Presence and Duration of Symptoms in Febrile Infants With an
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A data is provided by demonstrating the typically benign symptomatology and clinical course of febrile infants with SARS-CoV2 infection, which will inform and comfort parents and clinicians who are confronted with this illness. Available data on SARS-CoV-2 infection suggests that children under 1 year of age may experience more severe symptoms when compared with older children. In this study, it was aimed to compare the presence and duration of symptoms in febrile infants less than 60 days old with and without SARS-CoV-2.

A prospective cohort study of febrile infants less than 60 days old with SARS-CoV-2 testing who were evaluated in the emergency department (ED) or transferred from affiliated hospitals from March 1 to May 15, 2020 was conducted. Phone interviews with parents and treating physicians to obtain data on demographics, medical history, presence and duration of presenting symptoms, and initial physical examination findings were conducted.

The primary outcome was the duration of individual symptoms as determined by daily phone follow-up conducted until the infant was symptom-free for 48 hours or for up to 21 days post index ED visit. Symptoms were entered retrospectively if the parent was not reachable on a given day. Additionally, 7 and 14 day calls and 14-day medical record reviews were conducted to determine the presence of severe outcomes during the course of illness, defined as acute respiratory distress syndrome, respiratory failure, development of sepsis or shock, requirement for intensive care unit–level of care or death. Medical records were also reviewed at least 6 weeks after each index visit to assess for the development of (MIS-C) associated with coronavirus disease 2019 (COVID-19).

Of 40 febrile infants screened, 33 (83%) had SARS-CoV-2 testing completed, and of those, 23 (70%) were prospectively enrolled. Median age was 41 days (interquartile range: 18–50 days). All but one had complete telephone follow-up, and all had complete medical record reviews.

Seven of the 23 enrolled infants tested positive for SARS-CoV-2, while 16 tested negative. Initial clinical presentations of infants with and without SARS-CoV-2 frequently overlapped, with SARS-CoV-2-positive infants more frequently reporting cough (3/7 or 43% versus 2/16 or 13%) and nasal congestion (3/7 or 43% versus 3/16 or 19%). Removing all those with urinary tract infections (n = 6), who may have unique symptom profiles, did not meaningfully change the findings (data available upon request). No infants experienced cyanotic or apneic episodes.

There were no infants with bacteremia, bacterial meningitis or severe outcomes. No therapies targeting COVID-19 were given. One infant who tested negative for SARS-CoV-2 was diagnosed with septic arthritis. None of the SARS-CoV-2-positive infants returned to the index ED within 6 weeks with symptoms concerning for MIS-C. However, a SARS-CoV-2-negative infant subsequently underwent outpatient cardiology and rheumatology evaluation for MIS-C given prolonged fever lasting 9 days. Inflammatory markers, electrocardiogram and echocardiogram findings were all negative. Antibodies for COVID-19 were not sent, but the infant’s symptoms were deemed not to be consistent with MIS-C. No severe outcomes were observed among the missed eligible patients.

Source: https://journals.lww.com/pidj/Fulltext/2020/11000/Presence_and_Duration_of_Symptoms_in_Febrile.28.aspx
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