duration of mechanical ventilation was 6 days (IQR 2.5–12.5). The remaining patients were managed with high‐flow nasal cannula. Four patients died.

Defining the pediatric response to SARS-CoV-2 variants

“…Findings implied that the higher hospitalization rates seen with the emergence of Delta were not a result of increased pathogenicity of the variant but simply due to the increased prevalence of infection. However, a case series in Tunisia reported that Delta causes critical outcomes in infants (<2 years) without any underlying conditions whose mothers were unvaccinated, where over half of the patients had pediatric ARDS and 20% ended with death ( 46 ). While this is not an overarching outcome of all pediatric SARS-CoV-2 infections, it emphasizes the potential risk new variants could bring.…”