Lay summary
The current pandemic of COVID-19 has affected all the countries globally. However, the adverse impact of the pandemic is more seen in the low-income and middle-income countries (LMICs). Although there is evidence on the adverse impact of the SARS-CoV-2 on the health of mothers and neonates, the evidence is mainly from high-income countries. For reducing the mortality and morbidity due to COVID-19 in LMICs, there is a need to generate evidence from the LMICs. The present study is a part of the National Registry of pregnant women with COVID-19 in India (PregCovid registry). Our study demonstrates a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates. The study also showed the risk of SARS-CoV-2 infection in 6.3% of neonates born to mothers with COVID-19.
Introduction
We describe the clinical characteristics, management, and short-term outcomes of SARS-CoV-2 neonates born to mothers with COVID-19 in a tertiary care hospital in Mumbai, India.
Methods
The study is a retrospective analysis of 524 neonates born to mothers with COVID-19 admitted from 14th April 2020 to 31st July 2020.
Results
SARS-CoV-2 infection was detected in 6.3% of the newborns of the mothers with COVID-19. No significant differences were observed between maturity at gestation, birth weight and sex of SARS-CoV-2 infected and non-infected newborns. The risk of sepsis was 4.09 (95% CI,1.28-13.00) fold higher in the neonates with SARS-CoV-2 as compared to the non-infected group (p = 0.031). Poor feeding was significantly more common among SARS-CoV-2 infected neonates (12.1%) as compared to the non-infected neonates (2.7%) (p = 0.017). There was a total of 13 neonatal deaths, of which 3 deaths occurred in SARS-CoV-2 infected neonates (9%) while 10 (3%) in the SAR-CoV-2 negative group. The risk of neonatal death was higher in SARS-CoV-2 infected newborns (OR 4.8; 95% CI 1.25-18.36).
Conclusion
Neonatal SARS-CoV-2 infection is observed in almost 6% of neonates born to mothers with perinatal COVID-19. There is a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the non-infected neonates.
Neonatal sepsis is a major cause of morbidity and mortality in newborns. It presents a diagnostic challenge to the neonatologists due to a lack of objective evaluation. It may mimic noninfective conditions, such as inborn error of metabolism, birth asphyxia, and even respiratory distress syndrome in preterms. Nonetheless, over-diagnosis and initiating unwanted empirical antibiotics may pose the threat of drug resistance, increasing the hospital stay and cost of treatment. Traditionally, investigations such as white blood cell count, absolute neutrophil count, immature to total neutrophil ratio, C-reactive protein levels, and blood cultures have been used to diagnose sepsis. However, these have low sensitivity and specificity because they may be elevated in conditions other than sepsis. The in-depth understanding of the neonatal immune system’s response to early infection has led to the discovery of advanced diagnostic tools, including biomarkers.
This literature review briefs on the various haematological parameters and biomarkers in neonatal sepsis, exploring newer biomarkers and comparing them with their older counterparts. This will help early diagnosis, treatment, and improved prognosis in neonatal sepsis. As there is a spectrum of markers for diagnosing neonatal sepsis, it is preferable to compile these markers and correlate clinically.
A thorough search of this literature was done on the electronic databases PubMed, Elsevier’s Web of Science, and the Cochrane Library. The authors found around 90 relevant articles: 84 were from PubMed, 4 from Elsevier, and 2 from the latest Cochrane database. Of these articles, 57 were selected from between early 2000 and January 2019.
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