Infantile COVID-19: An Evidence-based and Updated Narrative Review

Abstract: Infantile COVID-19, caused by SARS-CoV-2, presents unique challenges in diagnosis, management, and outcomes compared to adults. Due to their physiological limits, infants, defined as children under one year old, are categorized among vulnerable health groups, highlighting the importance of effective and timely prevention, diagnosis, and treatment. This review provides the latest evidence on the epidemiology, prevention, clinical diagnosis, and treatment of COVID-19 infection in infants, discussing the existing controversies and highlighting current knowledge gaps. An extensive literature search was performed in MEDLINE (via PubMed), Web of Science, and Scopus databases with relevant free keywords and MeSH terms to identify related records without any restrictions in time or language. Generally exhibiting nonspecific symptoms, COVID-19 can overlap with common respiratory infections among infants. Moreover, the lack of effective verbal communication in infants complicates the symptom assessment, turning the timely diagnosis into a difficult challenge for healthcare providers. Additionally, maternal transmission of SARS-CoV-2 during pregnancy, childbirth, or postpartum care also raises concerns about neonatal infection, with potential implications for both maternal and infant health. Several agents have been proposed for the treatment of infantile COVID-19, including glucocorticoids, intravenous immunoglobulin, tocilizumab, and antivirals such as remdesivir, ritonavir, and favipiravir. Current evidence supports the potential effectiveness of extracorporeal membrane oxygenation and nutrition supplements; however, their ultimate effectiveness is still controversial. As an effective preventive strategy, more studies are required to determine the safety and efficacy of vaccination in this population. The complexity of diagnostic and clinical management associated with COVID-19 poses serious challenges for this group of patients. In managing infantile COVID-19, supportive care is still critical, emphasizing good nutritional support, efficient oxygenation, and hemodynamic maintenance. Given the limited available evidence on immunomodulators, antiviral medications, and other pharmaceutical interventions in this population, safety and efficacy profiles must be carefully considered. Future research should focus on the effectiveness of vaccination, the safety of the currently proposed treatments, and the long-term consequences of COVID-19 infection.