COVID-19 Associated With Life-Threatening Apnea in an Infant Born Preterm: A Case Report

Incidental Hyperferritinemia in Very Young Infants with Mild Symptoms of COVID-19 Disease

BACKGROUND

The number of children infected with novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has increased during the outbreak of the Omicron strain. Hyperferritinemia has been reported in severe cases of COVID-19, and in children or neonates with multisystem inflammatory syndrome (MIS). Hyperferritinemia is considered to be one of the signs of MIS, but thus far, there have been few summarized reports on it. We retrospectively analyzed four infants less than 3 months of age with SARS-CoV-2 infections treated in our institution during the outbreak of the Omicron strain.

RESULTS

most patients were in good condition, but hyperferritinemia was observed in all of four cases.

CONCLUSIONS

Hyperferritinemia can be observed in infantile COVID-19 patients even with mild symptoms. It is necessary to carefully monitor their clinical course and monitor the patients.

Apneas requiring respiratory support in young infants with COVID-19: a case series and literature review

The objective of this study is to describe the clinical features of young infants with apneas as a clinical sign of COVID-19. We reported the cases of 4 infants who needed respiratory support in our PICU for a severe course of COVID-19 complicated with recurrent apneas. Moreover, we conducted a review of the literature about COVID-19 and apneas in infants ≤ 2 months of corrected age. A total of 17 young infants were included. Overall, in most of the cases (88%), apnea was an initial symptom of COVID-19, and in two cases, it recurred after 3-4 weeks. Regarding neurological workup, most children underwent a cranial ultrasound, while a minority underwent electroencephalography registration, neuroimaging, and lumbar punctures. One child showed signs of encephalopathy on electroencephalogram, with further neurological workup resulting normal. SARS-CoV-2 was never found in the cerebrospinal fluid. Ten children required intensive care unit admission, with five of them needing intubation and three non-invasive ventilation. A less invasive respiratory support was sufficient for the remaining children. Eight children were treated with caffeine. All patients had a complete recovery.  Conclusion: Young infants with recurrent apneas during COVID-19 usually need respiratory support and undergo a wide clinical work-up. They usually show complete recovery even when admitted to the intensive care unit. Further studies are needed to better define diagnostic and therapeutic strategies for these patients. What is Known: • Although the course of COVID-19 in infants is usually mild, some of them may develop a more severe disease needing intensive care support. Apneas may be a clinical sign in COVID-19. What is New: • Infants with apneas during COVID-19 may require intensive care support, but they usually show a benign course of the disease and full recovery.

Contributing factors to pediatric COVID-19 and MIS-C during the initial waves: A systematic review of 92 case reports

Background

As the coronavirus disease 2019 (COVID-19) pandemic continues to sweep the world with unprecedented speed and devastation, data has shown that cases in the pediatric population have been significantly lower than in the adult population. We conducted a systematic review of case reports to identify the contributing factors of confirmed pediatric COVID-19 patients.

Methods

Using the PubMed platform, and Cochrane Central, we searched for primary studies alone. All database searches were performed between December 2019 and December 2020. We incorporated keywords including “pediatrics,” “Case reports,” “Cases,” “Covid-19″ into all searches.

Results

A total of 92 records were included in this novel review. Of all patients, 58% were male and the mean age of the patients was 6.2 years (SD: 5.9). Contributing factors to MIS-C infections were G6PD deficiency (17.6%), Group A streptococcus co-infection (17.6%), infancy (11.8%), whereas those in COVID-19 pediatric patients included congenital (18.5%), and genetic defects (13.8%), in addition to vertical transmission or during infancy (16.9%). Data of baseline demographic characteristics and clinical sequelae of included COVID-19 pediatric and MIS-C patients is presented.

Conclusion

With schools reopening and closing, the pediatric age group is susceptible to high rates of COVID-19 community transmission. We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients. These insights are critical to guide future guidelines on the management and potential vaccination efforts.

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COVID-19 continues to devastate communities worldwide.

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The pediatric population has faced the ups and downs of the many variants of disease.

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This systematic review includes a total of 92 studies and identifies key contributing factors from developmental, maternal and pediatric.

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We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients.

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These insights are critical to guide future guidelines on the management and potential vaccination efforts.

Apnea in a Two-Week-Old Infant Infected with SARS-CoV-2 and Influenza B

Paucity of data exists on presenting symptoms and outcomes in infants with COVID-19. Reports of coinfection with COVID-19 and influenza B are sparse in the literature. Coinfection was uncovered during evaluation of neonatal apnea. Apnea has been reported in infants with SARS-CoV-2 infection, though it is rare. We describe a 2-week-old healthy term infant presenting with apnea and coinfection. The infant had a mild clinical course and complete recovery.

Cardiorespiratory alterations in a newborn ovine model of systemic viral inflammation

BACKGROUND

Respiratory viruses can be responsible for severe apneas and bradycardias in newborn infants. The link between systemic inflammation with viral sepsis and cardiorespiratory alterations remains poorly understood. We aimed to characterize these alterations by setting up a full-term newborn lamb model of systemic inflammation using polyinosinic:polycytidylic acid (Poly I:C).

METHODS

Two 6-h polysomnographic recordings were carried out in eight lambs on two consecutive days, first after an IV saline injection, then after an IV injection of 300 μg/kg Poly I:C.

RESULTS

Poly I:C injection decreased locomotor activity and increased NREM sleep. It also led to a biphasic increase in rectal temperature and heart rate. The latter was associated with an overall decrease in heart-rate variability, with no change in respiratory-rate variability. Lastly, brainstem inflammation was found in the areas of the cardiorespiratory control centers 6 h after Poly I:C injection.

CONCLUSIONS

The alterations in heart-rate variability induced by Poly I:C injection may be, at least partly, of central origin. Meanwhile, the absence of alterations in respiratory-rate variability is intriguing and noteworthy. Although further studies are obviously needed, this might be a way to differentiate bacterial from viral sepsis in the neonatal period.

IMPACT

Provides unique observations on the cardiorespiratory consequences of injecting Poly I:C in a full-term newborn lamb to mimic a systemic inflammation secondary to a viral sepsis. Poly I:C injection led to a biphasic increase in rectal temperature and heart rate associated with an overall decrease in heart-rate variability, with no change in respiratory-rate variability. Brainstem inflammation was found in the areas of the cardiorespiratory control centers.