Clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2

doi:10.3877/cma.j.issn.1673-5250.2023.05.014

Objective

To explore the clinical characteristics of coronavirus disease 2019(COVID-19) neonates were infected by Omicron variant during the pandemic of Omicron variant.

Methods

A total of 63 COVID-19 neonates who infected by Omicron variant in the neonatal isolation ward of West China Second Hospital, Sichuan University from December 20, 2022 to January 16, 2023 were enrolled in this study. Their epidemiological history, clinical manifestations, laboratory examinations, imaging manifestations, treatment and outcome were retrospectively analyzed. The procedures followed in this study comply with the regulations of the Ethics Committee of West China Second University Hospital, Sichuan University, and have been approved by the Ethics Committee of the hospital (Approval No. 2022-069).

Results

Among the 63 neonates, there were 30 boys and 33 girls. 84.1%(53/63) of the cases had close contact history with confirmed or suspected cases of SARS-CoV-2 Omicron variant. In clinical classification, 76.2% (48/63) were mild to moderate, 4.8% (3/63) were severe, and 19.0% (12/63) were asymptomatic. The main manifestations of these neonates were fever (65.1%, 41/63), respiratory symptoms (63.5%, 40/63), and digestive symptoms (46.0%, 29/63). The laboratory examination results showed that the normal proportions of peripheral blood white blood cell count, C-reactive protein, and procalcitonin (PCT) were 79.4% (50/63), 88.9% (56/63), and 91.1%(41/45), respectively. Chest X-ray plain films of 36 cases (75.0%, 36/48) and chest CT scans of 8 cases showed signs of pneumonia. And 63 cases were treated with symptomatic supportive therapy, and 5 cases were treated with respiratory support. All cases were cured and discharged.

Conclusions

Neonatal cases of SARS-CoV-2 Omicron variant infection is mainly mild to moderate, and the most common clinical manifestation is fever. Laboratory examination are non-specific. The prognosis of these cases is good. Horizontal transmission is the main of transmission route, and we should pay attention to the isolation of newborns during the pandemic.

Key words: COVID-19, SARS-CoV-2 infection, Omicron variant, Clinical characteristic, Computed tomography, X-ray plain film, Magnetic resonance imaging, Infant, newborn

表1 63例确诊为Omicron变异株感染所致COVID-19新生儿的一般临床资料

项目	结果
性别[例数(%)]
男	30(47.6)
女	33(52.4)
胎龄[例数(%)]
<37周	3(4.8)
≥37周	60(95.2)
出生体重[kg，M(Q₁，Q₃) ]	3.3(3.0，3.4)
剖宫产术分娩[例数(%)]	31(49.2)
母乳喂养[例数(%)]	52(82.5)
发病时年龄[d，M(Q₁，Q₃) ]	12(5，17)
诊断时年龄[d，M(Q₁，Q₃) ]	13(7，19)
暴露或接触史[例数(%)]
确诊或疑似病例	53(84.1)
感染来源不明	10(15.9)

表1 63例确诊为Omicron变异株感染所致COVID-19新生儿的一般临床资料

项目	结果
性别[例数(%)]
男	30(47.6)
女	33(52.4)
胎龄[例数(%)]
<37周	3(4.8)
≥37周	60(95.2)
出生体重[kg，M(Q₁，Q₃) ]	3.3(3.0，3.4)
剖宫产术分娩[例数(%)]	31(49.2)
母乳喂养[例数(%)]	52(82.5)
发病时年龄[d，M(Q₁，Q₃) ]	12(5，17)
诊断时年龄[d，M(Q₁，Q₃) ]	13(7，19)
暴露或接触史[例数(%)]
确诊或疑似病例	53(84.1)
感染来源不明	10(15.9)

表2 本组63例Omicron变异株感染所致COVID-19新生儿临床表现比较[% (n/n′)]

项目	结果
临床分型
无症状	19.0(12/63)
轻/中型	76.2(48/63)
重型	4.8(3/63)
临床症状
发热(℃)	65.1(41/63)
37.5～38.0	34.1(14/41)
38.1～38.5	48.8(20/41)
38.6～38.9	14.6(6/41)
≥39.0	2.4(1/41)
黄疸	34.9(22/63)
摄入奶量下降	28.6(18/63)
咳嗽	27.0(17/63)
吐奶	17.5(11/63)
鼻塞	15.9(10/63)
气促	14.3(9/63)
神萎	12.7(8/63)
嗜睡	11.1(7/63)
抽搐	3.2(2/63)

表2 本组63例Omicron变异株感染所致COVID-19新生儿临床表现比较[% (n/n′)]

项目	结果
临床分型
无症状	19.0(12/63)
轻/中型	76.2(48/63)
重型	4.8(3/63)
临床症状
发热(℃)	65.1(41/63)
37.5～38.0	34.1(14/41)
38.1～38.5	48.8(20/41)
38.6～38.9	14.6(6/41)
≥39.0	2.4(1/41)
黄疸	34.9(22/63)
摄入奶量下降	28.6(18/63)
咳嗽	27.0(17/63)
吐奶	17.5(11/63)
鼻塞	15.9(10/63)
气促	14.3(9/63)
神萎	12.7(8/63)
嗜睡	11.1(7/63)
抽搐	3.2(2/63)

图2 1例Omicron变异株感染所致COVID-19患儿(男性，6 d龄)头颅轴位MRI(DWI相)影像图(双侧侧脑室旁脑白质内条片、结片状异常信号，累及双侧背侧丘脑及胼胝体)

表3 本组63例Omicron变异株感染所致COVID-19新生儿入院后7 d内的实验室检查结果比较[例数(%)]

检查项目	正常	降低	升高
白细胞计数	50(79.4)	12(19.0)	1(1.6)
淋巴细胞计数	38(60.3)	23(36.5)	2(3.2)
血小板计数	34(54.0)	3(4.8)	26(41.3)
单核细胞比例	3(4.8)	0(0)	60(95.2)
CRP	56(88.9)	0(0)	7(11.1)
PCT^a	41(91.1)	0(0)	4(8.9)

表3 本组63例Omicron变异株感染所致COVID-19新生儿入院后7 d内的实验室检查结果比较[例数(%)]

检查项目	正常	降低	升高
白细胞计数	50(79.4)	12(19.0)	1(1.6)
淋巴细胞计数	38(60.3)	23(36.5)	2(3.2)
血小板计数	34(54.0)	3(4.8)	26(41.3)
单核细胞比例	3(4.8)	0(0)	60(95.2)
CRP	56(88.9)	0(0)	7(11.1)
PCT^a	41(91.1)	0(0)	4(8.9)

图4 本组1例Omicron变异株感染所致COVID-19患儿(男性，16 d龄)感染后第7天的胸部CT检查影像图(提示双侧肺弥漫间质改变)

表4 本组63例Omicron变异株感染所致COVID-19新生儿的治疗与转归结果比较

治疗方式	例数(%)或M(Q₁，Q₃)
抗菌药物	50(79.3)
抗病毒药物	1(1.6)
呼吸支持	5(7.9)
对症支持	63(100.0)
结局和转归
治愈	63(100.0)
死亡	0(0)
住院时间(d)	7(6，8)

表4 本组63例Omicron变异株感染所致COVID-19新生儿的治疗与转归结果比较

治疗方式	例数(%)或M(Q₁，Q₃)
抗菌药物	50(79.3)
抗病毒药物	1(1.6)
呼吸支持	5(7.9)
对症支持	63(100.0)
结局和转归
治愈	63(100.0)
死亡	0(0)
住院时间(d)	7(6，8)

[1]	于乐成，宋勇. 新型冠状病毒奥密克戎变异株的病原学、临床特点、感染控制及治疗[J].解放军医学杂志，2022，47(11)：1063-1072. DOI: 10.11855/j.issn.0577-7402.2022.11.1063.
[2]	蒋荣猛，谢正德，姜毅，等. 儿童新型冠状病毒感染诊断、治疗和预防专家共识(第五版)——应对奥密克戎变异株[J]. 中华实用儿科临床杂志，2023, 38(1): 20-30. DOI: 10.3760/cma.j.cn101070-20230114-00036.
[3]	中国当代儿科杂志编辑委员会围产新生儿新型冠状病毒感染防控管理预案工作组. 围产新生儿新型冠状病毒感染防控管理预案(第三版)[J].中国当代儿科杂志，2023，25(1)：1-4. DOI: 10.7499/j.issn.1008-8830.2212074.
[4]	叶友强，孙艳，刘辉，等．四川省首例COVID-19婴儿病例分析及文献复习[J/OL].中华妇幼临床医学杂志(电子版), 2020, 16(2)：131-138. DOI: 10.3877/cma.j.issn.1673-5250.2020.02.002.
[5]	Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2[J]. Nat Microbiol, 2020, 5(4): 536-544. DOI: 10.1038/s41564-020-0695-z.
[6]	National Institute of Allergy and Infectious Diseases, U．S. National institutes of health[DB/OL]. International Committee on Taxonomy of Viruses [2023-01-01]. URL
[7]	何洋，唐军，张萌，等. 儿童COVID-19的临床特征：一项关于SARS、MERS及COVID-19的系统评价[J].中国当代儿科杂志，2020，22(8)：844-853. DOI: 10.7499/j.issn.1008-8830.2005172.
[8]	张苡菲，梁世山，吴沛霖，等. 201例儿童新型冠状病毒Omicron变异株感染的临床特征分析[J].中国当代儿科杂志，2023, 25(1): 5-10. DOI: 10.7499/j.issn.1008-8830.2207052.
[9]	Cui X, Zhao Z, Zhang T, et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19) [J]. J Med Virol, 2021, 93(2): 1057-1069. DOI: 10.1002/jmv.26398.
[10]	钟海琴，蒋鲲，蒲田，等. 儿童普通型新型冠状病毒Omicron株感染者的初诊临床特征及胸部CT影像学表现 [J]. 临床肺科杂志，2023, 28(3): 390-393, 398. DOI: 10.3969/j.issn.1009-6663.2023.03.013.
[11]	蒋青莲，王凤颜，郑铠军. 新型冠状病毒Omicron变异株流行期间不同年龄儿童感染的临床特征分析[J].中国当代儿科杂志，2023, 25(6): 600-605. DOI: 10.7499/j.issn.1008-8830.2302014.
[12]	García H, Allende-López A, Morales-Ruíz P, et al. COVID-19 in neonates with positive RT-PCR test. systematic review [J]. Arch Med Res, 2022, 53(3): 252-262. DOI: 10.1016/j.arcmed.2022.03.001.
[13]	深圳新生儿数据协作网. 新型冠状病毒Omicron变异株感染新生儿临床特征的多中心横断面调查[J].中国当代儿科杂志，2023，25(7)：678-684. DOI: 10.7499/j.issn.1008-8830.2302049.
[14]	王彦梅，朱艳萍，江立英，等. 新生儿新型冠状病毒Omicron变异株感染23例临床分析[J].中国当代儿科杂志，2023, 25(5): 516-520. DOI: 10.7499/j.issn.1008-8830.2212103.
[15]	陈求凝，张雪梅，谢邦贵，等. 三亚地区11例新生儿新型冠状病毒Omicron变异株BA.5.1.3感染临床与流行病学特征[J]. 中华医院感染学杂志，2022，32(24)：3767-3771. DOI：10.11816/cn.ni.2022-221432.
[16]	张可，蒋思远，严恺，等. 新型冠状病毒Omicron变异株流行期间新生儿感染16例临床特征分析[J].中华儿科杂志，2022, 60(11): 1158-1162. DOI: 10.3760/cma.j.cn112140-20220617-00561.
[17]	须丽清，曹清，刘彪，等. 新生儿社区获得性新型冠状病毒奥密克戎变异株感染7例临床分析[J].中华新生儿科杂志，2022, 37(5): 413-417. DOI: 10.3760/cma.j.issn.2096-2932.2022.05.006.
[18]	Tetsuhara K, Akamine S, Matsubara Y, et al. Severe encephalopathy associated with SARS-CoV-2 Omicron BA.1 variant infection in a neonate [J]. Brain Dev, 2022, 44(10): 743-747. DOI: 10.1016/j.braindev.2022.06.010.
[19]	Fragoso DC, Marx C, Dutra BG, et al. COVID-19 as a cause of acute neonatal encephalitis and cerebral cytotoxic edema [J]. Pediatr Infect Dis J, 2021, 40(7): e270-e271. DOI: 10.1097/INF.0000000000003145.
[20]	李文星，唐军，曾燕，等. SARS感染孕产妇、新生儿及儿童、青少年的系统评价[J].中国循证医学杂志，2020，20(4)：426-436. DOI: 10.7507/1672-2531.202002027.
[21]	何洋，唐军，张萌，等. 孕产妇及儿童MERS患者临床特征的系统评价[J].中国循证医学杂志，2020, 20(5): 576-584. DOI: 10.7507/1672-2531.202002090.
[22]	Wang J, Dong W. COVID-19: the possibility, ways, mechanisms, and interruptions of mother-to-child transmission [J]. Arch Gynecol Obstet, 2023, 307(6): 1687-1696. DOI: 10.1007/s00404-022-06639-5.

[1]	Lianlian Zhang, Pinjing Hui, Yafang Ding. Clinical value of carotid Doppler ultrasonography in assessing vulnerability of atherosclerotic plaques[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 816-821.
[2]	Yanna Ye, Ruiting Ye, Yanling Chen, Wen Peng, Le Liu, Wenqiu Xiao, Hui Huang, Mingshen Li, Muyi Zhong, Xian Ye. Nomogram based on clinicopathological and imaging features to predict recurrence of benign and borderline breast phyllodes tumor[J]. Chinese Journal of Breast Disease(Electronic Edition), 2023, 17(04): 229-237.
[3]	Qiangyun Liao, Zhen Wang, Jieyu Lin, Xia Liao, Jinhua Deng, Jiefeng Li, Jianwei Deng, Ming Li, Xinzhou Rong. Clinical observation on vibrio vulnificus infection in Humen area[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2023, 18(05): 394-398.
[4]	Ruochen Qi, Shuaijun Ma, Shichao Han, Guohui Wang, Kepu Liu, Xiaoyan Zhang, Xiaojian Yang, Weijun Qin. Diagnosis and treatment of COVID-19 in kidney transplant recipients: experience from a single center[J]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(04): 232-239.
[5]	Yu Han, Wu Zhang, Anqi Li, Wenying Chen, Sidong Xie. Diagnostic value of MRI Liver Image Reporting and Data System (LI-RADS) for hepatocellular carcinoma in patients with non-cirrhotic hepatitis B[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 669-673.
[6]	Manshi Lei, Sisi Deng, Xinrong Wang, Jinbin Huang, Qing Xiang, Anni Xiong, Zhan'ao Meng. Application of artificial intelligence-assisted compression sensing technology in upper abdominal fat-suppressed T2WI sequence[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(05): 551-556.
[7]	Jinpu Li, Xiangrong Rao. Antiviral drugs and acute kidney injury[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(05): 287-290.
[8]	Guangjun Zhong, Chunhua Liu, Wansen Zhu, Xiaolei Xu, Zhaojun Wang. Application of conventional MRI combined with different scanning sequences in preoperative staging diagnosis, chemotherapy efficacy and prognosis evaluation of gastric cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 378-382.
[9]	Baoru Hu, Naijian Shang, Di Gao. DCE-MRI and DWI findings of advanced hepatocellular carcinoma and their correlation with prognosis after immunotherapy[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 399-403.
[10]	Yuxian Wu, Yayuan Feng, Lei Huo, Ningyang Jia, Juan Zhang. Study on the diagnostic value of imaging in primary hepatic lymphoma[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(05): 349-353.
[11]	Haitao Feng, Tao Xu, Wenyang Liu, Chen Sun, Shangchao Cao. Value of three-dimensional arterial spin labeling combined with DCE-MRI in the diagnosis of postoperative recurrence and radiation brain necrosis of glioma[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(04): 262-265.
[12]	Zhiwen Wang, Xuemei Zheng, Qingkun Zhang, Haijiang Wang. Clinical analysis of 75 cases of spontaneous intracranial hypotension[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 398-401.
[13]	Yang Yu, Xiaojie Liu, LiJuan Wang, Yuchen Gao, Yao Ding, Hushan Ao. Training model for cardiopulmonary resuscitation under the background of regular control of COVID-19[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 483-486.
[14]	Hua Wang, Hanhua Zhang, Huanyu Liu, Pei Shao, Xiaoxia Ren, Chongzhi Hou, Dan Nan, Nan Yan, Ying Fang. Clinical characteristics of 153 cases of children mistakenly swallowing magnetic digestive tract foreign body[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(04): 248-252.
[15]	Tun Zhao, Jihua Xu, Youdi He, Ming Lu. Acute spontaneous trace amount cerebral hemorrhage misdiagnosed as cerebral infarction and nearly thrombolysis: a case report[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(04): 369-372.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export