Severe Malnutrition and Anemia Are Associated with Severe COVID in Infants

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ABSTRACT

Background

COVID-19 is uncommon and less severe in children than adults. It is thought that infants may be at higher risk for severe disease than older children. There is a paucity of literature on infants with COVID, particularly those with severe disease.

Objective

We describe demographic, epidemiologic, clinical, radiological, laboratory features and outcomes of infants with confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital in Pune, India

Methodology

Infants who tested positive for SARS-CoV-2 and were admitted between 1 April 2020 and 7 August 2020 were included in the study.

Results

A total of 13 infants were admitted during the study period. The median age was 8 months (IQR 6) and nine were male. Common presenting features were fever ( n = 8, 62%), poor feeding, irritability, and runny nose ( n = 3, 23%). Comorbidities noted were severe acute malnutrition (SAM) in three cases (23%) and nutritional megaloblastic anemia, iron deficiency anemia, sickle thalassemia and renal calculi in one case (8%) each. There was a history of low birth weight in two cases (15%). Pallor was noted in three cases (23%), SAM in three cases (23%) and tachypnea and respiratory distress in four cases (30%). Severe anemia, thrombocytopenia, elevated ferritin, abnormal procalcitonin, abnormal C Reactive Protein and deranged D-dimer was noted in three cases (23%) each. Neutrophil–lymphocyte ratio was normal in all cases. Three infants (43%) had evidence of pneumonia on the chest radiograph, of which one had adult respiratory distress syndrome (ARDS) like pattern, one infant had cardiomegaly and perihilar infiltrates. Hydroxychloroquine and azithromycin were given to five patients (38%), Intravenous Immunoglobulin and methylprednisolone were administered to one patient (8%). One infant died of ARDS with multi-organ dysfunction with refractory shock and hemophagocytic lymphohistiocytosis.

Conclusion

SAM and anemia may be associated with severe COVID in infants.

Related collections

Most cited references 15

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Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China

Yuanyuan Dong, Xi Mo, Yabin Hu … (2020)

To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China.

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SARS-CoV-2 Infection in Children

Xiaoxia Lu, Liqiong Zhang, Hui Du … (2020)

To the Editor: As of March 10, 2020, the 2019 novel coronavirus (SARS-CoV-2) has been responsible for more than 110,000 infections and 4000 deaths worldwide, but data regarding the epidemiologic characteristics and clinical features of infected children are limited. 1-3 A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age. 2 In order to determine the spectrum of disease in children, we evaluated children infected with SARS-CoV-2 and treated at the Wuhan Children’s Hospital, the only center assigned by the central government for treating infected children under 16 years of age in Wuhan. Both symptomatic and asymptomatic children with known contact with persons having confirmed or suspected SARS-CoV-2 infection were evaluated. Nasopharyngeal or throat swabs were obtained for detection of SARS-CoV-2 RNA by established methods. 4 The clinical outcomes were monitored up to March 8, 2020. Of the 1391 children assessed and tested from January 28 through February 26, 2020, a total of 171 (12.3%) were confirmed to have SARS-CoV-2 infection. Demographic data and clinical features are summarized in Table 1. (Details of the laboratory and radiologic findings are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.) The median age of the infected children was 6.7 years. Fever was present in 41.5% of the children at any time during the illness. Other common signs and symptoms included cough and pharyngeal erythema. A total of 27 patients (15.8%) did not have any symptoms of infection or radiologic features of pneumonia. A total of 12 patients had radiologic features of pneumonia but did not have any symptoms of infection. During the course of hospitalization, 3 patients required intensive care support and invasive mechanical ventilation; all had coexisting conditions (hydronephrosis, leukemia [for which the patient was receiving maintenance chemotherapy], and intussusception). Lymphopenia (lymphocyte count, <1.2×109 per liter) was present in 6 patients (3.5%). The most common radiologic finding was bilateral ground-glass opacity (32.7%). As of March 8, 2020, there was one death. A 10-month-old child with intussusception had multiorgan failure and died 4 weeks after admission. A total of 21 patients were in stable condition in the general wards, and 149 have been discharged from the hospital. This report describes a spectrum of illness from SARS-CoV-2 infection in children. In contrast with infected adults, most infected children appear to have a milder clinical course. Asymptomatic infections were not uncommon. 2 Determination of the transmission potential of these asymptomatic patients is important for guiding the development of measures to control the ongoing pandemic.

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Gender Differences in Patients With COVID-19: Focus on Severity and Mortality

Jian-Min Jin, Peng Bai, Wei He … (2020)

Objective: The recent outbreak of Novel Coronavirus Disease (COVID-19) is reminiscent of the SARS outbreak in 2003. We aim to compare the severity and mortality between male and female patients with COVID-19 or SARS. Study Design and Setting: We extracted the data from: (1) a case series of 43 hospitalized patients we treated, (2) a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and (3) data of 524 patients with SARS, including 139 deaths, from Beijing in early 2003. Results: Older age and a high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. Age was comparable between men and women in all data sets. In the case series, however, men's cases tended to be more serious than women's (P = 0.035). In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015). Conclusion: While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age.

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Author and article information

Contributors

Rajesh Kulkarni

Uday Rajput

Rahul Dawre

Naresh Sonkawade

Sameer Pawar

Somendra Sonteke

Balaji Varvatte

K C Aathira

Kailas Gadekar

Santosh Varma

Leena Nakate

Anju Kagal

Aarti Kinikar

Journal

Journal ID (nlm-ta): J Trop Pediatr

Journal ID (iso-abbrev): J Trop Pediatr

Journal ID (publisher-id): tropej

Title: Journal of Tropical Pediatrics

Publisher: Oxford University Press

ISSN (Print): 0142-6338

ISSN (Electronic): 1465-3664

Publication date (Electronic): 14 December 2020

Electronic Location Identifier: fmaa084

Affiliations

Department of Pediatrics, B.J. Government Medical College , Pune, India

Department of Biochemistry, B.J. Government Medical College , Pune, India

Department of Pathology, B.J. Government Medical College , Pune, India

Department of Microbiology, B.J. Government Medical College , Pune, India

Department of Pediatrics, B.J. Government Medical College , Pune, India

Author notes

Correspondence: Aarti Kinikar, Department of Pediatrics, B.J. Government Medical College, J.P. Narayan Road, Pune, India. Tel: +91 9850039063. E-mail: < aarti.kinikar63@ 123456gmail.com> .

Article

Publisher ID: fmaa084

DOI: 10.1093/tropej/fmaa084

PMC ID: 7798483

PubMed ID: 33313926

SO-VID: d3a050b4-fdb5-4c20-875a-2d4c8dcf0343

License:

This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

History

Page count

Pages: 7

Custom metadata

article-lifecycle PAP

ScienceOpen disciplines: Pediatrics

Keywords: infant,covid,severe malnutrition,anemia

Data availability: