Comparison of neonatal COVID-19 clinical features based on onset timing

The clinical features of neonatal sepsis that develop early and late differ, and it is unclear whether neonatal coronavirus disease 19 (COVID-19) varies depending on the day of onset. Based on whether the onset occurred within the first 5 days of life, all neonatal COVID-19 cases were divided into the early-onset group (EOG) and late-onset group (LOG). Clinical data of these cases diagnosed between December 14, 2022, and January 9, 2023, were gathered and analyzed retrospectively. Of the 212 neonates with COVID-19 included, 36 were in EOG and 176 were in EOG. The percentages of asymptomatic, mild, moderate, and severe cases were 9.4%, 76.9%, 11.3%, and 2.4%, respectively, and there were no critical cases. While 82.4% of mild cases and 15.4% of moderate or severe cases were in LOG, the EOG had a considerably larger proportion of asymptomatic infections (44.4% vs 2.3%) and only 1 moderate or severe case. The most common symptom (87.3%) was fever, which was more prevalent and lasted longer in LOG (93.8% vs 55.6%). The LOG also had higher rates of coughing (43.8% vs 5.6%) and poor appetite (70.5% vs 13.9%). Except for increased C-reactive protein in EOG and decreased white blood cells in LOG, there were no appreciable variations in liver enzymes, cardiac enzymes, or other infection biomarkers between the groups. Most pneumonia cases (96.8%) diagnosed by chest radiography occurred in LOG. Steroids and antiviral medications were not administered to any of infected infants, who only received symptomatic treatment. Five critical patients received neonatal intensive care. All the patients were cured and discharged. COVID-19 often manifests only weakly. Although the general prognosis was good for all groups, the LOG was more likely to experience fever, respiratory and gastrointestinal symptoms, and a small percentage of patients with moderate or severe disease.