新型冠状病毒Omicron变异株感染新生儿临床特征的多中心横断面调查

Clinical characteristics of neonates infected with the Omicron variant of SARS-CoV-2: a multicenter cross-sectional survey

摘要:

目的 探究新型冠状病毒Omicron变异株感染新生儿的临床特征。 方法 将2022年12月7日—2023年1月12日（新型冠状病毒Omicron变异株流行期间）深圳新生儿数据协作网27家医院542例确诊为新型冠状病毒感染的住院新生儿作为研究对象，采用横断面调查方法调查其临床特征。根据有无症状分为无症状感染组及有症状感染组，比较两组患儿的临床特征、实验室检查结果、胸部X线检查结果及转归。 结果 542例患儿中，男285例，女257例；515例（95.0%）为足月儿，27例（5.0%）为早产儿。无症状感染组60例，有症状感染组482例。轻型336例（69.7%），中型125例（25.9%），重型15例（3.1%），危重型6例（1.2%）。发热是最常见的症状（434例，90.0%），其次为咳嗽和/或吐沫（183例，38.0%）、鼻塞和/或流涕（131例，27.2%）、气促（36例，7.5%）、喂养不耐受（30例，6.2%）等。325例行胸部X线检查，其中肺部斑片状阴影或实变阴影136例（41.8%），气胸2例（0.6%），肺透过度降低2例（0.6%），余185例（57.0%）未见异常。396例（73.1%）予治疗，其中对症治疗341例（86.1%），使用抗生素治疗137例（34.6%），免疫球蛋白治疗4例（1.0%），呼吸支持治疗23例（5.8%）。542例患儿临床症状缓解后出院，住院时间中位数为5 d。有症状感染组白细胞计数、中性粒细胞计数、血红蛋白浓度、降钙素原水平低于无症状感染组（P<0.05），而血小板计数和血糖水平高于无症状感染组（P<0.05）。有症状感染组中性粒细胞减少、血小板计数升高及血红蛋白浓度下降患儿比例均高于无症状感染组（P<0.05）。 结论 新型冠状病毒Omicron变异株感染新生儿多为轻型，以发热为主要表现。有症状感染患儿多伴有血中性粒细胞计数减少、血小板计数升高及血红蛋白下降等表现。患儿以对症治疗为主，预后良好。

Abstract:

Abstract：Objective To investigate the clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods A cross-sectional survey was conducted on 542 hospitalized neonates with confirmed coronavirus disease 2019 (COVID-19) in 27 hospitals in Shenzhen from December 7, 2022, to January 12, 2023 (during the Omicron variant epidemic period). The neonates were divided into two groups: asymptomatic infection and symptomatic infection. The clinical characteristics, results of laboratory examination, chest X-ray findings, and outcome were compared between the two groups. Results Among the 542 neonates, there were 285 males and 257 females. Among them, 515 (95.0%) were full-term infants, and 27 (5.0%) were preterm infants. The asymptomatic infection group had 60 cases, and the symptomatic infection group had 482 cases. Among them, 336 cases (69.7%) were mild, 125 cases (25.9%) were moderate, 15 cases (3.1%) were severe, and 6 cases (1.2%) were critical. Fever was the most common symptom (434 cases, 90.0%), followed by cough and/or spitting (183 cases, 38.0%), nasal congestion and/or runny nose (131 cases, 27.2%), shortness of breath (36 cases, 7.5%), and feeding intolerance (30 cases, 6.2%). Among the 325 cases who underwent chest X-ray examination, 136 cases (41.8%) had patchy or consolidative shadows in the lungs, 2 cases (0.6%) had pneumothorax, 2 cases (0.6%) had decreased lung transparency, and 185 cases (57.0%) showed no abnormality. Among the 396 cases (73.1%) who received treatment, 341 cases (86.1%) received symptomatic treatment, 137 cases (34.6%) received antibiotic treatment, 4 cases (1.0%) received immunoglobulin treatment, and 23 cases (5.8%) received respiratory support treatment. All 542 neonates were discharged from the hospital after their clinical symptoms were relieved, and the median hospital stay was 5 days. The white blood cell count, neutrophil count, hemoglobin, and procalcitonin were lower in the symptomatic infection group than those in the asymptomatic infection group (P<0.05), while the platelet count and blood glucose levels were higher in the symptomatic infection group than those in the asymptomatic infection group (P<0.05). The proportions of neonates with decreased neutrophil count, increased platelet count, and decreased hemoglobin concentration were higher in the symptomatic infection group than those in the asymptomatic group (P<0.05). Conclusions Most neonates with COVID-19 caused by the Omicron variant of SARS-CoV-2 are mild, with fever as the predominant symptom. Symptomatic neonates with COVID-19 are often accompanied by decreased neutrophil count, increased platelet count, and decreased hemoglobin level. Symptomatic treatment is the main treatment, and the prognosis is good.