Treatment Approach for COVID-19 in Infants

Clinical Management

For asymptomatic neonates and young infants with suspected COVID-19 infection, monitoring and supportive care in a quarantined setting are essential, including vital observations such as heart rate, respiration rate, and SpO2, and continuation of neonatal feeding if the mother is COVID-19 positive, as recommended by the International Journal of Surgery 1
Medical management and supportive interventions are necessary for symptomatic neonates, with supportive care being the cornerstone of management 1
Antibiotics are not routinely recommended unless there is evidence of bacterial co-infection or superinfection, and consideration should be given to possible healthcare-associated pneumonia or other nosocomial infections when evaluating for co-infections 1
Corticosteroids are not routinely recommended for viral pneumonia in infants with COVID-19, as their use in studies on influenza has been found to exacerbate infection and increase mortality rates 1

For MIS-C treatment, consider intravenous immunoglobulin (IVIG) and/or glucocorticoids as first-tier agents, low-dose aspirin for patients with MIS-C and Kawasaki disease-like features and/or thrombocytosis, and anticoagulation therapy for documented thrombosis or ejection fraction <35%, as recommended by the American College of Rheumatology 2
Close monitoring of cardiac function is essential, especially in cases with MIS-C or myocardial involvement, with repeat echocardiograms obtained at 7–14 days and 4–6 weeks after initial presentation in cases with cardiac involvement, and EKG performed at a minimum of every 48 hours in hospitalized patients with cardiac involvement 3