29 Management of infants under 90 days of age presenting with fever and with evidence of SARS-CoV-2 infection

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; pp. A100 - A101
• Main Authors: Tan, Lin, Rendall, Lisa, Longbottom, Katherine, Wallace, Kirsten
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Age; Antibiotics; Bacteria; Bacterial infections; Bronchopneumonia; Cerebrospinal fluid; Cough; COVID-19; Evidence; Fever; Infants; Infections; Patients; Pediatrics; Population studies; Rhinitis; Rhinovirus; Severe acute respiratory syndrome coronavirus 2; Test Results; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.169

ObjectivesFever in infants under 90 days of age can be a common yet challenging presentation. Lack of localising signs and the risk of serious bacterial infection (SBI), mean that most infants are screened for SBI and treated empirically with antibiotics. In infants, fever is one of most common presenting symptom of COVID-19.1We aimed to review the presentation, management and outcomes of infants under 90 days of age presenting with fever, with evidence of SARS-CoV-2 infection. To determine the incidence of co-infection and serious bacterial infection in this cohort. To audit clinical practice against the NICE guideline ‘Fever in under 5s: assessment and initial management’ (NG143).MethodThis was a retrospective study. Our population included infants under 90 days of age presenting to the Royal Hospital for Children (RHC), Glasgow, with fever or a within 24 hours of presentation and evidence of SARS-CoV-2 infection, between January and December 2021. Patients with a positive SARS-CoV-2 PCR test result at the RHC were identified. This included laboratory or point of care PCR testing. Patient electronic records were reviewed to determine the presenting complaint and clinical information. Patients were not included if they presented for reasons other than fever.Results60 infants with evidence of SARS-CoV-2 infection presented with fever. The most common presenting symptom was poor feeding, followed by cough, then coryza. 27 (45%) had Paediatric Early Warning Scores (PEWS) over 3 at presentation. 36 (60%) had findings on clinical examination, the most common findings were mottling and increased work of breathing.Of 60 infants, 29 (48%) were observed for less than 24 hours and were discharged without further investigation. 19 (32%) had a full septic screen. No positive bacterial cultures (blood, urine, cerebrospinal fluid) were identified. 24 (40%) patients were treated with antibiotics. 6 (10%) required treatment for bronchiolitis with oxygen and/or feeding support. 3 (5%) infants had viral co-infection.No patients were admitted to PICU. Median length of stay was 1 day. 4 infants re-presented within 1 week, 2 were admitted for bronchiolitis management, of these 1 was rhinovirus PCR positive.Audit findings showed that NICE guidance was followed in around 50% of infants, including those under 28 days of age.ConclusionWe describe 60 infants with COVID-19. None had co-existing SBI. All had good outcomes. Larger studies are needed to determine the incidence of SBI in this cohort, on which recommendations for practice may be based.ReferenceSwann Olivia V, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ 370 (2020).