COVID-19 in Infants Less than 3 Months: Severe or Not Severe Disease?

Area of Science:

• Pediatrics
• Infectious Diseases
• Medical Informatics

Background:

• Severe or fatal coronavirus disease 2019 (COVID-19) is less common in children than adults.
• Infants under 90 days old may have a higher risk of COVID-19 progression.
• Existing pediatric COVID-19 severity scores lack standardization for infants.

Purpose of the Study:

• To compare the diagnostic accuracy of four different pediatric COVID-19 severity scoring systems in infants under 90 days old.
• To evaluate the variability in reported severe COVID-19 rates among infants based on different scoring systems.
• To determine the need for a unique clinical score for neonates and infants with COVID-19.

Main Methods:

• A cohort of 216 infants under 90 days old admitted with COVID-19 across 35 Italian institutions was analyzed.
• COVID-19 severity was classified using scores from Venturini, Dong, Kanburoglu, and Gale.
• Diagnostic accuracy was assessed by comparing these scores against an a posteriori severity score based on clinical presentation and outcomes.

Main Results:

• The percentage of infants classified with severe/critical COVID-19 varied significantly: 18% (Venturini), 6% (Dong), 4.2% (Kanburoglu), and 29.6% (Gale).
• Correlation analysis showed increasing accuracy from Gale (R = 0.355) to Venturini (R = 0.425), Dong (R = 0.734), and Kanburoglu (R = 0.859).
• The Kanburoglu score demonstrated the strongest correlation with the a posteriori severity assessment.

Conclusions:

• The choice of severity scoring system significantly impacts the reported incidence of severe COVID-19 in infants.
• There is a clear need for a standardized, unique clinical scoring system tailored for neonates and infants diagnosed with COVID-19.
• Standardization will improve accurate assessment and management of COVID-19 in this vulnerable population.