四川省首例COVID-19婴儿病例分析及文献复习

The first case of COVID-19 infant in Sichuan Province:case report and literature review

目的探讨1例输入性、家庭聚集性严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的2+个月龄新型冠状病毒疾病(COVID-19)婴儿的临床流行病学资料及影像学资料特点,并进行文献复习。方法选择2020年2月7日,四川省金堂县第一人民医院收治的2+个月龄COVID-19婴儿为研究对象。采用回顾性分析方法,收集该例婴儿的临床病例资料,对其临床流行病学特点、影像学资料、诊断、治疗方案及预后进行分析。本研究对报道COVID-19婴儿的相关文献进行复习,设定检索策略为:以“婴儿”“新型冠状病毒肺炎”“新型冠状病毒疾病”“2019-nCoV”“NCP”“SARS-CoV-2”“COVID-19”“infant”等为关键词,在PubMed、Medline、中国知网、维普中文科技期刊数据库、万方数据知识服务平台,以及“医学界儿科频道”等公众平台及新闻网站中,检索相关文献,检索时间设定为2019年12月1日至2020年2月21日。总结符合本研究纳入、排除标准的文献中报道的COVID-19婴儿临床特点及其诊断、治疗方案与预后。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①病史采集、诊断、治疗结果:患儿,男性,生后2个月+29 d;2020年1月18日,患儿姨妈自武汉返蓉,密切接触后,患儿出现气促、轻微咳嗽、腹泻等症状。入院后,患儿检查结果显示,肺炎支原体及衣原体、甲型及乙型流感病毒抗原均呈阴性。胸部CT检查结果显示,患儿双肺胸膜下多发性浅淡磨玻璃病灶。2次鼻咽拭子SARS-CoV-2核酸检测均呈阳性。根据流行病学史、临床与影像学表现及核酸检测结果,确诊为普通型COVID-19患儿。经过对症治疗后,患儿气促、咳嗽临床症状消失,胸部影像学检查结果显示,肺部炎症病灶吸收,SARS-CoV-2核酸检测呈阴性。目前,患儿继续观察中,等候出院。②文献复习结果:按照本研究设定的文献检索策略,共计检索出5篇国内有关婴儿COVID-19文献及2篇婴儿COVID-19新闻报道,涉及18例COVID-19婴儿的临床特点、诊断、治疗方案及预后等研究。这18例COVID-19婴儿,均具有家庭聚集性、输入性感染特点(武汉COVID-19患者接触史)。其中,3例新生儿及其母亲均为SARS-CoV-2感染者。出生后,对2例新生儿进行有效隔离,无感染者接触史。这18例COVID-19婴儿的首发症状为:发热5例(27.8%)、咳嗽及下呼吸道症状3例(16.7%)、打喷嚏及吐奶1例(5.6%)、无症状3例(16.7%)、病史不详6例(33.3%)。其中,7例婴儿文献报道胸部CT检查结果,并且均存在异常,表现为双肺或单侧肺纹理增粗、磨玻璃影和(或)实变影。除2例婴儿未报道预后情况外,其余16例婴儿均预后良好,无死亡病例报道。结论文献报道的COVID-19婴儿及纳入本研究的1例婴儿,均具有输入性、家庭聚集性感染特点,而且对新生儿患者,目前尚不能排除母婴垂直传播可能性。对于临床症状相对较轻,肺部病变范围相对较小且局限的COVID-19婴儿,一般预后较好。在COVID-19暴发流行期,应尽可能加强儿童,特别是婴儿的防护,避免输入性、家庭聚集性SARS-CoV-2感染。

Objective To explore clinical epidemiological and imaging data of a 2+-month-old infant with corona virus disease 2019(COVID-19)by imported and familial cluster infection of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),and review the literatures.Methods The 2+-month-old infant with COVID-19 who was admitted to the First People′s Hospital of Jintang County,Sichuan Province on February 7,2020 were selected as the study subject.Clinical data of the infant with COVID-19 were collected by retrospective analysis method,and clinical epidemiological characteristics and imaging data,diagnosis,treatment protocol and prognosis were analyzed.With the keywords of"infant""2019 novel coronavirus(2019-nCoV)""novel coronavirus pneumonia(NCP)""SARS-CoV-2"and"COVID-19",literatures related with COVID-19 infants were retrieved from PubMed,Medline,China National Knowledge Infrastructure,VIP database,Wanfang Data Knowledge Service Platform,and on public platforms such as the"medical pediatric channel"and news websites.Literatures retrieval time was set from December 1,2019 to February 21,2020.Clinical characteristics,diagnosis,treatment protocols and prognosis of COVID-19 infants were summarized.This study was consistent with the requirements of World Medical Association Declaration of Helsinki revised in 2013.Results①The results of medical history collection,diagnosis,and treatment of the infant were as follows:infant,male,two months and 29 days old.On January 18,2020,the infant′s aunt came back from Wuhan the outbreak centre of epidemic to Sichuan Province.After close contact,the infant developed symptoms,such as shortness of breath,slight cough,and diarrhea.The results of the Mycoplasma pneumonia,Chlamydophila pneumonia,influenza A and B virus antigens all were negative after admission.Chest CT examination results showed that multiple subpleural light ground glass opacities were found in both lungs.Two times of nasopharyngeal swabs of SARS-CoV-2 both were positive with RT-PCR test,and the infant was confirmed as COVID-19 based on epidemiological data,clinical manifestations,imaging findings,and RT-PCR test results.Clinical symptoms of shortness of breath and cough disappeared,lung lesions absorbed on chest imaging,and RT-PCR test turned to negative after symptomatic treatment of the infant.Currently,the infant was observed continually and waited for discharge.②Literatures review results revealed that 5 literatures and 2 news reports about infant COVID-19 in China were retrieved according to the literature search strategy in this study,involving the clinical characteristics,diagnosis,treatments and prognosis of 18 cases of infants with COVID-19.All of the 18 cases showed epidemiological characteristics of imported and familial cluster infection(with a history of contact with Wuhan COVID-19 patient).Among the 18 cases,there were 3 neonates whose mothers were infected with SARS-CoV-2.Among the 3 neonates,2 cases were effectively quarantined without any contact with infected patients.Initial symptoms of the 18 cases were as follows:fever in 5 cases(27.8%),cough and lower respiratory symptoms in 3 cases(16.7%),sneezing and vomiting milk in 1 case(5.6%),asymptomatic in 3 cases(16.7%),and unknown in 6 cases(33.3%).There were 7 infants with report of chest CT examinations results,and CT images results of them all were abnormal with increased bronchovascular shadows,ground glass opacity,and/or consolidation of bilateral or unilateral lung.Among them,16 cases had satisfying prognosis except for 2 cases with no prognostic data,and no death was reported.Conclusions COVID-19 infants reported in literatures and the infant included in this study all have the characteristics of imported and familial cluster infection characteristics.As for newborn patients,the possibility of vertical transmission from mother to child still cannot be excluded.In addition,clinical symptoms of infant patients are mild,the pulmonary lesions are small and limited,and their prognoses are relatively good.During the outbreak of COVID-19,the protection of children,especially infants should been strengthened,and avoid imported,familial cluster infection of SARS-CoV-2.