COVID-19: infants show mild neurological signs, CSF negative for SARS-CoV-2

  • Nathan N, & et al.
  • Lancet Infect Dis
  • 28 Apr 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • French clinicians highlight neurological symptoms such as drowsiness and hypotonia in infants (ages
  • Cerebrospinal fluid (CSF) samples from all patients were SARS-CoV-2-negative.
  • UK and Italian researchers have reported case series of Kawasaki-like, severe multisystem inflammatory COVID-19 manifestations in children. 

Why this matters

  • With limited information available on COVID-19 presentation in infants, clinical suspicion is warranted.
  • Infants with isolated fever should be tested for SARS-CoV-2 infection.
  • Close monitoring for 2 weeks can be warranted.

Key points

  • 5 male infants, average age 2 months, admitted with poorly tolerated fever (37.4-38.5°C); all had SARS-CoV-2-positive nasopharyngeal swabs.
  • Oxygen saturation was normal in all cases.
  • 4/5 had rhinitis; 4/5 had coughs; 4/5 had mottled skin.
  • 4/5 showed neurological symptoms at admission: axial hypotonia, drowsiness, moaning.
  • None had received NSAIDs before admission.
  • During hospitalization, infants received only acetaminophen.
  • Fever peak during hospitalization: 38-39°C.
  • Cerebrospinal fluid was clear, RT-PCR negative for SARS-CoV-2.
  • Chest X-rays showed no relevant abnormalities.
  • Clinical course was rapidly favorable.
  • 1 infant had transient diffuse erythema, mild diarrhea.
  • Overall hospital stay was 1-3 days.
  • All were followed by daily phone check-ins for 2 weeks.
  • Parents of these infants had signs for