Features of the course of new coronavirus infection in newborns and first-year infants

The aim of the study was to assess the features of the course of new coronavirus infection in newborns and children of the first year of life.

Materials and methods. Thirty-six children aged eight days to 11 months were hospitalized in the covid centre of the National Medical Research Center for Children’s Health (of which nine children were transferred from one of the surgical hospitals in Moscow due to the contact with SARS-CoV-2).

Results. Despite severe concomitant surgical pathology in 25% of patients, 98% of children had mild to moderate disease. Febrile temperature (up to a maximum of 39 °C) was observed in 4 infants, sub-febrile temperature in 5 people. In other children, for the entire period of treatment, there was no increase in temperature. Mothers’ complaints about lethargy dominated the clinical picture of the disease, followed by refusal to eat, runny nose, sneezing, swallowing voice, coughing, shortness of breath in their children. During the examination, the following signs were revealed: yawn hyperemia, mucous separated from the nose, hard breathing and dry wheezing (in 1 infant). The general blood test showed anemia (mostly related to prematurity anemia, or iron deficiency anemia), leftward leukocytosis (due to concomitant surgical pathology), leukopenia, various changes in the leukocytic formula of blood. In some instances, thrombocytopenia increased in D-dimer C-RP, procalcitonin, ferritin, bilirubin, and alanine aminotransferase. In only six infants with a moderate disease course, changes characteristic of a new coronavirus infection were identified on the chest CT scan. Six infantas had rhythm disorders detected in electrocardiographic examination (no deviations were found in echocardiographic examination).

Conclusion. According to both foreign literature and data obtained during our study, it can be concluded that, compared with adults, infants have a milder course of the disease and less pronounced changes obtained during laboratory and instrumental studies.

Contribution:
Kharitonova N.A. — concept and design of the study, writing the text;
Kharitonova N.A., Illarionova M.S., Nesterovich M.I. — collection and processing of material;
Kharitonova N.A., Basargina M.A. — statistical processing, editing.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: June 18, 2021
Accepted: June 23, 2021
Published: July 16, 2021

1. Sun P., Lu X., Xu C., Sun W., Pan B. Understanding of COVID-19 based on current evidence. J. Med. Virol. 2020; 92(6): 548-51. https://doi.org/10.1002/jmv.25722

2. Wu Z., McGoogan J.M. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020; 323(13): 1239-42. https://doi.org/10.1001/jama.2020.2648

3. Zimmermann P., Curtis N. COVID-19 in children, pregnancy and neonates: a review of epidemiologic and clinical features. Pediatr. Infect. Dis. J. 2020; 39(6): 469-77. https://doi.org/10.1097/INF.0000000000002700

4. Patel P.A., Chandrakasan S., Mickells G.E., Yildirim I., Kao C.M., Bennett C.M. Severe pediatric COVID-19 presenting with respiratory failure and severe thrombocytopenia. Pediatrics. 2020; 146(1): e20201437. https://doi.org/10.1542/peds.2020-1437

5. Ovalı F. SARS-CoV-2 infection and the newborn. Front. Pediatr. 2020; 8: 294. https://doi.org/10.3389/fped.2020.00294

6. Ludvigsson J.F. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Pediatr. 2020; 109(6): 1088-95. https://doi.org/10.1111/apa.15270

7. Tagarro A., Epalza C., Santos M., Sanz-Santaeufemia F.J., Otheo E., Moraleda C., et al. Screening and severity of Coronavirus Disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr. 2020; e201346. https://doi.org/10.1001/jamapediatrics.2020.1346

8. Erdeve Ö., Çetinkaya M., Baş A.Y., Narlı N., Duman N., Vural M., et al. The Turkish Neonatal Society proposal for the management of COVID-19 in the neonatal intensive care unit. Turk Pediatri Ars. 2020; 55(2): 86-92. https://doi.org/10.14744/turkpediatriars.2020.43788

9. Fang F., Luo X.P. Facing the pandemic of 2019 novel coronavirus infections: the pediatric perspectives. Zhonghua Er Ke Za Zhi. 2020; 58(2): 81-5. https://doi.org/10.3760/cma.j.issn.0578-1310.2020.02.001 (in Chinese)

10. Kam K.Q., Yung C.F., Cui L., Tzer Pin Lin R., Mak T.M., Maiwald M., et al. A well infant with coronavirus disease 2019 (COVID-19) with high viral load. Clin. Infect. Dis. 2020; 71(15): 847-9. https://doi.org/10.1093/cid/ciaa201

11. Hong H., Wang Y., Chang H.T., Chen C.J. Clinical characteristics of novel coronavirus disease 2019 (COVID-19) in newborn, infant and children. Pediatr. Neonatol. 2020; 61(2): 131-2. https://doi.org/10.1016/j.pedneo.2020.03.001

12. Zhang T., Cui X., Zhao X., Wang J., Zheng J., Zheng G., et al. Detectable SARS-CoV-2 viral RNA in feces of three children during recovery period of COVID-19 pneumonia. J. Med. Virol. 2020; 92(7): 909-14. https://doi.org/10.1002/jmv.25795

13. Zeng L., Xia S., Yuan W., Yan K., Xiao F., Shao J., et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr. 2020; 174(7): 722-5. https://doi.org/10.1001/jamapediatrics.2020.0878

14. Dong L., Tian J., He S., Zhu C., Wang J., Liu C., et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn (letter). JAMA. 2020; 323(18): 1846-8. https://doi.org/10.1001/jama.2020.4621

15. Liu W., Wang Q., Zhang Q., Chen L., Chen J., Zhang B., et al. Coronavirus disease 2019 (COVID-19) during pregnancy: a case series. Am. J. Obstet. Gynecol. 2020; 222(6): 521-31. https://doi.org/10.1016/j.ajog.2020.03.021

16. Mehboob R., Lavezzi A. Neuropathological explanation of minimal COVID-19 infection rate in newborns, infants and children - a mystery so far. New insight into the role of Substance P. J. Neurol. Sci. 2020; 420(6): 117276. https://doi.org/10.1016/j.jns.2020.117276

17. Lee P.I., Hu Y.L., Chen P.Y., Huang Y.C., Hsueh P.R. Are children less susceptible to COVID-19? J. Microbiol. Immunol. Infect. 2020; 53(3): 371-2. https://doi.org/10.1016/j.jmii.2020.02.011

18. Liu F., Xu A., Zhang Y., Xuan W., Yan T., Pan K., et al. Patients of COVID-19 may benefit from sustained lopinavir-combined regimen and the increase of eosinophil may predict the outcome of COVID-19 progression. Int. J. Infect. Dis. 2020; 95: 183-91. https://doi.org/10.1016/j.ijid.2020.03.013