COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease?

Daniele Dona’; Carlotta Montagnani; Costanza Di Chiara; Elisabetta Venturini; Luisa Galli; Andrea Lo Vecchio; Marco Denina; Nicole Olivini; Eugenia Bruzzese; Andrea Campana; Roberta Giacchero; Filippo Salvini; Antonella Meini; Matteo Ponzoni; Sandra Trapani; Elena Rossi; Mary Haywood Lombardi; Raffaele Badolato; Luca Pierri; Giulia Pruccoli; Sara Rossin; Claudia Colomba; Salvatore Cazzato; Ilaria Pacati; Giangiacomo Nicolini; Luca Pierantoni; Sonia Bianchini; Andrzej Krzysztofiak; Silvia Garazzino; Carlo Giaquinto; Guido Castelli Gattinara; on behalf of The Italian SITIP-SIP Pediatric SARS-CoV-2 Infection Study Group

COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease?

2022

Compared to adults, severe or fatal COVID-19 disease is much less common in children. However, a higher risk for progression has been reported in infants. Different pediatric COVID-19 severity scores are reported in the literature. Methods: Subjects under 90 days of age admitted to 35 Italian institutions for COVID-19 were included. The severity of COVID-19 was scored as mild/moderate or severe/critical following the classification reported in the literature by Venturini, Dong, Kanburoglu, and Gale. To assess the diagnostic accuracy of each classification system, we stratified all enrolled patients developing a posteriori severity score based on clinical presentation and outcomes and then compared all different scores analyzed. Results: We included 216 infants below 90 days of age. The most common symptom was fever, followed by coryza, poor feeding, cough, and gastrointestinal manifestations. According to Venturini, Dong, Kanburoglu, and Gale’s severity scores, 18%, 6%, 4.2%, and 29.6% of infants presented with severe/critical disease, respectively. A correlation analysis between these four scores and the a posteriori severity score assigned to all enrolled subjects was performed, and a crescent strength of correlation from Gale (R = 0.355, p < 0.001) to Venturini (R = 0.425, p < 0.001), Dong (R = 0.734, p < 0.001), and Kanburoglu (R = 0.859, p < 0.001) was observed. Conclusions: The percentage of infants with severe COVID-19 varies widely according to the score systems. A unique clinical score should be designed for neonates and infants with COVID-19.

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