Clinical Characteristics of COVID-19 in Neonates and Infants Younger Than 3 Months

Background: COVID-19 is a respiratory infection that was generated in 2019 as a pandemic affecting children and adults. Objectives: To better understand COVID-19 in young children, we evaluated the epidemiological, clinical, and outcomes of SARS-CoV-2 infection in neonates and 1-3 months old infants and compared the difference between the two groups. Methods: This retrospective analysis included children admitted to Bouali and Imam Khomeini tertiary hospitals in Sari, between March 2019 and March 2022 with a COVID-19 diagnosis. Demographic data such as age, sex, comorbidity, clinical characteristics and symptoms, medications and laboratory test results were extracted from the patients' medical records. Statistical analysis was performed using SPSS software, version 22.0, and p-values less than 0.05 were considered statistically significant. Results: This study evaluated 152 children including 34(22.4%) neonates and 118(77.6%) infants with a median age of 49.5 [33-66] days. The frequencies of mild, moderate, and severe/MIS-C cases were 96(63.2%), 29(19.1%), and 27(17.8%), respectively (p=0.879). Overall, 90(59.2%) patients were boys and 62(40.8%) were girls (p=0.695). COVID-19 RT-PCR test was positive in 65(42.8%) children (p= 0.022) and 3(2%) children expired. Fever was the most common symptom (75%), followed by cough (56.6%), poor feeding (46.1%), dyspnea (32.9%), and lethargy (32.2%). 29(19.1%) patients required ICU admission and 6(3.9%) patients underwent mechanical ventilation (p=0.463 and p=0.126, respectively). The median duration of hospital stay was 5 days [IQR= 4-7 days]. The median duration of antibiotic therapy did not differ among the groups (p= 0.786). Sepsis workup was performed in 82.9% of patients, and none had a positive CSF culture.