455 - Symptomatic Neonatal COVID-19: a Scoping Review of Initial Clinical Presentation, Investigations and Management

Poster Number: 455
Publication Number: 455.431

Gabriela de Carvalho Nunes, Dalhousie University Faculty of Medicine, Saint John, NB, Canada; Bayane Sabsabi, McGill University Faculty of Medicine and Health Sciences, Montreal, PQ, Canada; Michelle Ryan, Montreal Children’s Hospital, Montreal, PQ, Canada; Amy Bergeron, McGill University Health Centre, Montreal, PQ, Canada; Daniele De Luca, Paris Saclay, Paris, Ile-de-France, France; Guilherme Sant'Anna, McGill University Health Center, MONTREAL, PQ, Canada

Background: Since the beginning of the pandemic, several studies have reported on neonatal COVID-19 and its transmission and prevention, but few have stated on clinical presentation, investigations and management of symptomatic neonates.

Objective: This scoping review aims to describe those cases and their management.

Design/Methods: Select keywords pertaining to infants, COVID-19 and management were used by a librarian to conduct a search within MEDLINE, EMBASE, Web of Science, Clinical Trials, Cochrane and unpublished literature to identify full-text articles published after 2019 in any language. Articles were selected if they addressed the diagnosis, clinical symptoms, investigations or medical management of symptomatic infants from birth and up to 1 month of corrected age.

Results: A total of 87 studies including 472 patients met the inclusion criteria. Sixty-one articles reported gestational age at birth and included both term (n=47) and preterm infants (n=38), with a mean gestational age of 351/7 ± 3 weeks and 4 days and birth weight of 2621g±822g. Only 17 articles described previous morbidities, the most frequent being congenital heart disease (7) and bronchopulmonary dysplasia (3). Symptoms were first present at a median age of 8 days [IQR 2-17 days] of life, and viral transmission was primarily horizontal (58). Initial symptoms are displayed in Figure 1; the most prevalent was fever (75), followed by respiratory distress (47) and hypoxemia (25). The need for respiratory support was frequent (75), including mechanical ventilation (51). A total of 77 publications described at least one chest x-ray done, of which 21 were reported as "normal" (Figure 2). Most findings were bilateral (48): consolidations/opacities/pneumonia (29), ground glass pattern (19) and non-specific infiltrate (8). Management specific to COVID-19 is shown in Table 1 and includes antiviral drugs (26), biological therapies (21) and hydroxychloroquine (11). Supportive management included antibiotics (64) and corticosteroids (29). Complications were reported in 32 studies, mostly inflammatory (10) and cardiovascular (10). These symptomatic neonates' median length of stay was 15 days [IQR 7-26]. The occurrence of death was low (16 infants = 3.4%).

Conclusion(s): For neonates with symptomatic COVID-19, the literature pertaining to initial clinical presentation, investigations, and management is scarce and highly heterogenous, not allowing for formal recommendations. Higher-quality research is needed to determine how to best manage these patients.