Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
Demographic and Clinical Findings
4. Discussion
4.1. Clinical Presentation
4.2. Blood and Urine Test Findings
4.3. Management and Outcome
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total n = 274 | Patients <29 Days Old n = 60 | Patients ≥29 Day Old n = 214 | p | |
---|---|---|---|---|
Age, median (IQR 25–75) | 47 (31–68) | 16 (10.75–22.25) | 54.5 (41–71) | <0.0001 |
Sex, male (%) | 152 (55.0%) | 33 (55%) | 119 (55.5%) | 0.93 |
Comorbidities, yes (%) | 23 (9%) | 5 (8.5%) | 18 (9%) | 0.81 |
Older sibling, yes (%) | 76 (43.5%) | 22 (47%) | 54 (42%) | 0.58 |
Maternal GBS, positive (%) | 17 (6.5%) | 6 (10.5%) | 11 (5.5%) | 0.19 |
Admission, yes (%) | 195 (71%) | 50 (83.5%) | 145 (67.5%) | 0.018 |
LOS in h, median (IQR 25–75) | 48 (48–72) | 48 (48–78) | 48 (48–72) | 0.94 |
Poor clinical condition, yes (%) | 8 (3%) | 3 (5%) | 5 (2.5%) | 0.27 |
Asymptomatic, yes (%) | 19 (7%) | 6 (10%) | 13 (6%) | 0.29 |
Fever, yes (%) | 209 (76%) | 43 (71.5%) | 166 (77.5%) | 0.34 |
Fever < 6 h, yes (%) | 120 (57.5%) | 35 (81%) | 85 (51%) | 0.004 |
Blood exams, yes (%) | 206 (75%) | 48 (80%) | 158 (74%) | 0.32 |
Blood exams in fever, yes (%) | 188 (90%) | 43 (100%) | 145 (87%) | 0.013 |
Blood exams in afebrile, yes (%) | 65 (24%) | 5 (29.5%) | 13 (27%) | 0.85 |
Urine exams, yes (%) | 192 (70%) | 38 (63%) | 154 (78%) | 0.19 |
Positive nitrites, yes (%) | 2 (1%) | 0 (%) | 2 (1.5%) | 0.47 |
Leukocyturia, yes (%) | 9 (4.5%) | 0 (%) | 9 (6%) | 0.12 |
Urine culture collected, yes (%) | 66 (34%) | 12 (31.5%) | 54 (35%) | 0.68 |
Urine culture, positive (%) | 2 (3%) | 0 (0%) | 2 (3.5%) | 0.49 |
Blood culture collected, yes (%) | 47 (23%) | 11 (23%) | 36 (22.5%) | 0.98 |
Blood culture, positive (%) | 0 (0%) | 0 (%) | 0 (%) | / |
RSV coinfection, yes (%) | 5 (2%) | 0 (0%) | 5 (2.5%) | 0.23 |
GI symptoms, yes (%) | 18 (6.5%) | 3 (5%) | 15 (7%) | 0.57 |
Poor feeding, yes (%) | 61 (22%) | 19 (31.5%) | 42 (19.5%) | 0.047 |
LRT symptoms, yes (%) | 19 (7%) | 2 (3.5%) | 17 (8%) | 0.21 |
URT symptoms, yes (%) | 93 (34%) | 21 (35%) | 72 (33.5%) | 0.84 |
Dyspnea, yes (%) | 16 (6%) | 3 (3.5%) | 13 (6%) | 0.69 |
Apnea, yes (%) | 6 (2%) | 1 (1.5%) | 5 (2.5%) | 0.75 |
Cutaneous rash, yes (%) | 7 (2.5%) | 1 (1.5%) | 6 (3%) | 0.62 |
Oxygen supplementation, yes (%) | 10 (3.5%) | 3 (3.5%) | 7 (3.5%) | 0.52 |
HFNC, yes (%) | 1 (0.5%) | 0 (0%) | 1 (0.5%) | 0.59 |
Total Patients n = 107 | Patients <29 Days Old n = 35 | Patients ≥29 Days Old n = 72 | p | |
---|---|---|---|---|
CRP in mg/dL, median (IQR 25–75) | 0.00 (0.00–0.00) | 0.00 (0.00–0.00) | 0.00 (0.00–0.08) | 0.34 |
CRP > 2 mg/dL, yes (%) | 11 (10%) | 0 (0%) | 11 (15%) | 0.014 |
PCT in ng/mL, median (IQR 25–75) | 0.11 (0.05–0.14) | 0.11 (0.08–0.13) | 0.10 (0.05–0.14) | 0.85 |
PCT > 0.5 ng/mL, yes (%) | 2 (2%) | 1 (3%) | 1 (1.5%) | 0.59 |
WBC in cells/mm3, median (IQR 25–75) | 7100 (5300–8750) | 7900 (6000–8850) | 6650 (5150–8375) | 0.16 |
WBC > 10,000 cells/mm3, yes (%) | 12 (11%) | 3 (8.5%) | 9 (12.5%) | 0.54 |
ANC in cells/mm3, median (IQR 25–75) | 2300 (1750–3400) | 2800 (2100–3600) | 2150 (1500–3200) | 0.03 |
ANC < 1000 cells/mm3, yes (%) | 3 (3%) | 1 (3%) | 2 (3%) | 0.98 |
ANC > 5000 cells/mm3, yes (%) | 6 (6%) | 0 (0%) | 6 (8.5%) | 0.07 |
Total Patients n = 81 | Patients <29 Days Old n = 8 | Patients ≥29 Days Old n = 73 | p | |
---|---|---|---|---|
CRP in mg/dL, median (IQR 25–75) | 0.00 (0.00–0.00) | 0.00 (0.00–0.04) | 0.00 (0.00–0.00) | 0.51 |
CRP > 2 mg/dL, yes (%) | 2 (2.5%) | 1 (12.5%) | 1 (1.5%) | 0.054 |
PCT in ng/mL, median (IQR 25–75) | 0.11 (0.05–0.16) | 0.15 (0.10–0.19) | 0.10 (0.05–0.15) | 0.65 |
PCT > 0.5 ng/mL, yes (%) | 1 (1%) | 0 (0%) | 1 (1.5%) | 0.73 |
WBC in cells/mm3, median (IQR 25–75) | 7200 (5150–9800) | 10,200 (7400–11,000) | 6500 (4300–8900) | 0.005 |
WBC > 10,000 cells/mm3, yes (%) | 19 (23.5%) | 5 (62.5%) | 14 (19%) | 0.006 |
ANC in cells/mm3, median (IQR 25–75) | 1970 (1000–2525) | 2100 (1600–2550) | 1600 (1000–2500) | 0.25 |
ANC < 1000 cells/mm3, yes (%) | 18 (22%) | 2 (25%) | 16 (22%) | 0.84 |
ANC > 5000 cells/mm3, yes (%) | 5 (6%) | 1 (12.5%) | 4 (5.5%) | 0.43 |
Total < 29 Days Old Patients n = 48 | Febrile Patients n = 43 | Afebrile Patients n = 5 | p | |
---|---|---|---|---|
Age, median (IQR 25–75) | 16 (10.75–22.25) | 16 (10.50–22.00) | 16 (11.00–23.00) | 0.67 |
Sex, male (%) | 25 (52%) | 22 (51%) | 3 (60%) | 0.70 |
CRP in mg/dL, median (IQR 25–75) | 0.00 (0.00–0.00) | 0.00 (0.00–0.00) | 0.00 (0.00–0.00) | 0.60 |
CRP > 2 mg/dL, yes (%) | 1 (2%) | 1 (2.5%) | 0 (0%) | 0.73 |
PCT in ng/mL, median (IQR 25–75) | 0.11 (0.07–0.15) | 0.12 (0.08–0.15) | 0.08 (0.04–0.12) | 0.87 |
PCT > 0.5 ng/mL, yes (%) | 1 (2%) | 1 (2.5%) | 0 (0%) | 0.73 |
WBC in cells/mm3, median (IQR 25–75) | 7900 (6300–9200) | 7950 (6400–9975) | 8500 (6750–10,400) | 0.20 |
WBC > 10,000 cells/mm3, yes (%) | 9 (19%) | 8 (18.5%) | 1 (20%) | 0.94 |
ANC in cells/mm3, median (IQR 25–75) | 2500 (1950–3500) | 2450 (2000–3475) | 1500 (1450–2150) | 0.065 |
ANC < 1000 cells/mm3, yes (%) | 1 (2%) | 3 (7%) | 0 (0%) | 0.54 |
ANC > 5000 cells/mm3, yes (%) | 0 (0%) | 1 (2.5%) | 0 (0%) | 0.73 |
Total 29–90 Days Old Patients n = 158 | Febrile Patients n = 145 | Afebrile Patients n = 13 | p | |
---|---|---|---|---|
Age, median (IQR 25–75) | 54.5 (41–71) | 55.5 (42–72) | 51.00 (37.75–67.75) | 0.26 |
Sex, male (%) | 88 (55.5%) | 81 (56%) | 7 (54%) | 0.88 |
CRP in mg/dL, median (IQR 25–75) | 0.00 (0.00–0.00) | 0.00 (0.00–0.00) | 0.00 (0.00–0.00) | 0.27 |
CRP > 2 mg/dL, yes (%) | 12 (7.5%) | 12 (8%) | 0 (0%) | 0.28 |
PCT in ng/mL, median (IQR 25–75) | 0.09 (0.03–0.14) | 0.10 (0.05–0.15) | 0.00 (0.00–0.05) | 0.32 |
PCT > 0.5 ng/mL, yes (%) | 2 (1.5%) | 2 (1.5%) | 0 (0%) | 0.66 |
WBC in cells/mm3, median (IQR 25–75) | 6600 (4800–8900) | 6600 (4800–8900) | 8900 (5900–9550) | 0.19 |
WBC > 10,000 cells/mm3, yes (%) | 25(16%) | 23 (16%) | 2(15%) | 0.96 |
ANC in cells/mm3, median (IQR 25–75) | 2000 (1285–2800) | 2000 (1200–2700) | 1700 (1400–2500) | 0.59 |
ANC < 1000 cells/mm3, yes (%) | 20 (12.5%) | 18 (12.5%) | 2 (15%) | 0.75 |
ANC > 5000 cells/mm3, yes (%) | 10 (6%) | 10 (7%) | 0 (0%) | 0.32 |
Hospitalization | Univariable | Multivariable | ||||
---|---|---|---|---|---|---|
No | Yes | p | Odds Ratio (95% CI) | p | Odds Ratio (95% CI) | |
Sex | 0.893 | 1.06 (0.628–1.79) | ||||
Female | 36 (29.5%) | 86 (70.5%) | ||||
Male | 43 (28.3%) | 109 (71.7%) | ||||
Maternal positive GBS | 3 (17.6%) | 14 (82.4%) | 0.572 | 1.79 (0.499–6.45) | ||
Comorbidities | 4 (17.4%) | 19 (82.6%) | 0.457 | 1.68 (0.548–5.13) | ||
Older sibling | 11 (14.5%) | 65 (85.5%) | 0.546 | 1.31 (0.579–2.98) | ||
Poor clinical condition | 0 (0) | 8 (100%) | 0.11 | 7.12 (0.406–125) * | ||
Fever | 54 (25.8%) | 155 (74.2%) | 0.06 | 1.79 (0.997–3.23) | 0.002 | 2.79 (1.44–5.39) |
Dyspnea | 0 (0) | 16 (100%) | 0.008 | 14.6 (0.866–247) * | 0.986 | / |
URT symptoms | 24 (25.8%) | 69 (74.2%) | 0.482 | 1.25 (0.715–2.2) | ||
LRT symptoms | 1 (5.3%) | 18 (94.7%) | 0.017 | 7.93 (1.04–60.5) | 0.128 | 5.43 (0.61–47.98) |
Vomiting | 0 (0) | 5 (100%) | 0.326 | 4.59 (0.251–84.0) * | ||
Diarrhea | 7 (50%) | 7 (50%) | 0.125 | 0.383 (0.130–1.13) | ||
Poor feeding | 9 (15%) | 51 (85%) | 0.009 | 2.75 (1.28–5.91) | 0.015 | 2.78 (1.21–6.35) |
Cutaneous rash | 1 (14.3%) | 6 (85.7%) | 0.677 | 2.48 (0.293–20.9) | ||
WBC > 10,000/mmc | 0 (0) | 15 (100%) | 0.213 | 5.69 (0.323–100) * | ||
ANC > 5000/mmc | 1 (16.7%) | 5 (83.3%) | 0.58 | 0.745 (0.08–6.85) | ||
CRP > 2 mg/dL | 0 (0) | 1 (100%) | 1 | 1.10 (0.05–22.4) * | ||
PCT > 0.5 ng/mL | 0 (0) | 2 (100%) | 1 | 1.04 (0.04–22.9) * | ||
Age (days, median) | 57 | 42 | <0.001 | 0.98 (0.968–0.992) | <0.001 | 0.976 (0.964–0.989) |
LOS (h, Median) | Univariable | Multivariable | |||
---|---|---|---|---|---|
p | Estimate (95% CI) | p | Estimate (95% CI) | ||
Sex (male) | 48 | 0.183 | 4.48 (−14.8–2.85) | ||
Maternal positive GBS | 84 | 0.020 | 20.3 (3.29–37.3) | 0.154 | 19.10 (−7.35–45.6) |
Comorbidities | 72 | 0.051 | 14.7 (−0.06–29.4) | ||
Older sibling | 48 | 0.246 | 6 (−4.18–16.2) | ||
Poor clinical condition | 108 | <0.001 | 46.2 (25.2–67.3) | 0.190 | 25.14 (−12.77–63.1) |
Fever | 48 | 0.629 | −2.69 (−13.6–8.26) | ||
Dyspnea | 84 | 0.003 | 23.8 (8.21–39.4) | 0.979 | −0.443 (−34.22–33.3) |
URT symptoms | 72 | 0.185 | 6.18 (−2.97–15.3) | ||
LRT symptoms | 96 | <0.001 | 26.1 (11.4–40.7) | 0.139 | 28.47 (−9.5–66.4) |
Vomiting | 72 | 0.338 | 13.4 (−14.2–41) | ||
Diarrhea | 48 | 0.441 | −9.19 (−32.7–14.3) | ||
Poor feeding | 48 | 0.006 | 13.8 (3.99–23.7) | ||
Cutaneous rash | 60 | 0.854 | 2.37 (−23–27.7) | ||
WBC > 10,000/mmc | 72 | 0.210 | 11.3 (−6.46–29) | ||
ANC > 5000/mmc | 48 | 0.249 | −17 (−46–12.1) | ||
CRP > 2 mg/dL | 96 | 0.183 | 24.7 (−11.9–61.4) | ||
PCT > 0.5 ng/mL | 120 | 0.012 | 58.2 (13.3–103.1) | 0.020 | 54.64 (9.07–100.2) |
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Bellini, T.; Brisca, G.; Orfanos, I.; Mariani, M.; Pezzotta, F.; Giordano, B.; Pastorino, A.; Misley, S.; Formigoni, C.; Fueri, E.; et al. Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway. Healthcare 2024, 12, 528. https://doi.org/10.3390/healthcare12050528
Bellini T, Brisca G, Orfanos I, Mariani M, Pezzotta F, Giordano B, Pastorino A, Misley S, Formigoni C, Fueri E, et al. Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway. Healthcare. 2024; 12(5):528. https://doi.org/10.3390/healthcare12050528
Chicago/Turabian StyleBellini, Tommaso, Giacomo Brisca, Ioannis Orfanos, Marcello Mariani, Federico Pezzotta, Benedetta Giordano, Andrea Pastorino, Silvia Misley, Clelia Formigoni, Elena Fueri, and et al. 2024. "Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway" Healthcare 12, no. 5: 528. https://doi.org/10.3390/healthcare12050528
APA StyleBellini, T., Brisca, G., Orfanos, I., Mariani, M., Pezzotta, F., Giordano, B., Pastorino, A., Misley, S., Formigoni, C., Fueri, E., Ferretti, M., Marin, M., Finetti, M., Piccotti, E., Castagnola, E., & Moscatelli, A. (2024). Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway. Healthcare, 12(5), 528. https://doi.org/10.3390/healthcare12050528