Clinical Outcomes and Characteristics of COVID-19 in Neonates: A Single-Center Study in Romania

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Abstract
Background: SARS-CoV-2 infection is generally associated with less severe forms of disease in children, where most cases only require symptomatic treatment. However, there is a paucity of information regarding the impact and clinical course of COVID-19 in neonate patients. This study aimed to analyze the epidemiological and clinical aspects of COVID-19 in this particular age group who were patients treated in our department. Materials and methods: This is a retrospective observational study that includes neonates (aged less than 1 month) who were diagnosed with COVID-19. The patients were admitted between 1 January 2022 and 31 December 2023, to the Infectious Diseases Pediatric Department of the Hospital Clinic of Pneumophthisiology and Infectious Diseases in Brașov, Romania. All the patients were tested for SARS-CoV-2 infection at admission, using either a real-time PCR (RT-PCR) or rapid antigen testing, according to the national COVID-19 protocol in use at the time. We collected the following data: demographic data, clinical picture and laboratory values at presentation, clinical course, complications, and other significant data. All the data were extracted from existing hospital administrative databases or electronic medical records. Results: Nine neonates were hospitalized with COVID-19, of which five were boys, and four were girls; the mean age was 18.89 days (ranging between 6 and 28 days). The clinical picture at admission mainly consisted of fever (eight cases) and nasal obstruction and cough (five cases each). Only one patient required oxygen support. Co-infections with Streptococcus pneumoniae and Haemophilus influenzae (one case), respiratory syncytial virus (RSV, one case), and rotavirus (one case) were identified. Complications were represented by acute bronchiolitis in three patients. Biologically, lymphopenia was found in three cases, monocytosis in five cases, and increased ferritin values in five cases. The clinical outcome was favorable in all the cases. The patients were discharged in improved condition after an average stay of 5.11 days (ranging between 3 and 10 days). Conclusions: Our data support the observation that infection with SARS-CoV-2 in neonates is a relatively benign condition with a good prognosis. Our study has several limitations and establishes a foundation for future studies on a larger sample of term and premature neonates with different comorbidities.

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