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
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.
关键词
新型冠状病毒感染 /
临床特征 /
Omicron变异株 /
新生儿
Key words
Coronavirus disease 2019 /
Clinical characteristic /
Omicron variant /
Neonate
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参考文献
1 World Health Organization. WHO coronavirus (COVID-19) dashboard[EB/OL]. (2023-01-21)[2023-02-01]. https://covid19.who.int/more-resources.
2 Lu X, Zhang L, Du H, et al. SARS-CoV-2 infection in children[J]. N Engl J Med, 2020, 382(17): 1663-1665. PMID: 32187458. PMCID: PMC7121177. DOI: 10.1056/NEJMc2005073.
3 国家卫生健康委办公厅, 国家中医药局综合司. 新型冠状病毒感染诊疗方案（试行第十版）[EB/OL]. (2023-01-05)[2023-01-23]. http://www.nhc.gov.cn/ylyjs/pqt/202301/32de5b2ff9bf4eaa88e75bdf7223a65a/files/02ec13aadff048ffae227593a6363ee8.pdf.
4 中国当代儿科杂志编辑委员会围产新生儿新型冠状病毒感染防控管理预案工作组. 围产新生儿新型冠状病毒感染防控管理预案（第三版）[J]. 中国当代儿科杂志, 2023, 25(1): 1-4. PMID: 36655656. PMCID: PMC9893817. DOI: 10.7499/j.issn.1008-8830.2212074.
5 国务院应对新型冠状病毒肺炎疫情联防联控机制综合组. 关于印发新型冠状病毒肺炎防控方案（第九版）的通知: 联防联控机制综发［2022］71 号[EB/OL]. (2022-06-27)[2023-01-23]. http://www.gov.cn/xinwen/2022-06/28/5698168/files/9585944023424f45a4b4d522b5f5c034.pdf.
6 国务院应对新型冠状病毒肺炎联防联控机制综合组. 关于印发新冠病毒抗原检测应用方案（试行）的通知: 联防联控机制综发［2022］21?号[EB/OL]. (2022-03-10)[2023-01-23]. http://www.nhc.gov.cn/yzygj/s7659/202203/d4d7fb72088447f7a4f9cd10966a67eb.shtml.
7 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019: 917, 1068-1076.
8 O'Driscoll M, Ribeiro Dos Santos G, Wang L, et al. Age-specific mortality and immunity patterns of SARS-CoV-2[J]. Nature, 2021, 590(7844): 140-145. PMID: 33137809. DOI: 10.1038/s41586-020-2918-0.
9 Nyberg T, Ferguson NM, Nash SG, et al. Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 Omicron (B.1.1.529) and Delta (B.1.617.2) variants in England: a cohort study[J]. Lancet, 2022, 399(10332): 1303-1312. PMID: 35305296. PMCID: PMC8926413. DOI: 10.1016/S0140-6736(22)00462-7.
10 Sankaran D, Nakra N, Cheema R, et al. Perinatal SARS-CoV-2 infection and neonatal COVID-19: a 2021 update[J]. Neoreviews, 2021, 22(5): e284-e295. PMID: 33931474. DOI: 10.1542/neo.22-5-e1001.
11 Fleming P, Pereira S, Kapellou O, et al. Possible in utero transmission of SARS-CoV-2 and severe respiratory disease in a preterm infant[J]. Pediatrics, 2022, 150(1): e2021054557. PMID: 35425990. DOI: 10.1542/peds.2021-054557.
12 Allotey J, Chatterjee S, Kew T, et al. SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis[J]. BMJ, 2022, 376: e067696. PMID: 35296519. PMCID: PMC8924705. DOI: 10.1136/bmj-2021-067696.
13 Zhang ZJ, Yu XJ, Fu T, et al. Novel coronavirus infection in newborn babies aged <28 days in China[J]. Eur Respir J, 2020, 55(6): 2000697. PMID: 32269087. PMCID: PMC7144267. DOI: 10.1183/13993003.00697-2020.
14 Raschetti R, Vivanti AJ, Vauloup-Fellous C, et al. Synthesis and systematic review of reported neonatal SARS-CoV-2 infections[J]. Nat Commun, 2020, 11(1): 5164. PMID: 33060565. PMCID: PMC7566441. DOI: 10.1038/s41467-020-18982-9.
15 Pavel AB, Wu J, Renert-Yuval Y, et al. SARS-CoV-2 receptor ACE2 protein expression in serum is significantly associated with age[J]. Allergy, 2021, 76(3): 875-878. PMID: 32726474. PMCID: PMC8278339. DOI: 10.1111/all.14522.
16 王彦梅, 朱艳萍, 江立英, 等. 新生儿新型冠状病毒Omicron变异株感染23例临床分析[J]. 中国当代儿科杂志, 2023, 25(5): 516-520. PMID: 37272179. PMCID: PMC10247196. DOI:10.7499/j.issn.1008-8830.2212103.
17 张可, 蒋思远, 严恺, 等. 新型冠状病毒Omicron变异株流行期间新生儿感染16例临床特征分析[J]. 中华儿科杂志, 2022, 60(11): 1158-1162. PMID: 36319150. DOI: 10.3760/cma.j.cn112140-20220617-00561.
18 García H, Allende-López A, Morales-Ruíz P, et al. COVID-19 in neonates with positive RT-PCR test. Systematic review[J]. Arch Med Res, 2022, 53(3): 252-262. PMID: 35321802. PMCID: PMC8919773. DOI: 10.1016/j.arcmed.2022.03.001.
19 张苡菲, 梁世山, 吴沛霖, 等. 201例儿童新型冠状病毒Omicron变异株感染的临床特征分析[J]. 中国当代儿科杂志, 2023, 25(1): 5-10. PMID: 36655657. PMCID: PMC9893821. DOI: 10.7499/j.issn.1008-8830.2207052.
20 Henry BM, Benoit SW, de Oliveira MHS, et al. Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): a pooled analysis and review[J]. Clin Biochem, 2020, 81: 1-8. PMID: 32473151. PMCID: PMC7251358. DOI: 10.1016/j.clinbiochem.2020.05.012.
21 Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19[J]. Am J Hematol, 2020, 95(7): 834-847. PMID: 32282949. PMCID: PMC7262337. DOI: 10.1002/ajh.25829.
22 Kosmeri C, Koumpis E, Tsabouri S, et al. Hematological manifestations of SARS-CoV-2 in children[J]. Pediatr Blood Cancer, 2020, 67(12): e28745. PMID: 33009893. PMCID: PMC7646039. DOI: 10.1002/pbc.28745.
23 Folino F, Menis C, Di Pietro GM, et al. Incidental occurrence of neutropenia in children hospitalised for COVID-19[J]. Ital J Pediatr, 2022, 48(1): 43. PMID: 35292084. PMCID: PMC8922397. DOI: 10.1186/s13052-022-01234-5.
24 Amgalan A, Othman M. Hemostatic laboratory derangements in COVID-19 with a focus on platelet count[J]. Platelets, 2020, 31(6): 740-745. PMID: 32456506. DOI:10.1080/09537104.2020.1768523.
25 Rubino F, Amiel SA, Zimmet P, et al. New-onset diabetes in covid-19[J]. N Engl J Med, 2020, 383(8): 789-790. PMID: 32530585. PMCID: PMC7304415. DOI: 10.1056/NEJMc2018688.
26 Montefusco L, Ben Nasr M, D'Addio F, et al. Acute and long-term disruption of glycometabolic control after SARS-CoV-2 infection[J]. Nat Metab, 2021, 3(6): 774-785. PMID: 34035524. PMCID: PMC9931026. DOI: 10.1038/s42255-021-00407-6.
27 Boly TJ, Reyes-Hernandez ME, Daniels EC, et al. Hyperglycemia and cytopenias as signs of SARS-CoV-2 Delta variant infection in preterm infants[J]. Pediatrics, 2022, 149(6): e2021055331. PMID: 35237826. PMCID: PMC10158391. DOI: 10.1542/peds.2021-055331.
28 Liu WZ, Li HL. COVID-19: attacks the 1-beta chain of hemoglobin and captures the porphyrin to inhibit human heme metabolism[J]. ChemRxiv[Preprint]. (2020-07-13) [2023-02-02]. DOI: 10.26434/chemrxiv.11938173.v9.
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