High CRP, PT levels signal more severe COVID-19 in symptomatic neonates

Neonates with symptomatic novel coronavirus disease (COVID-19) more frequently require respiratory support, with high C-reactive protein (CRP) levels or greater prothrombin time (PT) indicating a more severe disease, according to a recent study.

“Oxygen and noninvasive ventilation requirement are frequent, although mechanical ventilation is rarely needed in symptomatic patients,” the researchers said. “Neutropaenia is common, [but] it is not associated with prognosis.”

Twenty-four neonatal intensive care units around Turkey, in which outpatient neonates with COVID-19 were registered in an online national database, were included in this prospective multicentred cohort study. Full-term and premature neonates diagnosed with COVID-19 were eligible for analysis, whether hospitalized or followed up as ambulatory patients.

On the other hand, those with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were not included.

Among 37 symptomatic neonates who met the eligibility criteria, the most common findings were fever (49 percent), hypoxaemia (41 percent), and cough (27 percent). Oxygen administration (41 percent) and noninvasive ventilation (16 percent) were frequently needed, but the use of mechanical ventilation (3 percent) was rare. [Pediatr Infect Dis J 2020;39:e297-e302]

Median hospital stay was 11 days (1–35 days). One death was recorded, and this patient had Down syndrome and congenital cardiovascular disorders. CRP and PT levels were higher in neonates who required supplemental oxygen (CRP: 0.9 vs 5.8; p=0.002; PT: 11.9 vs 15.2; p=0.01) or who were severe/critical (CRP: 1.0 vs 4.5; p=0.01; PT: 11.7 vs 15.0; p=0.001).

“Clinical characteristics of community-acquired neonatal COVID-19 differ from other age groups,” the researchers said. “To the best of our knowledge, all neonatal series published up to now was on the risk of vertical transmission, and no outpatient series was reported specifically for neonates.”

In previous studies, children diagnosed with COVID-19 presented a milder clinical course with nonspecific viral symptoms. In addition, they rarely required hospitalization and respiratory support, except young children or infants who were vulnerable to COVID-19 infection. [Pediatrics 2020;145:e20200702; Pediatr Infect Dis J 2020;39:e100-e103]

However, all neonates in the present study were symptomatic, with fever and cough being the most common presenting symptom. Diarrhoea, nasal congestion, and rhinorrhoea rarely occurred and generally presented with respiratory distress symptoms. [nt J Med Sci 2020;17:1142-1146; World J Pediatr 2020;16:251-259; N Engl J Med 2020;383:187-190; Pediatrics 2020;doi:10.1542/peds.2020-0702]

“CRP and PT are ubiquitous tests, and we found that they may be applicable to differentiate disease severity. Patients who had CRP values below 5 mg/L and PT values lower than 14 seconds were less likely to be severe/critical or need oxygen,” the researchers noted.

“Although the sensitivity of CRP and PT was not good enough to predict the progression, they were helpful to rule out severe/critical disease due to their high specificity,” they added.