From the Departments of Pediatrics.
Pediatric Emergency Medicine.
Pediatr Emerg Care. 2023 Dec 1;39(12):929-933. doi: 10.1097/PEC.0000000000002940. Epub 2023 Apr 11.
There are scant data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in infants younger than 90 days. This study was designed to characterize COVID-19 presentation and clinical course in this age group and evaluate the risk of serious bacterial infection.
Data on all SARS-CoV-2-polymerase chain reaction-positive infants presenting to the pediatric emergency department (PED) were retrospectively collected, followed by a case-control study comparing those infants presenting with fever (COVID group) to febrile infants presenting to the PED and found to be SARS-CoV-2 negative (control group).
Of the 96 PCR-positive SARS-CoV-2 infants who met the inclusion criteria, the most common presenting symptom was fever (74/96, 77.1%) followed by upper respiratory tract infection symptoms (42/96, 43.8%). Four (4.2%) presented with symptoms consistent with brief resolved unexplained event (4.2%).Among the febrile infants, the presenting symptoms and vital signs were similar in the COVID and control groups, with the exception of irritability, which was more common in the control group (8% and 26%; P < 0.01). The SARS-CoV-2-positive infants had decreased inflammatory markers including: C-reactive protein (0.6 ± 1 mg/dL vs 2.1 ± 2.7 mg/dL; P < 0.0001), white blood cell count (9.3 ± 3.4 × 10 9 /L vs 11.8 ± 5.1 × 10 9 /L; P < 0.001), and absolute neutrophils count (3.4 ± 2.4 × 10 9 /L vs 5.1 ± 3.7 × 10 9 /L; P < 0.001). The rate of invasive bacterial infection was similar between groups (1.4% and 0%; P = 0.31). No mortality was recorded. Although not significantly different, urinary tract infections were less common in the COVID group (7% and 16%; P = 0.07).
The SARS-CoV-2 infection in infants aged 0 to 90 days who present to the PED seems to be mostly mild and self-limiting, with no increased risk of serious bacterial infection.
关于 90 天以下的婴儿严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的数据很少。本研究旨在描述该年龄段 COVID-19 的表现和临床过程，并评估严重细菌感染的风险。
回顾性收集所有 SARS-CoV-2-聚合酶链反应阳性的婴儿到儿科急诊部（PED）就诊的数据，然后进行病例对照研究，将发热（COVID 组）的婴儿与发热并在 PED 就诊且 SARS-CoV-2 阴性的婴儿（对照组）进行比较。
符合纳入标准的 96 例 PCR 阳性 SARS-CoV-2 婴儿中，最常见的首发症状是发热（74/96，77.1%），其次是上呼吸道感染症状（42/96，43.8%）。4 例（4.2%）表现为短暂性不明原因事件一致的症状（4.2%）。在发热的婴儿中，COVID 组和对照组的首发症状和生命体征相似，除了对照组更常见的易激惹（8%和 26%；P<0.01）。SARS-CoV-2 阳性婴儿的炎症标志物降低，包括：C 反应蛋白（0.6±1mg/dL 与 2.1±2.7mg/dL；P<0.0001）、白细胞计数（9.3±3.4×109/L 与 11.8±5.1×109/L；P<0.001）和绝对中性粒细胞计数（3.4±2.4×109/L 与 5.1±3.7×109/L；P<0.001）。两组侵袭性细菌感染率相似（1.4%和 0%；P=0.31）。无死亡记录。尽管没有显著差异，但 COVID 组的尿路感染较少（7%和 16%；P=0.07）。
儿科急诊就诊的 0 至 90 天婴儿 SARS-CoV-2 感染似乎大多为轻度和自限性，严重细菌感染的风险没有增加。
