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Mendez DR, Paul K, Richardson J, Jehle D. Risk of Urinary Tract Infection and Bacteremia in Infants Infected With COVID-19. Pediatr Emerg Care 2024:00006565-990000000-00523. [PMID: 39264181 DOI: 10.1097/pec.0000000000003274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
OBJECTIVE Our objective was to evaluate the risk of urinary tract infection (UTI) and bacteremia in infants 1 year or less of age infected with COVID-19. METHODS This was a retrospective study from TriNetX database in the United States. This study was from March 11, 2020, to May 11, 2023, during the COVID-19 pandemic. Patients were included if they were infants, 1 year or less, had a fever, and had a COVID-19 polymerase chain reaction test 1 week before or after presentation to the emergency department (ED) or hospital. We compared outcomes of bacteremia and a UTI in those with COVID-19 and those without COVID-19. Propensity matching was done to account for the confounders of age, gender, race, immune disorders, genitourinary abnormalities, preterm birth, and circumcision. RESULTS Infants who were positive for COVID-19 were at a reduced risk of UTI and bacteremia. There was a significant decreased risk of having a UTI if one had COVID-19 (1.0%) versus those without COVID-19 (2.3%) (risk ratio = 0.37, 95% confidence interval = 0.37-0.50, P < 0.001). For bacteremia, there was also a decreased risk if the infant had COVID-19 (0.4%), versus those without COVID-19 (0.5%) (risk ratio = 0.74, 95% confidence interval = 0.56-0.97, P = 0.03). CONCLUSIONS Infants with fever found to have COVID-19 had lower risks of UTI and bacteremia.
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Affiliation(s)
- Donna R Mendez
- From the Department of Emergency Medicine, University of Texas Medical Branch, Galveston, TX
| | - Krishna Paul
- From the Department of Emergency Medicine, University of Texas Medical Branch, Galveston, TX
| | - Joan Richardson
- Department of Pediatrics, University of Texas Medical Branch, Galveston, TX
| | - Dietrich Jehle
- From the Department of Emergency Medicine, University of Texas Medical Branch, Galveston, TX
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2
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Erdem G, Watson JR, Tomatis C, Ceyhan K, Barson W. Impact of viral testing on duration of antibiotic treatment and hospitalisation of febrile infants. Acta Paediatr 2024. [PMID: 39227731 DOI: 10.1111/apa.17413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/27/2024] [Accepted: 08/22/2024] [Indexed: 09/05/2024]
Abstract
AIM To assess the duration of antimicrobial treatment; hospital length of stay; and invasive bacterial infections rates in hospitalised infants following the adoption of a management guideline. METHODS Faculty agreed to a standard of 24 h of antibiotic treatment for well-appearing febrile infants with proven viral infection and no growth on bacterial cultures. The outcomes were the duration of hospitalisation and antibiotic treatment of febrile infants less than 8 weeks of age who have enterovirus, parechovirus, respiratory viruses detected. We monitored re-admissions and missed invasive infections. RESULTS Of the total 1696 infants studied, the median antibiotic treatment duration decreased from 31.5 to 24.8 h in virus-infected infants ≤21 days of age (p = 0.02) and from 26 to 19.7 h in infants 22-56 days of age (p < 0.001). The decrease was less in infants not infected with a virus. No patient had an invasive infection identified after discharge. CONCLUSION The implementation of our care standard resulted in reduction in antibiotic treatment duration without known delayed diagnosis of bacterial infections. Infants without a proven viral aetiology may need further study to inform management decisions.
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Affiliation(s)
- G Erdem
- Section of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - J R Watson
- Section of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - C Tomatis
- Section of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - K Ceyhan
- Department of Neurosurgery, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - W Barson
- Section of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University School of Medicine, Columbus, Ohio, USA
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3
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Brigadoi G, Tirelli F, Rossin S, Casotto V, Riello F, Gallinaro G, Donà D, Bressan S, Da Dalt L. Severe and invasive bacterial infections in infants aged less than 90 days with and without SARS-CoV-2 infection. Ital J Pediatr 2024; 50:148. [PMID: 39143644 PMCID: PMC11325733 DOI: 10.1186/s13052-024-01721-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/06/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Fever in children represents one of the most common causes of medical evaluation. Infants younger than 90 days of age are at higher risk of severe and invasive bacterial infections (SBI and IBI). However, clinical signs and symptoms of viral and bacterial infections in young infants are frequently similar, and several studies have shown that the risk of SBIs remains non-negligible even in the presence of a positive point-of-care viral test. Our study aims to evaluate whether the proportion of SBIs and IBIs in febrile infants younger than 90 days during the COVID-19 pandemic was higher than that in the pre-pandemic period, and to describe the proportion of SBIs and IBIs in infants with and without SARS-CoV-2 infection. METHODS This was a retrospective single-center cohort study conducted at the Children's Hospital of the University of Padua in Italy, involving febrile young infants evaluated in the Pediatric Emergency Department (PED) and admitted to Pediatric Acute Care Unit (PACU) between March 2017 to December 2022. Infants admitted before the COVID-19 pandemic were compared to infants admitted during the pandemic period and SARS-CoV-2 positive patients to the negative ones. RESULTS 442 febrile infants younger than 90 days were evaluated in Padua PED and admitted to the wards. The proportion of SBIs and IBIS did not significantly change over the study periods, ranging between 10.8% and 32.6% (p = 0.117) and between 0% and 7.6%, respectively (p = 0.367). The proportion of infants with a diagnosis of SBIs and IBIs was higher in the SARS-CoV-2 negative group (30.3% and 8.2%, respectively) compared to the positive group (8.5% and 2.8%, respectively) (p < 0.0001). The most common diagnosis in both groups was UTI, mainly caused by E. coli. A similar proportion of blood and urine cultures were performed, whereas lumbar puncture was more frequently performed in SARS-CoV-2 negative infants (40.2% vs 16.9%, p = 0.001). CONCLUSIONS Although the risk of concomitant serious bacterial infection with SARS-CoV-2 is low, it remains non-negligible. Therefore, even in SARS-CoV-2-positive febrile infants, we suggest that the approach to screening for SBIs remains cautious.
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Affiliation(s)
- Giulia Brigadoi
- Department of Women's and Children' Health, Pediatric Infectious Disease Unit, Padua University, Padua, Italy.
| | - Francesca Tirelli
- Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy
- Department of Women's and Children' Health, Pediatric Rheumatology, Padua University, Padua, Italy
| | - Sara Rossin
- Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy
| | - Veronica Casotto
- Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy
| | - Francesca Riello
- Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy
| | - Giulia Gallinaro
- Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy
| | - Daniele Donà
- Department of Women's and Children' Health, Pediatric Infectious Disease Unit, Padua University, Padua, Italy
| | - Silvia Bressan
- Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy
| | - Liviana Da Dalt
- Department of Women's and Children' Health, Pediatric Emergency Department, Padua University, Padua, Italy
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Pérez-Porra S, Granda E, Benito H, Roland D, Gomez B, Velasco R. Prevalence of invasive bacterial infection in febrile infants ≤90 days with a COVID-19 positive test: a systematic review and meta-analysis. Emerg Med J 2024; 41:228-235. [PMID: 38071527 DOI: 10.1136/emermed-2023-213483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/15/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Febrile infants with an infection by influenza or enterovirus are at low risk of invasive bacterial infection (IBI). OBJECTIVE To determine the prevalence of IBI among febrile infants ≤90 days old with a positive COVID-19 test. METHODS MEDLINE, Embase, Cochrane Central Register databases, Web of Science, ClinicalTrials.gov and grey literature were searched for articles published from February 2020 to May 2023. INCLUSION CRITERIA researches reporting on infants ≤90 days of age with fever and a positive test for SARS-CoV-2 (antigen test/PCR). Case reports with <3 patients, articles written in a language other than English, French or Spanish, editorials and other narrative studies were excluded. Preferred Reposting Items for Systematic Reviews and Meta-analysis guidelines were followed, and the National Institutes of Health Quality Assessment Tool was used to assess study quality. The main outcome was the prevalence of IBI (a pathogen bacterium identified in blood and/or cerebrospinal fluid (CSF)). Forest plots of prevalence estimates were constructed for each study. Heterogeneity was assessed and data were pooled by meta-analysis using a random effects model. A fixed continuity correction of 0.01 was added when a study had zero events. RESULTS From the 1023 studies and 3 databases provided by the literature search, 33 were included in the meta-analysis, reporting 3943 febrile infants with a COVID-19 positive test and blood or CSF culture obtained. The pooled prevalence of IBI was 0.14% (95% CI, 0.02% to 0.27%). By age, the prevalence of IBI was 0.56% (95% CI, 0.0% to 1.27%) in those 0-21 days old, 0.53% (95% CI, 0.0% to 1.22%) in those 22-28 days old and 0.11% (95% CI, 0.0% to 0.24%) in those 29-60 days old. CONCLUSION COVID-19-positive febrile infants ≤90 days old are at low risk of IBI, especially infants >28 days old, suggesting this subgroup of patients can be managed without blood tests. PROSPERO REGISTRATION NUMBER CRD42022356507.
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Affiliation(s)
- Silvia Pérez-Porra
- Pediatrics Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Elena Granda
- Pediatrics Department, Hospital Universitario Rio Hortega, Valladolid, Spain
- Pediatrics Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Helvia Benito
- Gerencia de Atención Primaria de Segovia, Segovia, Spain
- CAP Concòrdia. Consorci Corporació Sanitària Parc Tauli, Sabadell, Barcelona, Spain
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario de Cruces. University of the Basque Country, UPV/EHU, Barakaldo, Bilbao, Basque Country, Spain
| | - Roberto Velasco
- Pediatric Emergency Unit, Department of Pediatrics, Hospital Universitari Parc Tauli, Sabadell, Barcelona, Spain
- Department of Paediatrics & Child Health, University College Cork, Cork, Ireland
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Üstündağ G, Karadag-Oncel E, Kara-Ulu N, Polat M, Salı E, Çakır D, Şahin A, Akaslan-Kara A, Kaçar P, Işık AD, Erdemli PC, Durmuş SY, Özdemir A, Çelik B, Sütçü M, Kara M, Kandemir-Gülmez T, Çelikyurt A, Ümit Z, Aktürk H, Arıkan K, Kaba Ö, Caymaz C, Bayhan C, Aygün D, Penezoğlu DN, Alataş ŞÖ, Özdemir H, Türel Ö, Akça M, Çelebi-Çongur E, Kepenekli E, Çelik Ü, Ecevit İZ, Belet N, Dalgıç N, Yılmaz N, Yılmaz D, Kuyucu N, Çiftçi E. COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey. Eur J Pediatr 2024; 183:1153-1162. [PMID: 37971516 DOI: 10.1007/s00431-023-05329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
To investigate coronavirus disease 2019 (COVID-19) in infants aged 0 to 3 months because there is currently a significant gap in the literature on the subject. A cross-sectional study was conducted with the involvement of 19 medical centers across Turkey and 570 infants. The majority of the patients were male (58.2%), and the three most common symptoms were fever (78.2%), cough (44.6%), and feeding intolerance (39.9%). The results showed that a small percentage of infants had positive blood (0.9%) or urine cultures (10.2%). Most infants presented with fever (78.2%). Children without underlying conditions (UCs) had mostly a complicated respiratory course and a normal chest radiography. Significant more positive urine culture rates were observed in infants with fever. A higher incidence of respiratory support requirements and abnormal chest findings were seen in infants with chronic conditions. These infants also had a longer hospital stay than those without chronic conditions. Conclusions: Our study discloses the clinical observations and accompanying bacterial infections found in infants aged under 3 months with COVID-19. These findings can shed light on COVID-19 in infancy for physicians because there is limited clinical evidence available. What is Known: • COVID-19 in infants and older children has been seen more mildly than in adults. • The most common symptoms of COVID-19 in infants are fever and cough, as in older children and adults. COVID-19 should be one of the differential diagnoses in infants with fever. What is New: • Although most infants under three months had fever, the clinical course was uneventful and respiratory complications were rarely observed in healthy children. • Infants with underlying conditions had more frequent respiratory support and abnormal chest radiography and stayed longer in the hospital.
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Affiliation(s)
- Gülnihan Üstündağ
- Izmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Eda Karadag-Oncel
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
| | - Nursel Kara-Ulu
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Gazi University, Ankara, Turkey
| | - Meltem Polat
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Gazi University, Ankara, Turkey
| | - Enes Salı
- Ümraniye Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Deniz Çakır
- Ümraniye Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Aslıhan Şahin
- Izmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Aybüke Akaslan-Kara
- Izmir Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Pelin Kaçar
- Izmir Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
| | - Aylin Dizi Işık
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Marmara University, Istanbul, Turkey
| | - Pınar Canizci Erdemli
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Marmara University, Istanbul, Turkey
| | - Sevgi Yaşar Durmuş
- Clinic of Pediatric Infectious Disease, Kayseri City Hospital, Kayseri, Turkey
| | - Ahmet Özdemir
- Clinic of Neonatal Intensive Care Unit, Kayseri City Hospital, Kayseri, Turkey
| | - Binnaz Çelik
- Clinic of Pediatrics, Kayseri City Hospital, Kayseri, Turkey
| | - Murat Sütçü
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Istinye University, Istanbul, Turkey
| | - Manolya Kara
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Istinye University, Istanbul, Turkey
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Yeditepe University, Istanbul, Turkey
| | | | - Aydın Çelikyurt
- Faculty of Medicine, Department of Pediatrics, Koç University, Istanbul, Turkey
| | - Zühal Ümit
- Clinic of Pediatric Infectious Diseases, Manisa City Hospital, Manisa, Turkey
| | - Hacer Aktürk
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Koç University, Istanbul, Turkey
| | - Kamile Arıkan
- Clinic of Pediatric Infectious Diseases, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey
| | - Özge Kaba
- Clinic of Pediatric Infectious Disease, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey
| | - Canan Caymaz
- Clinic of Pediatric Infectious Disease, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey
| | - Cihangül Bayhan
- Gülhane Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Ankara, Turkey
| | - Deniz Aygün
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Cerrahpaşa University Istanbul, Istanbul, Turkey
| | - Döndü Nilay Penezoğlu
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Şilem Özdem Alataş
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Halil Özdemir
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
| | - Özden Türel
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Bezmialem Foundation University, Istanbul, Turkey
| | - Mehtap Akça
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey
| | - Emel Çelebi-Çongur
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Eda Kepenekli
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Marmara University, Istanbul, Turkey
| | - Ümit Çelik
- Clinic of Pediatric Infectious Diseases, Adana City Hospital, Adana, Turkey
| | - İsmail Zafer Ecevit
- Gülhane Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Ankara, Turkey
| | - Nurşen Belet
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Nazan Dalgıç
- Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey
| | - Nisel Yılmaz
- Department of Medical Microbiology, Izmir Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Dilek Yılmaz
- Izmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Izmir Katip Çelebi University, Izmir, Turkey
| | - Necdet Kuyucu
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey
| | - Ergin Çiftçi
- Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey
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Hernández-Bou S, Trenchs V, Diego P, Seguí A, Luaces C. Bacterial coinfection in young febrile infants with SARS-CoV-2 infection. Eur J Pediatr 2024; 183:281-288. [PMID: 37872349 DOI: 10.1007/s00431-023-05212-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
We aimed to assess the prevalence of serious bacterial infections (SBIs) in febrile infants < 90 days of age with SARS-CoV-2 infection versus SARS-CoV-2-negative febrile infants. A retrospective cohort study was conducted in a tertiary pediatric emergency department between March 2020 and October 2022. Febrile infants < 90 days of age who underwent SARS-CoV-2 testing were included. SBIs were defined as urinary tract infection (UTI), bacteremia, and/or bacterial meningitis; bacteremia and bacterial meningitis were considered invasive bacterial infections (IBIs). SBIs rates were compared between SARS-CoV-2-positive and negative infants and stratified by age. We included 779 infants: 221 (28.4%) SARS-CoV-2-positive and 558 (71.6%) SARS-CoV-2-negative. The SBI rate in the SARS-CoV-2-positive group was 5.9% vs 22.9% in the SARS-CoV-2-negative group (p < 0.001; relative risk (RR) 0.26; [95% CI 0.15-0.44]); the most common infections were UTI (5.4% vs 22.0%; p < 0.001). The IBI rate was 0.5% in the SARS-CoV-2-positive group vs. 3.2% in the negative group (p = 0.024; RR 0.14 [95% CI 0.02-1.04]). There were no cases of bacterial meningitis in the positive infants. SARS-CoV-2-positive infants > 28 days of age had a decreased likelihood of SBI (RR 0.22 [95% CI 0.11-0.43]), with no cases of IBI identified. Conclusions: Febrile infants < 90 days of age with SARS-CoV-2 infection are at significantly lower risk of SBIs than those who are SARS-CoV-2-negative. Nevertheless, the rate of UTI remains considerable in SARS-CoV-2-positive infants. SARS-CoV-2 detection may be relevant in considering IBI risk for well-appearing febrile infants 29-89 days of age. What is Known: • Febrile infants with laboratory-confirmed viral infections have a significantly lower risk of serious bacterial infections when compared to those without them. Data focusing on very young febrile infants with a SARS-CoV-2 infection is still limited. What is New: • Young febrile infants with SARS-CoV-2 infection are at significantly lower risk of serious bacterial infections than those who are SARS-CoV-2-negative. Nevertheless, the rate of urinary tract infection remains considerable. SARS-CoV-2 detection may be relevant in considering invasive bacterial infection risk for well-appearing febrile infants 29-89 days of age.
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Affiliation(s)
- Susanna Hernández-Bou
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- Infectious Diseases and Microbiome, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
| | - Victoria Trenchs
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain.
- University of Barcelona, Barcelona, Spain.
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain.
| | - Patricia Diego
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Aina Seguí
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
| | - Carles Luaces
- Pediatric Emergency Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, 08940, Esplugues de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Environment Effects on Child/Adolescent Well-being, Institut de Recerca Sant Joan de Déu (IRSJD), Barcelona, Spain
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7
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Benenson-Weinberg T, Gross I, Bamberger Z, Guzner N, Wolf D, Gordon O, Nama A, Hashavya S. Severe Acute Respiratory Syndrome Coronavirus 2 in Infants Younger Than 90 Days Presenting to the Pediatric Emergency Department: Clinical Characteristics and Risk of Serious Bacterial Infection. Pediatr Emerg Care 2023; 39:929-933. [PMID: 37039445 DOI: 10.1097/pec.0000000000002940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES 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. METHODS 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). RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
| | | | | | | | - Dana Wolf
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oren Gordon
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmad Nama
- Department of Emergency Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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8
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Jacob R, Padeh G, Kaplan O, Koppel JH, Porat D, Weiser G, Levy N, Cohen N, Capua T, Schnapp Z, Friedman N. Bacterial Infections and Clinical Outcomes Among Febrile Infants up to 90 Days Old With SARS-CoV-2 Infection: A Multicenter Cohort Study. Pediatr Infect Dis J 2023; 42:905-907. [PMID: 37406214 DOI: 10.1097/inf.0000000000004019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
We present a large, multicenter, cohort study that aimed to assess bacterial infection rates among febrile infants up to 90 days old presenting to the pediatric emergency department with severe acute respiratory syndrome coronavirus 2 infection during 2021-2022 throughout successive variant waves. Overall, 417 febrile infants were included. Twenty-six infants (6.2%) had bacterial infections. All bacterial infections consisted of urinary tract infections, and there were no invasive bacterial infections. There was no mortality.
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Affiliation(s)
- Ron Jacob
- From the Pediatric Emergency Department, Ha'Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Gabi Padeh
- Emergency Department, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Or Kaplan
- Pediatric Emergency Department, Soroka Medical Center, Beer Sheva, Israel
| | - Jordanna H Koppel
- Pediatric Emergency Department, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danit Porat
- Pediatric Emergency Department, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giora Weiser
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nitai Levy
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Noy Cohen
- Pediatric Emergency Department, Samson Assuta University Hospital, Ashdod, Israel
| | - Tali Capua
- Pediatric Emergency Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zeev Schnapp
- Pediatric Emergency Department, Carmel Medical Center, Haifa, Israel
| | - Nir Friedman
- Pediatric Emergency Department, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Aronson PL, Louie JP, Kerns E, Jennings B, Magee S, Wang ME, Gupta N, Kovaleski C, McDaniel LM, McDaniel CE. Prevalence of Urinary Tract Infection, Bacteremia, and Meningitis Among Febrile Infants Aged 8 to 60 Days With SARS-CoV-2. JAMA Netw Open 2023; 6:e2313354. [PMID: 37171815 PMCID: PMC10182434 DOI: 10.1001/jamanetworkopen.2023.13354] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/30/2023] [Indexed: 05/13/2023] Open
Abstract
Importance The prevalence of urinary tract infection (UTI), bacteremia, and bacterial meningitis in febrile infants with SARS-CoV-2 is largely unknown. Knowledge of the prevalence of these bacterial infections among febrile infants with SARS-CoV-2 can inform clinical decision-making. Objective To describe the prevalence of UTI, bacteremia, and bacterial meningitis among febrile infants aged 8 to 60 days with SARS-CoV-2 vs without SARS-CoV-2. Design, Setting, and Participants This multicenter cross-sectional study was conducted as part of a quality improvement initiative at 106 hospitals in the US and Canada. Participants included full-term, previously healthy, well-appearing infants aged 8 to 60 days without bronchiolitis and with a temperature of at least 38 °C who underwent SARS-CoV-2 testing in the emergency department or hospital between November 1, 2020, and October 31, 2022. Statistical analysis was performed from September 2022 to March 2023. Exposures SARS-CoV-2 positivity and, for SARS-CoV-2-positive infants, the presence of normal vs abnormal inflammatory marker (IM) levels. Main Outcomes and Measures Outcomes were ascertained by medical record review and included the prevalence of UTI, bacteremia without meningitis, and bacterial meningitis. The proportion of infants who were SARS-CoV-2 positive vs negative was calculated for each infection type, and stratified by age group and normal vs abnormal IMs. Results Among 14 402 febrile infants with SARS-CoV-2 testing, 8413 (58.4%) were aged 29 to 60 days; 8143 (56.5%) were male; and 3753 (26.1%) tested positive. Compared with infants who tested negative, a lower proportion of infants who tested positive for SARS-CoV-2 had UTI (0.8% [95% CI, 0.5%-1.1%]) vs 7.6% [95% CI, 7.1%-8.1%]), bacteremia without meningitis (0.2% [95% CI, 0.1%-0.3%] vs 2.1% [95% CI, 1.8%-2.4%]), and bacterial meningitis (<0.1% [95% CI, 0%-0.2%] vs 0.5% [95% CI, 0.4%-0.6%]). Among infants aged 29 to 60 days who tested positive for SARS-CoV-2, 0.4% (95% CI, 0.2%-0.7%) had UTI, less than 0.1% (95% CI, 0%-0.2%) had bacteremia, and less than 0.1% (95% CI, 0%-0.1%) had meningitis. Among SARS-CoV-2-positive infants, a lower proportion of those with normal IMs had bacteremia and/or bacterial meningitis compared with those with abnormal IMs (<0.1% [0%-0.2%] vs 1.8% [0.6%-3.1%]). Conclusions and Relevance The prevalence of UTI, bacteremia, and bacterial meningitis was lower for febrile infants who tested positive for SARS-CoV-2, particularly infants aged 29 to 60 days and those with normal IMs. These findings may help inform management of certain febrile infants who test positive for SARS-CoV-2.
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Affiliation(s)
- Paul L. Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jeffrey P. Louie
- Division of Emergency Medicine, University of Minnesota, Masonic Children's Hospital, Minneapolis
| | - Ellen Kerns
- Division of Child Health Policy, Department of Pediatrics, University of Nebraska Medical Center, Omaha
| | | | - Sloane Magee
- American Academy of Pediatrics, Itasca, Illinois
| | - Marie E. Wang
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford, Palo Alto, California
| | - Nisha Gupta
- Division of Hospital Medicine, Inova Children’s Hospital, Falls Church, Virginia
| | - Christopher Kovaleski
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Inova Children’s Hospital, Falls Church, Virginia
| | - Lauren M. McDaniel
- Division of Hospital Medicine, Department of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland
- Now with Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle
| | - Corrie E. McDaniel
- Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle
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10
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Ohlin A. The febrile infant: Is it COVID-19 or a serious bacterial infection? Acta Paediatr 2023. [PMID: 37035897 DOI: 10.1111/apa.16783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Andreas Ohlin
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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11
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Guernsey D, Kostin S, Silver M, Vazquez H, Zerzan J. The evolving relationship between COVID-19 and serious bacterial infection evaluation in febrile neonates. Acta Paediatr 2023. [PMID: 36596467 DOI: 10.1111/apa.16655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/07/2022] [Accepted: 01/02/2023] [Indexed: 01/05/2023]
Abstract
AIM The COVID-19 omicron variant surge highlighted the evolving impact of COVID-19. Febrile infants <60 days old are high risk for serious bacterial infections (SBI). This study evaluated the rate of SBI based on COVID-19 infection. METHODS We conducted a retrospective chart review at an urban, academic paediatric emergency department. The study enrolled infants 60 days old or less with documented fever. The primary outcome was SBI diagnosed by blood, urine, and/or cerebrospinal fluid cultures. We compared the rate of SBI between COVID-19 groups with an omicron variant and 29- to 60-day-old subgroup analyses. RESULTS Two hundred and thirty-three (233) infants meet the criteria. The incidence of SBI was 18.7% in the COVID-19 negative and 1.7% in the COVID-19-positive group which is statistically significant (p < 0.001). Omicron subgroup analysis did not achieve statistical significance (p = 0.62) while COVID-19-positive infants 29-60 days old had a statistically significant lower rate of SBI (p = 0.006). CONCLUSION The omicron variant surge provided an additional understanding of the impact of COVID-19 on these high-risk infants. These results can lead to decreased invasive testing and exposure to antibiotics as well as examine the utility of viral testing for risk stratification.
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Affiliation(s)
- David Guernsey
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Shannon Kostin
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, New York, USA
| | - Michael Silver
- Department of Research Administration, Maimonides Medical Center, Brooklyn, New York, USA
| | - Hector Vazquez
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Jessica Zerzan
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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12
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Devin J, Marano R, Mikhael M, Feaster W, Sanger T, Ehwerhemuepha L. Epidemiology of Neonatal COVID-19 in the United States. Pediatrics 2022; 150:188898. [PMID: 35996224 DOI: 10.1542/peds.2022-056297] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Data on coronavirus disease 2019 (COVID-19) infections in neonates are limited. We aimed to identify and describe the incidence, presentation, and clinical outcomes of neonatal COVID-19. METHODS Over 1 million neonatal encounters at 109 United States health systems, from March 2020 to February 2021, were extracted from the Cerner Real World Database. COVID-19 diagnosis was assessed using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) laboratory tests and diagnosis codes. Incidence of COVID-19 per 100 000 encounters was estimated. RESULTS COVID-19 was diagnosed in 918 (0.1%) neonates (91.1 per 100 000 encounters [95% confidence interval 85.3-97.2]). Of these, 71 (7.7%) had severe infection (7 per 100 000 [95% confidence interval 5.5-8.9]). Median time to diagnosis was 14.5 days from birth (interquartile range 3.1-24.2). Common signs of infection were tachypnea and fever. Those with severe infection were more likely to receive respiratory support (50.7% vs 5.2%, P < .001). Severely ill neonates received analgesia (38%), antibiotics (33.8%), anticoagulants (32.4%), corticosteroids (26.8%), remdesivir (2.8%), and COVID-19 convalescent plasma (1.4%). A total of 93.6% neonates were discharged home after care, 1.1% were transferred to another hospital, and discharge disposition was unknown for 5.2%. One neonate (0.1%) with presentation suggestive of multisystem inflammatory syndrome in children died after 11 days of hospitalization. CONCLUSIONS Most neonates infected with SARS-CoV-2 were asymptomatic or developed mild illness without need for respiratory support. Some had severe illness requiring treatment of COVID-19 with remdesivir and COVID-19 convalescent plasma. SARS-CoV-2 infection in neonates, though rare, may result in severe disease.
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Affiliation(s)
- Joan Devin
- Children's Health of Orange County, Orange, California.,School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Rachel Marano
- Children's Health of Orange County, Orange, California
| | | | | | - Terence Sanger
- Children's Health of Orange County, Orange, California.,University of California, Irvine, California
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13
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Shen DP, Vermeulen F, Debeer A, Lagrou K, Smits A. Impact of COVID-19 on viral respiratory infection epidemiology in young children: A single-center analysis. Front Public Health 2022; 10:931242. [PMID: 36203684 PMCID: PMC9530989 DOI: 10.3389/fpubh.2022.931242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background The COVID-19 pandemic impacts different health aspects. Concomitant with the adoption of non-pharmaceutical interventions (NPIs) to reduce the spread of SARS-CoV-2, global surveillance studies reported a reduction in occurrence of respiratory pathogens like influenza A and B virus (IAV & IBV) and respiratory syncytial virus (RSV). We hypothesized to observe this collateral benefit on viral respiratory infection epidemiology in young children. Methods Respiratory samples of children aged below 6 years, presenting at the outpatient clinic, emergency department, or pediatric infectious diseases department of the University Hospitals Leuven, between April 2017 and April 2021 were retrospectively analyzed. The occurrence (positivity rate), and seasonal patterns of viral respiratory infections were described. Chi-squared or Fisher's exact test (and Bonferroni correction) were used to explore differences in occurrence between 2020-2021 and previous 12-month (April to April) periods. Results We included 3020 samples (453 respiratory panels, 2567 single SARS-CoV-2 PCR tests). IAV and IBV were not detected from March and January 2020, respectively. For IAV, positivity rate in 2020-2021 (0%, n = 0) was significantly different from 2018-2019 (12.4%, n = 17) (p < 0.001) and 2019-2020 (15.4%, n = 19) (p < 0.001). IBV positivity rate in 2020-2021 (0%, n = 0) was not significantly different from previous periods. RSV occurrence was significantly lower in 2020-2021 (3.2%, n = 3), compared to 2017-2018 (15.0%, n = 15) (p = 0.006), 2018-2019 (16.1%, n = 22) (p = 0.002) and 2019-2020 (22.8%, n = 28) (p < 0.001). The RSV (winter) peak was absent and presented later (March-April 2021). Positivity rate of parainfluenza virus 3 (PIV-3) was significantly higher in 2020-2021 (11.8%, n = 11) than 2017-2018 (1%, n = 1) (p = 0.002). PIV-3 was absent from April 2020 to January 2021, whereas no clear seasonal pattern was distinguished the other years. For the other viruses tested, no significant differences in occurrence were observed between 2020-2021 and previous periods. From March 2020 onwards, 20 cases (0.7%) of SARS-CoV-2 were identified. Conclusion These findings reinforce the hypothesis of NPIs impacting the epidemiology of influenza viruses and RSV in young children. Compared to previous periods, no IAV and IBV cases were observed in the 2020-2021 study period, and the RSV peak occurred later. Since the pandemic is still ongoing, continuation of epidemiological surveillance, even on a larger scale, is indicated.
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Affiliation(s)
| | - François Vermeulen
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anne Debeer
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
- L-C&Y, KU Leuven Child & Youth Institute, Leuven, Belgium
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14
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Güngör A, Bodur İ, Göktuğ A, Güneylioğlu MM, Öztürk B, Yaradılmış RM, Yalçınkaya R, Karacan CD, Tuygun N. COVID-19 Infection in Well-Appearing 30- to 90-Day-Old Infants with Fever without a Source. J Trop Pediatr 2022; 68:6602428. [PMID: 35666180 PMCID: PMC9214102 DOI: 10.1093/tropej/fmac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Fever without a source (FWS) is common clinical status in the young infants. The aim of this study was to evaluate the clinical and laboratory findings of coronavirus disease (COVID-19) infection in well-appearing infants with FWS. Well-appearing febrile infants between 30 and 90 days who were evaluated as FWS in the pediatric emergency department and tested for COVID-19 were divided into two groups: COVID-19 (+) and (-). The clinical and laboratory findings of the patients were compared. The study included 95 febrile infants with FWS, and the mean age was 59.62 ± 16.82 days. The nasopharyngeal COVID-19 polymerase chain reaction test results of 29/95 (30.5%) patients were positive, while 66/95 (69.5%) were negative. The complaints of irritability and nasal congestion were found to be significantly more common in COVID-19-positive patients (p = 0.04 and p = 0.041, respectively). The hospitalization rate (p = 0.009), length of hospital stay (p = 0.026), initiation of antibiotic treatment (p < 0.001) and duration of antibiotic treatment (p = 0.036) were significantly lower in the COVID-19 (+) patients. The C-reactive protein (CRP, p < 0.001), absolute neutrophil count (ANC, p < 0.001), absolute lymphocyte count (ALC, p = 0.015), white blood cell (WBC, p < 0.001) and systemic immune-inflammation index (SII, p < 0.001) were found to be significantly lower in the COVID-19 (+) patient group. There was no significant difference between the groups in terms of neutropenia, lymphopenia or leukopenia. COVID-19 infection may present as an FWS. During the pandemic period, testing for COVID-19 among infants who were evaluated as FWS may reduce unnecessary hospitalizations and antibiotic treatments, and shorten hospital stays and duration of antibiotics.
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Affiliation(s)
- Ali Güngör
- Correspondence: Ali Güngör, Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey. E-mail <>.
| | - İlknur Bodur
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Aytaç Göktuğ
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Muhammed Mustafa Güneylioğlu
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Betül Öztürk
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Raziye Merve Yaradılmış
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Rumeysa Yalçınkaya
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Can Demir Karacan
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nilden Tuygun
- Department of Pediatric Emergency Medicine, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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15
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Guner Ozenen G, Sahbudak Bal Z, Bilen NM, Yildirim Arslan S, Ak G, Koc G, Cicek C, Kurugol Z, Ozkinay F. Clinical and Laboratory Findings of SARS-CoV-2 Infection in Children Younger than 6 Months Old: Neutropenia is More Common Not Lymphopenia. J Trop Pediatr 2022; 68:6591216. [PMID: 35608318 PMCID: PMC9213872 DOI: 10.1093/tropej/fmac041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Studies on age-related differences in clinical and laboratory features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are limited. We aimed to evaluate the demographic, clinical, laboratory findings of SARS-CoV-2 infection in children younger than 6 months old and compare them with older children. METHODS A single-center retrospective study, including 209 confirmed SARS-CoV-2 infection cases, was conducted between 11 March 2020 and 1 September 2021. The case group consisted of 47 patients younger than 6 months old, whereas the control group consisted of 162 patients older than 6 months old. RESULTS The mean age of the case group was 2.77 ± 1.52 months, and the control group was 101.89 ± 65.77 months. Cough was statistically higher in the control group, and poor feeding was higher in the case group (p = 0.043, 0.010). The underlying disease rate was statistically higher in the control group; however, the hospitalization rate was higher in the case group (p = 0.036, 0.001). The case group had significantly lower median values of the absolute neutrophil count, hemoglobin and higher median values of white blood cell, absolute lymphocyte count and platelet than the control group (p < 0.05). C-reactive protein, fibrinogen values were significantly lower, and procalcitonin, D-dimer, troponin T, N-terminal pro-B-type natriuretic peptide significantly higher in the case group (p < 0.05). Lymphopenia was more common in the control group, whereas neutropenia was more common in the case group (p = 0.001, 0.011). CONCLUSIONS We showed that most children younger than 6 months old had mild and asymptomatic SARS-CoV-2 infection; however, the hospitalization rate was higher, and neutropenia was more common in older children. Lay summaryStudies on age-related differences in clinical and laboratory features on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients are limited. We aimed to evaluate the demographic, clinical and laboratory findings of SARS-CoV-2 infection in children younger than 6 months old and compare them with older children. A single-center retrospective study was conducted, including 209 SARS-CoV-2 infection cases. The case group consisted of 47 patients younger than 6 months old, and the control group consisted of 162 patients older than 6 months old. Most children younger than 6 months old had mild and asymptomatic SARS-CoV-2 infection; however, the hospitalization rate was higher than older children. Neutropenia was more common in patients younger than 6 months than older children with SARS-CoV-2 infection, even if underlying diseases were excluded.
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Affiliation(s)
- Gizem Guner Ozenen
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Zumrut Sahbudak Bal
- Correspondence: Zumrut Sahbudak Bal, Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Bornova/Izmir 35100, Turkey. Tel: +905054423192. Fax: +902323889900. E-mail <>
| | - Nimet Melis Bilen
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Sema Yildirim Arslan
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Gunes Ak
- Department of Clinical Biochemistry, Medical School of Ege University, Izmir 35100, Turkey
| | - Gonca Koc
- Department of Radiology, Medical School of Ege University, Izmir 35100, Turkey
| | - Candan Cicek
- Department of Microbiology and Infectious Diseases, Medical School of Ege University, Izmir 35100, Turkey
| | - Zafer Kurugol
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
| | - Ferda Ozkinay
- Division of Infectious Disease, Department of Pediatrics, Medical School of Ege University, Izmir 35100, Turkey
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