comparative analysis of clinical and paraclinical manifestations of neonatal covid-19 and sepsis: a study from shiraz, iran

Background: neonates are particularly vulnerable to covid-19, presenting with symptoms that may overlap with those seen in neonatal sepsis.objectives: this study aims to compare the clinical and paraclinical manifestations of covid-19 and sepsis in neonates. methods: a cohort of 48 neonates diagnosed with either sepsis or covid-19 between february 2020 and december 2020 at namazi and hafez hospitals in shiraz, iran, were included in this analysis. clinical and paraclinical parameters were systematically recorded and analyzed. results: among the observed parameters, poor feeding (54.16% vs. 20.83%) and lethargy (33.33% vs. 8.33%) were significantly more prevalent in neonates with sepsis compared to those with covid-19 (p = 0.01, 0.03). blood cultures were positive in 100% of the sepsis group, while only 8.3% of covid-19 cases showed positive blood cultures (p < 0.001). all urine cultures in covid-19 cases were sterile, whereas 16.6% of neonates with sepsis had positive urine cultures (p = 0.29). platelet counts were significantly lower in the sepsis group compared to covid-19 group (199.08 ± 184.61 × 10³/mm³ vs. 296.73 ± 160.15 × 10³/mm³) (p = 0.03) and c-reactive protein (crp) levels were notably higher in sepsis cases (96.83 ± 53.55 mg/dl vs. 29.14 ± 52.72 mg/dl) (p < 0.001). radiological findings showed no significant differences between the groups. neonatal mortality was higher in the covid-19 group compared to the sepsis group (25% vs. 4.2%) (p = 0.35). conclusions: this study reveals distinct clinical and paraclinical differences between neonatal covid-19 and sepsis. poor feeding and lethargy are more common in sepsis, and neonates with sepsis exhibit higher rates of positive cultures and worse hematologic parameters compared to those with covid-19. these findings underscore the need for early differential diagnosis and tailored management strategies in neonatal infectious diseases.