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      SARS-CoV-2 Infection in Infants Less than 90 Days Old

      , MD MSCI 1 , ∗∗ , , , MD 2 , , , MD, Ph.D. 1 , , MD MSCI 1

      The Journal of Pediatrics

      Elsevier Inc.

      COVID-19, neonate

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          Abstract

          This is a single-center US case series of 18 infants <90 days old who tested positive for SARS-CoV-2. These infants had a mild febrile illness without significant pulmonary disease. One half were hospitalized; one had bacterial urinary tract co-infection. Nasopharyngeal viral loads were notably high. Latinx ethnicity was overrepresented.

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          Most cited references 3

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          Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China

           Y DONG,  X Mo,  Y HU (2020)
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            Atypical presentation of COVID-19 in young infants

            As of April 27, 2020, more than two million people worldwide have been diagnosed with coronavirus disease 2019 (COVID-19), with Europe being one of the current major clusters of the pandemic. 1 Despite an absence of evidence, children have been targeted as a potential source of children-to-adult virus dissemination, and schools have been closed in most countries. However, findings seem to indicate a lower susceptibility of children to COVID-19 and low contagiousness. 2 Within 7 days of imposed population quarantine in France (initiated on March 17, 2020), we observed an increase in number of young infants with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In our paediatric hospital, patients presenting with fever or respiratory symptoms, or both, and requiring admission to hospital are admitted to a dedicated SARS-CoV-2 infection unit. During the first week of quarantine, 14 infants younger than 3 months were admitted to this unit, and five of these young infants were diagnosed with COVID-19 on the basis of nasopharyngeal swabs positive for SARS-CoV-2. Their clinical presentations differed from those reported in articles about children with COVID-19,3, 4 which present little data from younger infants. The five infants with COVID-19 were boys. They had been healthy, but were admitted with poorly tolerated and isolated fever (appendix). None of the boys received non-steroidal anti-inflammatory drugs before admission, they had no respiratory symptoms before or during hospitalisation (in contrast with published data 5 ), and they did not need intensive care (chest x-rays are provided in the appendix). Four of the boys showed neurological symptoms at admission, such as axial hypotonia or drowsiness and moaning sounds, or both (appendix), which prompted us to do lumbar punctures. Cerebrospinal fluid samples were normal and tested negative for SARS-CoV-2 by RT-PCR. The infants received no drugs other than acetaminophen. Their clinical course was rapidly favourable, which allowed hospital discharge 1–3 days after admission. A dedicated paediatrician supervised the follow-up, which consisted of a daily phone call using a standardised questionnaire for 2 weeks. Here we describe our experience of COVID-19 in five young infants. In the pandemic context, infants younger than 3 months with isolated fever should be tested for SARS-CoV-2. Although infants might initially present signs of severe infection, our experience is that the youngest children tolerate and rapidly improve from COVID-19, in contrast to adults admitted to hospital with COVID-19. However, because little is known about SARS-CoV-2 infection in infants,4, 6 close monitoring is required for at least 2 weeks after the diagnosis. All of the infants' parents showed mild signs of viral infection (ie, rhinitis, or cough or fever, or both, for <1 week), which could be related to undiagnosed COVID-19.
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              Meta-analysis to Determine Risk for Serious Bacterial Infection in Febrile Outpatient Neonates With RSV Infection.

              This study aimed to analyze a large group of febrile neonates 28 days or younger who received outpatient sepsis evaluation and nasopharyngeal aspirate antigen testing (NPAT) for respiratory syncytial viral (RSV) infection to determine whether there is a clinically significant association between viral study results and risk for serious bacterial infection (SBI: bacterial meningitis, bacteremia, urinary tract infection, bacterial enteritis).
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                Author and article information

                Contributors
                Journal
                J Pediatr
                J. Pediatr
                The Journal of Pediatrics
                Elsevier Inc.
                0022-3476
                1097-6833
                18 June 2020
                18 June 2020
                Affiliations
                [1 ]Department of Pediatrics, Division of Infectious Diseases, Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
                [2 ]Department of Pediatrics, Division of Neonatology, Ann and Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
                Author notes
                [∗∗ ]Corresponding author: Leena B. Mithal, MD MSCI Address: 225 E Chicago Avenue, Box #20, Chicago IL 60611 Phone: 312.227.4080, Fax: 312.227.9709 lmithal@ 123456luriechildrens.org
                [∗]

                contributed equally

                Article
                S0022-3476(20)30750-2
                10.1016/j.jpeds.2020.06.047
                7301101
                © 2020 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Pediatrics

                neonate, covid-19

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