SARS-CoV-2 in Infants: Clinical Patterns, Laboratory Findings, and Implications for Pediatric Care in Viral Outbreaks.

Abstract

Background: The emergence of COVID-19 has placed unprecedented pressure on healthcare systems worldwide. Although the clinical features of COVID-19 are well-documented in adults, limited data are available regarding its impact on infants, particularly across different age groups.

Objectives: To compare the clinical presentation, laboratory findings, and outcomes of infants aged ⩽6 months with those aged >6 months diagnosed with COVID-19.

Design: Retrospective cross-sectional study.

Methods: This study was conducted at a tertiary pediatric hospital in Saudi Arabia. Data were extracted from electronic medical records of 388 infants with confirmed COVID-19 between March 2020 and December 2022. Demographic information, clinical signs and symptoms, laboratory parameters, and clinical outcomes were analyzed and compared between the two age groups using appropriate statistical methods.

Results: Among 388 infants diagnosed with COVID-19, 54.6% were aged ⩽6 months. Less than half of the cohort was symptomatic, with fever (41.0%), cough (37.1%), and rhinorrhea (20.1%) being the most common symptoms. Gastrointestinal symptoms differed significantly by age: infants >6 months had higher rates of diarrhea than those ⩽6 months (58.6% vs 41.4%, P = .028). Most infants had normal white blood cell (WBC) counts (76.5%), though WBC abnormalities varied by age group: leukopenia was more frequent in infants ⩽6 months, while leukocytosis was more common in older infants (P = .009). Elevated C-reactive protein was observed in 63.0% of tested infants, and hyperglycemia was detected in 83.6%. COVID-19-related mortality was low (1.03%), primarily affecting infants ⩽3 months with pre-existing comorbidities.

Conclusion: SARS-CoV-2 infection in infants was generally mild, with low rates of complications and mortality. However, infants aged ⩽6 months demonstrated greater clinical vulnerability compared to older infants. These findings underscore age-specific differences in clinical presentation and support the need for tailored risk assessment and management approaches in pediatric care.