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According to a new study, the frequency of COVID-19 in infants may depend on the degree of pandemic virus circulating in a community.
Published online June 30 in the journal Pediatrics, the study specifically found that infection rates with the virus that causes COVID-19 were higher in infants hospitalized, not for COVID-19 – but rather because they were being assessed for severe bacterial infection ( SBI) potential – during times of high COVID-19 traffic in New York City. The study also found that COVID-19 positivity rates in this age group were lower when infection rates in the city were low.
Led by researchers at NYU Langone Health, the study also looked at the clinical course of infection in young infants and found that the most common presentation of COVID-19 was fever with no other symptoms.
“Improving our knowledge of how COVID-19 infection affects young infants is important for informing clinical practice and for planning public health measures such as immunization distribution,” says Vanessa N. Raabe, MD, assistant professor in the departments of medicine and pediatrics at NYU Langone, in the Division of Pediatric Infectious Diseases, and one of the study’s lead investigators.
New York City was the first epicenter of COVID-19 in the United States, with more than 190,000 infections reported during the peak of the New York epidemic between March and May 2020. Three percent of reported cases were in children under 18. , although these numbers may underestimate the true impact given the lack of adequate testing. Most of the children infected with the disease were asymptomatic or had mild symptoms. However, there have been reports of serious illness and some reports suggest that young infants may be at higher risk for serious illness than older children.
Young babies are often treated with antibiotics in the hospital when they have a fever until doctors can make sure they don’t have a serious bacterial infection, such as meningitis or infection of the blood, the study authors explain.
“Because fever is a common symptom of COVID-19 in children, clinicians should consider COVID-19 as a potential cause of fever and not rely solely on laboratory or imaging results to guide the taking of decision on whether or not to test hospitalized infants for COVID. -19 “, explains Dr. Raabe.
The present study analyzed data from infants under 90 days admitted for SBI assessment at NYU Langone Health and NYC Health + Hospitals / Bellevue Hospital between March and December 2020. Among 148 infants, 15% tested positive for COVID-19, and two of the 22 infants with COVID-19 had to be admitted to the intensive care unit, but were released unharmed. Specifically, the team found that only 3% of infants tested positive during times of low community circulation, compared to 31% in communities with high infection rates.
The team also found a relatively low incidence (six percent) of hospitalized infants being infected with other common viruses, whether or not they have COVID-19. “This likely reflects a community-wide decrease in other respiratory viruses reported in New York City during the study period due to improved infection control practices, such as social distancing and wearing masks,” at the height of the pandemic, ”Raabe said.
Researchers recommend that clinicians continue to assess young infants with fevers for bacterial infections, regardless of COVID-19 status, and given the potential serious consequences if left untreated.
“It may be intuitive that what is happening in children reflects conditions in the surrounding community, but we find it reassuring that the evidence supports this relationship,” says lead author Michal Paret, MD, member of the Department of Pediatrics, of pediatrics. Infectious Diseases at NYU Langone. “The epidemiology of COVID-19 continues to evolve with the emergence of variant viruses and the implementation of vaccination. In the face of these changes, physicians must continue to study this age group, with the ultimate goal of determining whether a selective or universal testing strategy serves the best. long-term infant health. ”
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More research is needed on young infants assessed in a wider range of settings, including the emergency department and outpatient clinics, to truly understand the full impact of COVID-19 in this age group.
Along with Dr Raabe and Dr Paret, the study authors from the Department of Pediatrics were Adam J. Ratner, MD; Gail F. Shust, MD; Rebecca Pellet Madan, MD; Jennifer L. Lighter, MD; Asif Noor, MD; Annum Jaffer, MD; and Karim Lalani, MD.
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