Report: Infants with COVID-19 Experience Mild Symptoms in China

None of the 4 newborn babies identified in China who developed coronavirus disease 2019 (COVID-19) required intensive care or mechanical ventilation, according to a paper published in the European Respiratory Journal.

Investigators from Wuhan University identified novel coronavirus infections in newborns in order to describe the clinical features, treatment, outcomes, and intrauterine transmission potential. Wuhan was the initial epicenter of the pandemic outbreak, which has now spread throughout much of the world, and the city is slowly trying to return to a new normal. The investigators wrote that in the early days of the pandemic, older adults were reported to be more frequently infected; however, there have since been reports of pediatric and infant cases.

From December 8, 2019 through March 13, 2020 there were 81,026 cases of COVID-19 and 4 cases were among infants, the study authors reported. The infants’ ages ranged from 30 hours to 17 days old and 3 were males, the authors added.

The cases were confirmed through nucleic acid detection using nasopharyngeal swabs in 2 babies, while the other 2 received anal swabs. Three infants underwent CT scans and they all showed increased lung marking, the study authors said.

Of the four, 2 newborns had fever, 1 had shortness of breath, 1 had cough and 1 had no noticeable symptoms.

Disease onset occurred in the hospital for 2 babies and at home for the remaining 2 babies. Half were in isolation and the other half were not at the time of disease onset, the study authors continued. Time between dates of admission and symptoms to diagnosis was between 0 and 2 days.

All of the babies received supportive treatment, though none required stay in the intensive care unit or mechanical ventilation. None of the infants had any severe complications.

The hospital stays for each of the 3 newborns who were deemed recovered (after 2 consecutive nucleic acid tests done 24 hours apart) were 16, 23, and 30 days, respectively.

All 4 of the babies were born via C-section and 3 of them were separated from their mothers right after being born. They were not breastfed. The fourth baby was not separated from

the mother at birth and was breastfed for 16 days until symptom onset, according to the study authors.

All 4 of the babies’ mothers were determined to have COVID-19, according to the investigators, with 3 of the mothers showing symptoms prior to delivery and 1 developing symptoms after delivery. The most common symptoms exhibited by the mothers were fever, cough, appetite decline and oil intolerance. Each of the mothers also underwent CT scans (3 before and 1 after delivery), where they each had abnormal findings.

“It is encouraging that newborn babies and infants appear to be less vulnerable to SARS-CoV-2,” the study authors said.

“On the other hand, mild or no symptoms in the youngest make it difficult to detect and prevent further transmission.”

While there were 4 infections in newborns younger than 28 days in this study, the investigators said there were 9 babies with COVID-19 aged between 28 days and 1 year.

Therefore, the infection rate might be slightly higher proportionately in newborns than in infants. Transmission may be different, such as intrauterine transmission, which these findings support, the study authors said.

“The chance of infection through ways other than intrauterine transmission is deemed to be low,” they said, after outlining that all the babies were delivered via C-section and 3 were separated from their mothers. But they admitted that nosocomial infection could not be ruled out entirely, and said that nasopharyngeal and anal swabs cannot directly indicate intrauterine infection.

“Newborn babies are susceptible to SARS-CoV-2 infection,” the study authors concluded. “The symptoms in newborn babies were milder and outcomes were less severe as compared to adults.”