COVID-19 in Infants: Sometimes Severe, but (Somewhat) Preventable

Reviewed by Zachary Willis, MD MPH; UNC Health, Chapel Hill, NC

In an analysis of a prospective cohort from a collaboration of 62 hospitals in 31 states, Hobbs, et al., found that infants under one year of age represented 11% of pediatric patients admitted to the hospital for COVID-19. Infants were especially overrepresented among those with severe COVID-19, accounting for 20.3% of all such hospitalized pediatric patients. Infant COVID-19 admissions occurred most often early in life, with over 60% occurring before three months of age. As expected, infants with underlying conditions were more likely to have severe disease. Infants suffered a wide array of complications, though respiratory complications dominated, as expected. Prevention and treatment options for infants in this age group are limited and lack strong evidence.

Another recent report suggested one protective strategy for infants in this age group. Perez, et al., analyzed SARS-CoV-2 antibody content in the breast milk of 30 pregnant or lactating women for six months following vaccination. As would be expected, milk antibody levels waned over time, with neutralizing activity seen in 83%, 70%, and 25% of milk samples at 1, 3, and 6 months. Nonetheless, there is evidence that infants likely derive protection via breast milk for at least six months after maternal immunization; it is easy to speculate that vaccine boosting, which raises recipient IgG levels reliably, would prolong the benefit. Of course, it is most important that women be vaccinated prior to delivery to permit transplacental transmission of protective antibody to the fetus.


Hobbs CV, Woodworth K, Young CC, et al. Frequency, Characteristics and Complications of COVID-19 in Hospitalized Infants. The Pediatric Infectious Disease Journal. Published online January 11, 2022. doi:10.1097/INF.0000000000003435

Perez S, Luna Centeno LD, Cheng WA, et al. Human Milk SARS-CoV-2 Antibodies up to 6 Months After Vaccination. Pediatrics. Published online January 3, 2022:e2021054260. doi:10.1542/peds.2021-054260

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