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)

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