Clinical manifestations and disease severity of SARS-CoV-2 infection among infants in Canada

  1. Pierre-Philippe Piché-Renaud
  2. Luc Panetta
  3. Daniel S. Farrar
  4. Charlotte Moore-Hepburn
  5. Olivier Drouin
  6. Jesse Papenburg
  7. Marina I. Salvadori
  8. Melanie Laffin
  9. Fatima Kakkar
  10. Shaun K. Morris
  11. on behalf of the Canadian Paediatric Surveillance Program COVID-19 Study Team

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Abstract

There are limited data on outcomes of SARS-CoV-2 infection among infants (<1 year of age). In the absence of approved vaccines for infants, understanding characteristics associated with hospitalization and severe disease from COVID-19 in this age group will help inform clinical management and public health interventions. The objective of this study was to describe the clinical manifestations, disease severity, and characteristics associated with hospitalization among infants infected with the initial strains of SARS-CoV-2.

Methods

This is a national, prospective study of infants with SARS-CoV-2 from April 8 th 2020 to May 31 st 2021 using the infrastructure of the Canadian Paediatric Surveillance Program. Infants <1 year of age with microbiologically confirmed SARS-CoV-2 infection from both inpatients and outpatients seen in clinics and emergency departments were included. Cases were classified as either: 1) Non-hospitalized patient with SARS-CoV-2 infection; 2) COVID-19-related hospitalization; or 3) non-COVID-19-related hospitalization (e.g., incidentally detected SARS-CoV-2). Case severity was defined as asymptomatic, outpatient care, mild (inpatient care), moderate or severe disease. Multivariable logistic regression was performed to identify characteristics associated with hospitalization.

Results

A total of 531 cases were reported, including 332 (62.5%) non-hospitalized and 199 (37.5%) hospitalized infants. Among hospitalized infants, 141 of 199 infants (70.9%) were admitted because of COVID-19-related illness, and 58 (29.1%) were admitted for reasons other than acute COVID-19. Amongst all cases with SARS-CoV-2 infection, the most common presenting symptoms included fever (66.5%), coryza (47.1%), cough (37.3%) and decreased oral intake (25.0%). In our main analysis, infants with a comorbid condition had higher odds of hospitalization compared to infants with no comorbid conditions (aOR = 4.53, 2.06–9.97), and infants <1 month had higher odds of hospitalization then infants aged 1–3 months (aOR = 3.78, 1.97–7.26). In total, 20 infants (3.8%) met criteria for severe disease.

Conclusions

We describe one of the largest cohorts of infants with SARS-CoV-2 infection. Overall, severe COVID-19 in this age group was found to be uncommon. Comorbid conditions and younger age were associated with COVID-19-related hospitalization amongst infants.

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  1. Version published to 10.1371/journal.pone.0272648
  2. ScreenIT

    SciScore for 10.1101/2022.02.02.22270334: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethics approval was obtained from the Public Health Agency of Canada and Health Canada Research Ethics Board (REB 2020-002P), The Hospital for Sick Children (REB 1000070001) and the Institutional Review Board of the Centre Hospitalier Universitaire Sainte-Justine (IRB MP-21-2021-2901) as well as at individual sites, as required by local policies.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analyses were conducted using Stata 17 (StataCorp, College Station, TX).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2022.02.02.22270334 on medRxiv