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Characteristics of Infants Hospitalized With COVID-19

What are the clinical characteristics of children under 1 year old who are hospitalized with COVID-19 infection?

At the beginning of the COVID-19 pandemic, children and infants were erroneously believed to be immune to SARS-CoV-2 infection. Now, studies have shown that although pediatric patients typically have less severe disease, they contract COVID-19 at the same rate as adults.

One study, presented virtually at the 51st Critical Care Congress, examined the 2 types of SARS-CoV-2 infection children experience: multisystem inflammatory syndrome in children (MIS-C) and coronavirus disease (COVID-19, classic viral pneumonia with hypoxia).

The study analyzed data from symptomatic infants with laboratory-confirmed COVID-19 or MIS-C infection. The children were admitted to the 2 campuses of Advocate Children’s Hospital in Illinois from March 1, 2020-March 31, 2021. Data were reported to the Society of Critical Care Medicine’s Virus Infection and Respiratory Illness Universal Study registry. Infants under 1 year old were included in the study.

Out of 192 children under 18 admitted to the hospital during the study period, a total of 40 met the study’s inclusion criteria. The average age was 0.16 years, and the cohort was 63% male, 73% white, and 43% Hispanic. 22% of the cohort had preexisting conditions.

The most common symptom in the infants was fever (87%). Viral pneumonia was diagnosed in 3 of the 40 patients, and MIS-C was diagnosed in 2 of 40. The average length of hospital stay was 1.92 days, and there were no in-hospital mortalities. A total of 3 patients were admitted to the intensive care unit (ICU), 6 required respiratory support, and 1 needed nitric oxide. None of the patients required vasoactive, inotropic support, or renal replacement therapy.

Elevated liver enzymes were detected in 17% of the infant cohort, increased pro-BNP in 15%, and troponin in 12%. Positive blood culture was seen in 9.1% of patients, urine culture in 23.3%, and aseptic meningitis in 1. A 9-month-old child was admitted with acute COVID-19 and then readmitted with MIS-C 5 months later.

Lead author Beryl Valentine, MS, presented the conclusions of the study: infants comprised a high percentage of COVID-19 hospitalizations, but classic pneumonia with hypoxia and MIS-C were less common. Additionally, ICU admittance was low, and comorbidities were prevalent in this cohort. The investigators intend for their findings on infection characteristics in infants to inform future healthcare efforts for the treatment and prevention of pediatric COVID-19.

The study, “Clinical Characteristics of Infants With Severe Acute Respiratory Syndrome Coronavirus 2 Infection,” was presented on April 18, 2022, during the 51st Critical Care Congress.