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COVID-19 in Infants Less Than 90 days of Age

September 17, 2021

As an emergency medicine physician, I am often faced with determining whether or not I need to perform a sepsis evaluation on a febrile infant who tests positive for COVID-19, or whether the infant needs to be hospitalized. What symptoms do infants with COVID-19 have, if any, and what is the likelihood of developing severe disease?

Although we have learned a great deal about the impact of COVID-19 infection among adults and older children, limited data exist regarding the characteristics and outcomes among infants less than 90 days of age. Due to limited data in this vulnerable group of infants, there is uncertainty around the need for diagnostic testing and hospitalization.

Michal Paret and colleagues (10.1542/peds.2020-044685) present data regarding infants with COVID-19 infection at 4 hospitals in NYC, the epicenter of COVID-19 infection in the US. They evaluate the characteristics of these infants and compare outcomes to infants hospitalized for evaluation of serious bacterial infection (SBI). They further characterize the rate of COVID-19 positivity during periods of high versus low community SARS-CoV-2 circulation.

Among 148 infants under 90 days hospitalized for SBI evaluation, 22 (15%) tested positive for SARS-CoV-2. A total of 19 of 62 infants (31%) tested positive for SARS-CoV-2 during periods of high community circulation, while 3 of 86 infants (3%) tested positive during periods when community circulation was low. Hospitalized infants testing positive for SARS-CoV-2 were significantly less likely to have a positive urine or CSF culture and were significantly less likely to be admitted to an ICU.

Knowledge of the high rate of COVID-19 infections among young infants, particularly during periods of high community transmission, may be helpful when determining the need for further care. Pediatricians should read this article to learn how infants with COVID-19 differ from other infants hospitalized for SBI evaluation, and to learn more about the hospitalization course and outcomes of these infants.

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