Omicron in Infants-Respiratory or Digestive Disease?

Abstract

The Omicron variant of SARS-CoV-2 has caused a large number of cases and hospitalizations in the pediatric population. Infants due to their age are susceptible to viral infections that may have a worse prognosis. Therefore, the aim of the current study has been to characterize the clinical features and the outcome of infants hospitalized with confirmed SARS-CoV-2 infection during the Omicron wave. We conducted a retrospective study of all consecutive infants hospitalized with symptomatic COVID-19 and no other co-infections, from January to September 2022 in one of the largest infectious diseases hospitals from Bucharest, Romania. A total of 613 infants were included in the analysis. The median age was 5 months (IQR: 3, 8 months). The clinical features were dominated by fever (96.4%), cough (64.8%) and loss of appetite (63.3%), and overall, respiratory symptoms were the most numerous (76.0%). Infants between 1-3 months old had a 1.5-fold increased risk of elevated alanine aminotransferase (ALT) values, and a longer length of hospitalization as compared to older infants. Infants between 7-9 months of age had 1.5-fold higher odds of loss of appetite, 1.7-fold more frequent cough and 1.6-fold more frequent digestive symptoms compared to infants in other age groups. The presence of digestive symptoms increased the probability of hepatic cytolysis (increased ALT) by 1.9-fold. Continued monitoring of COVID-19 among infants is very necessary, given the progressive character of SARS-CoV-2, in order to take correct and rapid therapeutic measures and to adapt to clinical changes driven by viral variant change.

Keywords: COVID-19; Omicron; SARS-CoV-2; children; digestive; infants; respiratory.

Figure 1

Distribution of symptom type in infants in the study.

Figure 2

Number of days of onset of symptoms according to age group. Infants between 1–3 months presented to the hospital earliest after the onset of symptoms. In contrast, infants between 9–12 months presented the latest. Box and whiskers plot represent the 25th and 75th percentiles (box), the median (×) and the range (whiskers).

Figure 3

Number of days of hospitalization according to age group. The length of hospitalization was longer in infants between 1 and 3 months. Box and whiskers plot represent the 25th and 75th percentiles (box), the median (×) and the range (whiskers).

Figure 4

Number of days since onset of symptoms according to type of symptoms. The presence of general symptoms only (no digestive or respiratory symptoms) led to an earlier hospital presentation among infants. Box and whiskers plot represent the 25th and 75th percentiles (box), the median (×) and the range (whiskers).

Figure 5

Number of days of hospitalization according to type of symptoms. The length of hospitalization was not influenced by the type of symptoms and was similar in all groups. Box and whiskers plot represent the 25th and 75th percentiles (box), the median (×) and the range (whiskers).