Clinical features of infants with SARS-CoV-2 infection: a systematic review and meta-analysis.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to coronavirus disease 2019 (COVID-19) and is a public health problem. This meta-analysis reviewed the clinical features of SARS-CoV-2 infection among infants. METHODS: PubMed, Scopus, Web of Science, and the Cochrane Library were searched for studies on clinical features of infants with SARS-CoV-2 published before May 1, 2022. Two authors screened and extracted data on the number of infants with SARS-CoV-2 infection, clinical features, and number of clinical features. The proportion of asymptomatic infection, mild symptoms, moderate symptoms, severe symptoms, and the clinical features were analyzed. RESULTS: Forty-four studies with 6,304 infants with SARS-CoV-2 infections were included in this study. The proportion of asymptomatic infection was 20% (95% CI: 11-28%, I2=97%, P<0.01) in infants with SARS-CoV-2 infections. The proportion of infants with mild, moderate, and severe symptoms was 48% (95% CI: 30-65%, I2=96%, P<0.01), 27% (95% CI: 10-44%, I2=93%, P<0.01), and 8% (95% CI: 0-16%, I2=90%, P<0.01), respectively. Notably, the most common clinical features of infants with SARS-CoV-2 infection were fever (64%), cough (34%), and nasal symptoms (31%). CONCLUSIONS: This meta-analysis found that 20% of infants with SARS-CoV-2 infections were asymptomatic, while most infants with COVID-19 presented with mild symptoms.

Time Distributions of Common Respiratory Pathogens Under the Spread of SARS-CoV-2 Among Children in Xiamen, China.

Objectives: The aim of this study was to observe the effect of COVID-19 prevention and control measures on the transmission of common respiratory viruses in a pediatric population. Methods: This was a retrospective observational study. The study population was selected from children with respiratory diseases who attended Xiamen Children's Hospital from January 1, 2018 to January 31, 2021. All children were screened for influenza virus, parainfluenza virus, respiratory syncytial virus (RSV), adenovirus, and Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The changes in respiratory virus detection rates before and after the SARS-CoV-2 intervention were analyzed using an interrupted time-series model. Polynomial curve fitting was also used to predict future short-term trends in respiratory virus detection. Results: A total of 56,859 children were seen at Xiamen Children's Hospital from January 1, 2018 to Jan 31, 2021, of which 32,120 were tested for respiratory viruses via pharyngeal swabs. The overall positive detection rates of the four respiratory viral infections decreased significantly (P = 0.0017) after the implementation of the quarantine and school suspension measures in January 2020. Among them, the detection rate of RSV decreased most significantly (P = 0.008), and although there was no statistically significant difference in the detection rates of the influenza virus, parainfluenza virus, and adenovirus, a downward trend in the graph was observed. The positive detection rates of RSV in the 0-1-, 1-3-, and 3-7-year-old groups all decreased significantly (P = 0.035, 0.016, and 0.038, respectively). The change in the positive detection rate of RSV was relatively stable in the 7-18-year-old group. A total of 10,496 samples were tested for SARS-CoV-2, and no positive cases were reported. Conclusions: The combination of preventive and control measures for COVID-19 reduced the detection rate of four common respiratory viruses, with the greatest impact on RSV. If prevention and control measures continue to be maintained, the overall detection rate or absolute number of detections for the four respiratory viruses will remain low in the short term. However, this trend is likely to vary with the changes in measures.

Short-term developmental outcomes in neonates born to mothers with COVID-19 from Wuhan, China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease. The consequences of SARS-CoV-2 exposure in infants remain unknown. Therefore, this study aims to investigate whether neonates born to mothers with COVID-19 have adverse brain development. METHODS: This multicenter observational study was conducted at two designated maternal and children's hospitals in Hubei Province, mainland China from February 1, 2020 to May 15, 2020. Neonates born to mothers with COVID-19 were enrolled. Brain magnetic resonance imaging (MRI) findings, and volumes of grey and white matters, and physical growth parameters were observed at 44 weeks corrected gestational age. RESULTS: Of 72 neonates born to mothers with COVID-19, 8 (11%) were diagnosed with COVID-19, 8 (11%) were critically ill, and no deaths were reported. Among the eight neonates that underwent brain MRI at corrected gestational age of 44 weeks, five neonates were diagnosed with COVID-19. Among these five neonates, three presented abnormal MRI findings including abnormal signal in white matter and delayed myelination in newborn 2, delayed myelination and brain dysplasia in newborn 3, and abnormal signal in the bilateral periventricular in newborn 5. The other three neonates without COVID-19 presented no significantly changes of brain MRI findings and the volumes of grey matter and white matter compared to those of healthy newborns at the equivalent age (P > 0.05). Physical growth parameters for weight, length, and head circumference at gestational age of 44 weeks were all above the 3rd percentile for all neonates. CONCLUSIONS: Some of the neonates born to mothers with COVID-19 had abnormal brain MRI findings but these neonates did not appear to have poor physical growth. These findings may provide the information on the follow-up schedule on the neonates exposed to SARS-CoV-2, but further study is required to evaluate the association between the abnormal MRI findings and the exposure to SARS-CoV-2.

Effects of SARS-CoV-2 infection on neuroimaging and neurobehavior in neonates.

BACKGROUND: We collected neonatal neurological, clinical, and imaging data to study the neurological manifestations and imaging characteristics of neonates with coronavirus disease 2019 (COVID-19). METHODS: This case-control study included newborns diagnosed with COVID-19 in Wuhan, China from January 2020 to July 2020. All included newborns had complete neurological evaluations and head magnetic resonance imaging. We normalized the extracted T2-weighted imaging data to a standard neonate template space, and segmented them into gray matter, white matter, and cerebrospinal fluid. The comparison of gray matter volume was conducted between the two groups. RESULTS: A total of five neonates with COVID-19 were included in this study. The median reflex scores were 2 points lower in the infected group than in the control group (P = 0.0094), and the median orientation and behavior scores were 2.5 points lower in the infected group than in the control group (P = 0.0008). There were also significant differences between the two groups in the total scale score (P = 0.0426). The caudate nucleus, parahippocampal gyrus, and thalamus had the strongest correlations with the Hammersmith neonatal neurologic examination (HNNE) score, and the absolute correlation coefficients between the gray matter volumes and each part of the HNNE score were all almost greater than 0.5. CONCLUSIONS: We first compared the neurological performance of neonates with and without COVID-19 by quantitative neuroimaging and neurological examination methods. Considering the limited numbers of patients, more studies focusing on the structural or functional aspects of the virus in the central nervous system in different age groups will be carried out in the future.

Children with SARS-CoV-2 infection during an epidemic in China (outside of Hubei province).

BACKGROUND: Limited studies have reported the clinical and epidemiological characteristics of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to provide the epidemiological characteristics of children with COVID-19 throughout China (outside of Hubei Province) based on public data. METHODS: This was an observational, cross-sectional study. We included a total of 279 diagnosed children based on the data of children infected with SARS-CoV-2 reported by the Health Commission in each province, autonomous region, municipality, or special administrative region in China (outside of Hubei Province) from January 24, 2020 to February 16, 2020. RESULTS: The number of newborns (0 days ≤ age ≤28 days), infants (28 days < age ≤1 year), children (1 year < age ≤5 years), and children (5 years < age ≤18 years) accounted for 0.7%, 6.5%, 23.7%, and 69.2% of the total number of infected children, respectively. We found that from January 23, 2020, to January 31, 2020, infected children mainly came from Wuhan, China. After February 3, 2020, family clustering transmission became the main mode of transmission. CONCLUSIONS: Family clustering transmission is currently the main model of transmission in children. Considering the mild symptoms in infected children, the possibility that children may be a source of the transmission should not be ignored.