key: cord-266168-hxu5u5op
authors: Grimaud, Emilie; Challiol, Marie; Guilbaud, Camille; Delestrain, Céline; Madhi, Fouad; Ngo, Julien; Epaud, Ralph; Nattes, Elodie
title: Delayed acute bronchiolitis in infants hospitalized for COVID‐19
date: 2020-07-10
journal: Pediatr Pulmonol
DOI: 10.1002/ppul.24946
sha: 
doc_id: 266168
cord_uid: hxu5u5op

nan

To the Editor, Because of the infant's history, a chest X-ray was performed and returned normal. The child remained hospitalized for 5 days with nasogastric tube feeding but did not require oxygen supplementation. Long-term treatment with inhaled daily corticosteroids (fluticasone) was introduced.

A term eutrophic male with otherwise unremarkable neonatal history was referred for poorly tolerated high fever at age 2 months. He received first hexavalent vaccination 48 hours before. Both parents had clinical signs of COVID-19 but were not tested. The neurologic examination was normal but mild hypotonia was noted. The respiratory and clinical examination findings including hemodynamics were normal. The first blood test showed lymphopenia (lymphocyte count: 1.86 × 10 9 /L; normally: 4-6 × 10 9 /L) without modification of biological inflammatory parameters. Cytobacteriological examination of urine and blood culture was negative and spinal fluid analysis was not performed. RT-PCR testing of a nasopharyngeal swab was positive for SARS-CoV-2 but negative for RSV and IV. The patient did not receive antibiotics. On day 3 after admission, the respiratory condition progressively worsened, with retractions, wheezing, increased respiratory rate at 80/minute, and hypoxia (SpO 2 <92%) requiring supplemental oxygen together with enteral nutrition for 3 days. The chest X-ray was normal, and no lung ultrasonography was performed.

The infant returned to the emergency department 2 weeks later with a nonsevere wheezing episode and was discharged at home.

These two cases of COVID-19 in infants hospitalized for poorly tolerated high fever and neurological symptoms in whom acute bronchiolitis developed following a delay of 2 to 8 days suggest that SARS-CoV-2 infection may cause acute bronchiolitis in the absence of a viral coinfection such as RSV. Pneumonia is the most common respiratory illness among symptomatic children with COVID-19. 1 

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