CLINICAL AND IMAGING FEATURES OF COVID-19 IN NEWBORNS: A RETROSPECTIVE COHORT STUDY IN A REFERRAL COVID HOSPITAL IN ITALY
Authors: Rocco Maria Chiara , Santantonio Alfredo , Borrelli Angela , Barra Giuseppina , Colantuono Rossella , Rea Gaetano , Capozzi Laura , Fioretti Maria , Rosso Roberto , Orbinato Francesco , Vivo Massimiliano De , Ferrante Lorenza , Lieto Roberta , Spena Giovanna Russo , Magri Daniela , Chello Giovanni 
Published: October 2023

Introduction COVID-19 in newborns is a variable disease that remains
relatively understudied. In symptomatic newborns, infection may progress
with subtle or non-specific clinical and laboratory findings. Lung
ultrasound (LUS) can serve as a valuable imaging tool for evaluating
lung damage caused by COVID-19, all without radiation exposure.
Additionally, the long-term effects of COVID-19 in the neonatal
population are still inadequately investigated. Population and Methods A
retrospective cohort study was conducted from January to December 2022
at the Neonatal Intensive Care Unit (NICU) of Monaldi Hospital in
Naples, which serves as a hub for managing newborns with COVID-19 in our
region. The diagnosis of SARS-CoV-2 infection was established through
the analysis of nasal/oral-pharyngeal swabs using RT-PCR molecular
methods. Clinical, laboratory, and instrumental parameters of each
newborn were assessed during hospitalization and a 6-month follow-up
period. LUS was performed in the supine, prone, and lateral positions,
with the results compared to Chest-X-ray (CXR). Results A total of 31
patients with positive RT-PCR results were admitted. Of these, 65% were
male, with a median weight of 3514.1 ± 560.2 grams and a median
corrected age of 39 ± 2 weeks. The median age at admission was 21.1 ±
12.2 days. The median time for naso-pharyngeal swab negativization was
13.3 ± 5.4 days. The most common clinical manifestations in our sample
included fever (64.5%), respiratory distress (16%), and
gastrointestinal symptoms (10%). Antibiotics for suspected superimposed
bacterial infections were administered in 16% of cases, and hemodynamic
support was required in 6%. Additionally, 16% of infants needed
respiratory support, either in the form of high-flow nasal cannula
(HHHFNC) or oxygen therapy. Pathological findings were observed in
approximately 10% of infants on chest X-rays, while lung ultrasound
(LUS) revealed alterations in 22.5% of cases. The predominant LUS
pattern identified was characterized by A-lines (horizontal
reverberation artifacts), with a few B-lines (ring-down artifacts), and
a thin pleural hyperechoic line. Correlation analysis showed that the
time for swab negativization was not influenced by other variables.
Higher ferritin values at admission were associated with a more severe
disease course, particularly in terms of respiratory distress and the
need for ventilatory support (ρ 0.58; p 0.001). The ROC curve indicated
82% sensitivity and 58% specificity for this parameter. During the
6-month follow-up, all infants exhibited regular growth, a healthy
appearance, and normal vital signs. Mild to moderate transient
neutropenia was observed in 25.8% of infants. Only one infant displayed
persistent LUS alterations (a few B-lines) at 1 and 3-month follow-up,
which were no longer visible at the 6-month evaluation. Conclusion The
overall data from our population indicated favorable outcomes in infants
affected by COVID-19. Higher ferritin values at admission were
associated with a more severe disease course. The most common LUS
pattern observed included a reduction in A-lines, an increase in/fusion
of B-lines, and, at times, an abnormal/fragmented hyperechoic pleural
line. LUS appeared to be a sensitive and non-invasive tool for the
comprehensive evaluation of pulmonary pathology caused by COVID-19 in
newborns.