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Study: SARS-CoV-2 in hospitalized infants reflects community virus levels

June 30, 2021

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Infants hospitalized primarily for evaluation of serious bacterial infection were more likely to have SARS-CoV-2 infection when virus circulation in the community was high, according to a study published today in Pediatrics.

Case reports have shown that SARS-CoV-2 infection in young infants can cause severe disease. Researchers conducted a retrospective chart review to determine the prevalence of SARS-CoV-2 in infants who were being evaluated in the hospital for serious bacterial infection. They also aimed to describe the clinical characteristics of the infants.

The authors reviewed electronic health records of 1,119 infants younger than 90 days who were admitted to four inpatient facilities in New York City between March 15 and Dec. 15, 2020. During the nine-month period, 22 of 148 infants who met the eligibility criteria tested positive for SARS-CoV-2 by nasopharyngeal reverse transcription polymerase chain reaction.

During times of high virus circulation (defined as ≥ 5% seven-day rolling average COVID-19 testing positivity threshold), 31% (19/62) of infants tested positive for SARS-CoV-2. When virus circulation was low, 3% (3/86) of infants tested positive.

The study also showed:

  • Isolated fever was the most common presentation for infants who tested positive for SARS-CoV-2.
  • Illness generally was mild to moderate for infants who tested positive for SARS-CoV-2, but a few patients required respiratory support or admission to the intensive care unit.
  • Most infants had no pre-existing medical conditions.
  • The need for respiratory support did not differ among infants with or without SARS-CoV-2.
  • Length of hospital stay was similar for both groups.
  • All infants with SARS-CoV-2 survived to discharge.

Limitations of the study were the small sample size and lack of information on race or ethnicity. “Our results may not accurately reflect the prevalence and/or severity of infection among infants of racial or ethnic backgrounds that have been associated with more severe COVID-19,” authors wrote.

They also observed cases of concomitant urinary tract infections and bacteremia among infants with COVID-19.

“Given the potentially severe consequences of untreated bacterial infections, we recommend clinicians continue to assess young febrile infants for bacterial infections, regardless of SARS-CoV-2 status,” they wrote.

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