Characteristics, Presentation, and Illness Severity of COVID-19 in Infants Less Than Three Months of Age

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ESPR95
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Abstract: :

Background: SARS-CoV-2 has rapidly spread worldwide causing severe morbidity and mortality, particularly in adults. Few publications have shown varying degrees of illness severity in infants, ranging from asymptomatic or mild disease to more serious illness with neurologic symptoms including hypotonia and seizures.

Objective: To describe the characteristics, presentation, and outcomes of infants less than 3 months of age with positive SARS-CoV-2 infection.

Design/Methods: This is a retrospective case series of infants less than 3 months of age who presented to a tertiary care regional referral center between March 1 - May 31, 2020 with positive SARS-CoV-2 PCR. Subjects were identified through review of discharge and billing data for COVID-19 (ICD-10: U07.1). Data on demographics, comorbidities, exposure, presenting symptoms, physical exam findings, relevant investigations, and outcomes were obtained. Categorical variables were analyzed by frequencies while continuous variables were summarized by median and interquartile ranges. Illness severity was adapted from a previously published scoring system and modified to be age-specific and include respiratory rate.

Results: Data were collected on 22 infants less than 3 months of age with positive SARS-CoV-2 PCR testing. Seven (32%) were discharged from the Pediatric ED, 14 (64%) were admitted to the Pediatric Hospitalist Service, and one (4%) was admitted to the PICU. Age ranged from 16-63 days. Ten (45%) patients had no known exposure to COVID-19. Fever was the most common presenting sign (91%). Of the patients that were tested, 89% (17/19) had normal WBC count for age. Three patients had neutropenia (<1000 k/mm3) and two had lymphopenia (<2000 k/mm3). Eight patients had chest X-rays; none had focal findings. One patient had a concurrent viral respiratory illness on PCR testing and three patients had concurrent bacterial infections (2 UTI, 1 skin). Median length of stay was 2 days and all patients were discharged home within four days (Table). No infants required supplemental oxygen or escalation of care and all were categorized as having asymptomatic or mild disease severity. One infant was readmitted within 24 hours and required supplemental oxygen via nasal cannula for four days; illness severity for this readmission was categorized as severe.

Conclusions: The majority of young infants with SARS-CoV-2 infection presented with varied symptoms and did not appear to be at risk for severe disease or poor outcomes. Clinicians should be aware that young infants who present with fever or other symptoms may have COVID-19, regardless of known exposure to the virus. Our results suggest that young infants do not appear to be at increased risk for severe presentation, disease course, or outcomes, and can be managed similarly to those with other respiratory viral illnesses or fever. The long-term sequelae of COVID-19 infection at such a young age are not yet understood; additional studies are necessary.

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New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College
New York Medical College

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