Outcome of SARS-CoV-2 infected infants without symptoms and signs of lower respiratory tract infection compared between normal and abnormal chest X-ray groups

Abstract

Background: Currently SARS-CoV-2 infection causes less severe infection, however infants under 1 year old, who are considered as a high-risk group for severe manifestations, are more likely to be hospitalized and receive chest X-ray in most cases.

Objective: To study treatments and outcomes of hospitalized COVID-19 infants with absent symptoms and signs of lower respiratory tract infection (LRTI), comparing between a normal chest X-ray group and an abnormal chest X-ray group, in order to determine the necessity to perform chest X-ray in this population.

Methods: A cross-sectional study was conducted on COVID-19 infants who were hospitalized during March 1, 2022 to June 30, 2023 in QSNICH. Patients with LRTI, underlying conditions with pre-existing abnormal chest X-ray and no x-ray reports via radiologists were excluded. Clinical data, treatment and outcomes were analyzed.

Result: Among 208 patients, there were 96 (46.2%) infants with normal chest x-ray and 112 (53.8%) infants with abnormal chest x-ray. All of them received oral favipiravir as an antiviral agent. None of normal chest x-ray group developed LRTI, meanwhile 4 of 112 patients in abnormal chest x-ray group proceeded to LRTI (0 vs 3.6%, p value 0.47), substituted favipiravir to intravenous remdesivir (0 vs 3.6%, p value 0.27), and 3 of them obtained antibiotics (0 vs 2.6%, p value 0.43). Defervescence times after receiving antiviral agents, duration of upper respiratory tract symptoms and length of hospital stay were not statistically different between two groups {33.2(24,72) vs 36.2(24,72) hrs. (p value 0.076), 2.44 (0.93) vs 2.56 (0.54) days (p value 0.34) and 2.81 (1.03) vs 2.80 (0.95) days (p value 0.23) respectively. All of them made a full recovery.

Conclusion: There was no statistically significant difference in treatments and outcomes in COVID-19 infants, presenting with no clinical manifestations of LRTI, compared between normal and abnormal chest X-rays group. Performing chest X-ray may not be necessary in COVID-19 infants who do not have symptoms and signs of LRTI.