Hospitalized COVID-19 infections in Infants < 1 Year of Age

Background Nearly 4 million children have tested positive for coronavirus disease 2019 (COVID-19) in the United States. Some studies suggest infants might be at increased risk for severe illness and hospitalization from COVID-19. Our objective was to describe the clinical and laboratory features of young infants admitted to a hospital system with COVID-19. Methods An observational retrospective study was performed in infants ≤1 year of age admitted with COVID-19 from March 1, 2020 to May 30, 2021. Data was extracted into a REDCap database and analyzed using descriptive statistics. Results Sixteen infants < 1 year were hospitalized with COVID-19. Fever, poor feeding, and respiratory symptoms were the most common presenting symptoms (Table 1). Two required pediatric intensive care unit (ICU) care, three required oxygen support, and one was intubated. There were no deaths. Five infants with echocardiograms performed showed normal findings. Four infants received Remdesivir without side effects.CharacteristicsPatients (N=16)Age, range2 weeks to 10 monthsMale, n (%)10 (63)Hispanic, n (%) 7 (44)RaceBlack n (%)1 (6)White n (%)10 (63)Prematurity n (%)3 (19)Comorbid condition, n (%)0Contact with COVID-19 positive individual n (%) 13 (81)Clinical presentationFever n (%) 13 (81)Cough n (%)5 (31)Rhinorrhea n (%)5 (31)Respiratory distress n (%)2 (12)Poor feeding n (%)5 (31)Emesis n (%)3 (19)Diarrhea n (%)2 (13)Hypoxia n (%)3 (19)LaboratoryAbsolute neutrophil count, median (min, max)0.64 (0, 1.16)Neutropenia (< 1.5) n (%)7 (44)Lymphopenia (< 4.5) n (%)12 (75)Thrombocytopenia n (%) 3 (19)C-reactive protein highest value, mg/L, median (IQR)14. 3 (2.33, 11.73)Disposition & TherapiesLength of hospital stay, days, median (range)4.5 (1, 16)ICU admission n (%)2 (13)Any oxygen support, n (%) 3 (19)Mechanical ventilation, n (%) 1 (6)Vasopressor support n (%)0Antibiotics, n (%)13 (81)Remdesivir n (%)4 (25)Steroids, n(%)1 (6) Conclusion Infants with COVID-19 can present with severe disease requiring ICU care and oxygen support. In our experience, a large proportion of infants developed hematologic abnormalities, but none had cardiac involvement. Preventive measures including vaccination will become critical to decrease transmission and severe disease in this young patient population. Disclosures All Authors: No reported disclosures

Management and Early Outcomes of Neonates Born to Women with SARS-CoV-2 in 16 U.S. Hospitals.

OBJECTIVE: There is a paucity of evidence to guide the clinical care of late preterm and term neonates born to women with perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The objective of this case series is to describe early neonatal outcomes and inpatient management in U.S. hospitals. STUDY DESIGN: We solicited cases of mother-infant dyads affected by novel coronavirus disease 2019 (COVID-19) from the Better Outcomes through Research for Newborns (BORN) Network members. Using a structured case template, participating sites contributed deidentified, retrospective birth hospitalization data for neonates ≥35 weeks of gestation at birth with mothers who tested positive for SARS-CoV-2 before delivery. We describe demographic and clinical characteristics, clinical management, and neonatal outcomes. RESULTS: Sixteen U.S. hospitals contributed 70 cases. Birth hospitalizations were uncomplicated for 66 (94%) neonates in which 4 (6%) required admission to a neonatal intensive care unit. None required evaluation or treatment for infection, and all who were tested for SARS-CoV-2 were negative (n = 57). Half of the dyads were colocated (n = 34) and 40% directly breastfed (n = 28). Outpatient follow-up data were available for 13 neonates, all of whom remained asymptomatic. CONCLUSION: In this multisite case series of 70 neonates born to women with SARS-CoV-2 infection, clinical outcomes were overall good, and there were no documented neonatal SARS-CoV-2 infections. Clinical management was largely inconsistent with contemporaneous U.S. COVID-19 guidelines for nursery care, suggesting concerns about the acceptability and feasibility of those recommendations. Longitudinal studies are urgently needed to assess the benefits and harms of current practices to inform evidence-based clinical care and aid shared decision-making. KEY POINTS: · Birth hospitalizations were uncomplicated for late preterm and term infants with maternal COVID-19.. · Nursery management of dyads affected by COVID-19 varied between hospitals.. · Adherence to contemporaneous U.S. clinical guidelines for nursery care was low.. · Breastfeeding rates were lower for dyads roomed separately than those who were colocated..

Impact of outpatient SARS-CoV-2 infections in minority children.

ABSTRACT: Data regarding COVID-19 in the adult population and hospitalized children is rapidly evolving, but little is known about children infected with severe acute respiratory syndrome coronavirus 2 who do not require hospitalization.In an observational, retrospective study we analyzed risk factors, demographics and clinical course of non-hospitalized patients ≤ 21 years of age with COVID-19 infection.Of the 1,796 patients evaluated, 170 were infected, and 40 participated in a telephone survey. Children older >10 years of age (OR: 2.19), Hispanic ethnicity (OR: 3) and residing in counties with higher rates of poverty (OR: 1.5) were associated with higher risk of infection, while older girls were more likely to experience prolonged duration of symptoms (median: 32 days). Consistent with prior reports, fever and cough were present in most of our patients. Shortness of breath, diarrhea, anosmia, and ageusia were more common in our outpatient population than previously reported.Larger studies addressing the clinical and psychosocial impact of CoVID-19 infection in children living in high-risk environments are warranted.

The Impact of COVID-19 Infection on Labor and Delivery, Newborn Nursery, and Neonatal Intensive Care Unit: Prospective Observational Data from a Single Hospital System.

OBJECTIVE: Since its emergence in late 2019, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the novel coronavirus that causes novel coronavirus disease 2019 (COVID-19), has spread globally. Within the United States, some of the most affected regions have been New York, and Northern New Jersey. Our objective is to describe the impact of COVID-19 in a large delivery service in Northern New Jersey, including its effects on labor and delivery (L&D), the newborn nursery, and the neonatal intensive care unit (NICU). MATERIALS AND METHODS: Between April 21, 2020 and May 5, 2020, a total of 78 mothers (3.6% of deliveries) were identified by screening history or examination to either be COVID-19 positive or possible positives (persons under investigation). Of the mothers who were tested after admission to L&D, 28% tested positive for SARS-CoV-2. DISCUSSION: Isolation between mother and infant was recommended in 62 cases, either because the mother was positive for SARS-CoV-2 or because the test was still pending. Fifty-four families (87%) agreed to isolation and separation. The majority of infants, 51 (94%), were initially isolated on the newborn nursery. Six needed NICU admission. No infants had clinical evidence of symptomatic COVID-19 infection. Fourteen infants whose mothers were positive for SARS-CoV-2, and who had been separated from the mother at birth were tested for SARS-CoV-2 postnatally. All were negative. RESULTS: COVID-19 posed a significant burden to mothers, infants, and staff over the 5-week study period. The yield from screening mothers for COVID-19 on L&D was high. Most families accepted the need for postnatal isolation and separation of mother and newborn. CONCLUSION: Our study suggests that the transmission of SARS-CoV-2 from mother to her fetus/newborn seems to be uncommon if appropriate separation measures are performed at birth. KEY POINTS: · The yield of targeted testing for SARS-CoV-2, on mothers on Labor and Delivery is high.. · Agreement to separation of mothers and infants to reduce transmission of SARS-CoV-2 was high.. · The incidence of symptomatic COVID-19 in newborns is low, if appropriate separation occurs at birth..