309 - Characteristics and Outcomes of Hospitalized Febrile Young Infants with COVID-19

Poster Number: 309
Publication Number: 309.213

Bryn Carroll, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Christina R. Rojas, Children's National Health System, Washington, DC, United States; Julianne E. Burns, Stanford University School of Medicine, Redwood City, CA, United States; Laura N. El-Hage, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Naveen Muthu, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Morgan Congdon, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: When considering the effect of SARS-CoV-2 infection on children, febrile young infants are a unique subset as they may require hospitalization given an underlying risk of bacterial sepsis or meningitis. Prior studies describing the spectrum of COVID-19 among infants have been limited by cohort size.

Objective: To describe the demographics, clinical characteristics, and outcomes of what is, to our knowledge, the largest cohort to date of febrile young infants with COVID-19.

Design/Methods: We are conducting a retrospective, observational study of febrile young infants at an urban children’s hospital. Initial review included infants who presented to the emergency department (ED) between March 1, 2020 and December 31, 2021. Inclusion criteria included positive SARS-CoV-2 PCR, age ≤ 60 days, and temperature ≥ 38°C. Data extracted from the medical record was collected in REDCap and analyzed via descriptive statistics.

Results: A total of 28 infants met inclusion criteria and were admitted to the hospital. 13 infants met institutional low-risk criteria so were discharged from the ED. In the hospitalized cohort, the median age was 34 days (IQR 28, 46) and 18 (64%) were male. Additionally, 8 (29%) were Black, 12 (43%) identified as Hispanic, and 20 (71%) had public insurance. Common symptoms included rhinorrhea, cough, feeding difficulty, and irritability (Table 1). There were 6 (21%) infants with respiratory distress, but none had oxygen desaturation. On initial labs, 13 (46%) had lymphopenia and 11 (44%) had sterile pyuria (Table 2). Among the 15 patients with cerebrospinal fluid (CSF) studies, 8 patients (53%) had elevated protein and 6 patients (40%) had mild pleocytosis. However, CSF for 4 of these patients was characterized as “bloody,” complicating CSF interpretation. No infants had positive blood, urine, or CSF cultures. Four infants required respiratory support, and two were admitted to the intensive care unit (ICU). There were no deaths. Conclusion(s): This study describes the clinical characteristics and outcomes of the largest cohort to date of hospitalized febrile young infants with COVID-19. Similar to prior studies, the majority of infants did not experience severe illness, and none experienced bacterial sepsis or meningitis. The presence of lymphopenia and sterile pyuria, while non-specific, may suggest SARS-CoV-2 infection.
 
Our initial review is limited by an inability to make comparisons between admitted and discharged infants due to cohort sizes. Further study of infants who have presented through the end of 2021 is underway.
Table 1Historical Features and Clinical Presentation of Hospitalized Febrile Young Infants with COVID-19
Table 2Evaluation and Clinical Course of Hospitalized Febrile Young Infants with COVID-19