COVID-19 infection in infants

As there has been a sharp rise in the number of positive cases around the world, the number of pregnant women and infants with COVID-19 has also increased.

A study was published in the journal Jama Pediatrics in March 2020, which was based on 33 babies who were born to mothers with the COVID-19 infection in Wuhan. 

All the babies were born through the caesarian procedure as respiratory problems were present in the mothers. In the study, it was seen that out of 33 neonates, 3 babies showed an early onset of COVID-19 infection, soon after they were born. 

Though two of the babies with COVID-19 infection showed mild symptoms like lethargy, fever and vomiting and their X-rays showed pneumonia, their COVID-19 infection tests showed negative results on day 6. 

However, the third baby developed neonatal respiratory distress syndrome and showed severe symptoms than the rest of the babies. Yet, the third baby also showed negative results for COVID-19 infection on day 7. 

There have also been other instances which showed a late onset of COVID-19 infection in babies. A report from Spain showed a baby girl was found COVID-19 positive a week after she was born. However, she was treated with antibiotics and was given mechanical ventilation until her condition improved.

Another case of late-onset COVID-19 infection was published in the New England Journal of Medicine where a baby tested positive for COVID-19 infection with severe symptoms such as pneumothorax and sepsis, 3 weeks after being born. However, the baby was treated on time with mechanical ventilation, antibiotics and tube thoracostomy. The baby was discharged after being in the pediatric intensive care unit for 9 days.

COVID‐19 infection can result in asymptomatic to severe illness in infants. Children with no underlying medical condition appear to have milder symptoms. The common clinical symptoms of COVID‐19 in newborn babies are:

• Fever
• Fatigue
• Dry cough
• Vomiting (the baby vomits milk)
• Abdominal pain
• Diarrhoea 
• Shortness of breath

However, some of the patients may show upper respiratory symptoms, such as:

• Nasal obstruction
• Nasal discharge (runny nose)
• Sore throat

There are a few challenges that doctors have to face while treating newborn babies as the babies do not have a strong immune system. However, early identification and early isolation of the mother and baby can help in controlling the situation more efficiently. 

To diagnose SARS-CoV-2 infection in newborns, doctors are using the nucleic acid or virus gene tests. Nasopharyngeal swab, sputum, secretion of the lower respiratory tract, blood, and faeces samples are being taken for the test.

Once the baby is tested positive for COVID-19 infection, the following treatment plan is being adopted:  

• Babies with COVID‐19 infection are being admitted in negative pressure rooms, usually, the pediatric intensive care unit (PICU). If PICU is not available in that area, the babies are admitted in the rooms where the exhaust is filtered through high‐efficiency particulate air filters.
• No visitors are allowed to meet the newborn affected with COVID-19 infection.
• Since there are no treatments for COVID-19 infection, the babies are given symptomatic and supportive treatment which involves giving oxygen supply, maintaining the water‐electrolyte balance and the acid‐base balance. 
• The doctors give water and electrolyte supplements to avoid worsening of pulmonary oedema and reduced oxygen in the body. 
• For the newborns who suffer from severe acute respiratory distress syndrome, the doctors may use high‐dose pulmonary surfactant, inhaled nitric oxide, high‐frequency oscillatory ventilation, and extracorporeal membrane lung oxygenation (ECMO) to improve their condition.