June 19, 2020

Infants With COVID-19 Tend to Have Mild Illness, Fever Primary Symptom

A study published in The Journal of Pediatrics showed that infants aged younger than 90 days who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fared well with little or no respiratory involvement.

The study found that fever was often the primary or only symptom.

“While there is limited data on infants with COVID-19 from the United States, our findings suggest that these babies mostly have mild illness and may not be at higher risk of severe disease as initially reported from China,” said Leena B. Mithal, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois.

Among 171 infants aged <90 days tested for SARS-CoV-2 between April 11, 2020, and May 12, 2020, at Lurie Children’s Hospital, 18 (10%) tested positive (39% were male and none had significant past medical history).

Most infants (77.8%) had fever, only 2 had cough as the only symptom, and 1 infant had choking associated with feeding. One infant was asymptomatic but was screened and tested because parents had confirmed COVID-19.

“It is unclear whether young infants with fever and a positive test for SARS-CoV-2 require hospital admission,” said Dr. Mithal. “The decision to admit to the hospital is based on age, need for pre-emptive treatment of bacterial infection, clinical assessment, feeding tolerance, and adequacy of follow-up. There may be opportunities to utilise rapid SARS-CoV-2 testing to determine disposition of clinically well infants with fever.”

None of the infants required intensive care, none were hypoxemic or required respiratory support, and there were no viral co-infections.

The researchers also observed an overrepresentation of Latinx ethnicity among their sample of infants who tested positive for SARS-CoV-2 (78%). At the height of the COVID-19 pandemic in Chicago, over 40% of cases were in individuals of Latinx ethnicity.

“Although we expected that there would be many infants of Latinx ethnicity with COVID-19, there may be additional factors contributing to the disproportionate majority of Latinx cases we observed in this age group,” said Dr. Mithal. “Access to sick-visit care in some primary care paediatric offices has been limited, with practices referring symptomatic children to the emergency department. Limited access to telemedicine care also may be a factor. Finally, there may be a greater likelihood of exposure with extended family living in the home or family members working outside the home during this pandemic.”

Reference https://www.jpeds.com/article/S0022-3476(20)30750-2/pdf

SOURCE: Ann & Robert H. Lurie Children’s Hospital of Chicago
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