Clinical Characteristics, Transmission Rate and Outcome of Neonates Born to COVID-19-Positive Mothers: A Prospective Case Series From a Resource-Limited Setting

Abstract

Background: Coronavirus disease (COVID-19) infection during pregnancy could damage the placenta, but data on neonates born to COVID-19-positive mothers is scarce. In this case series, we aim to describe clinical characteristics, transmission rate and outcomes at 3 months of age among neonates born to mothers with COVID-19 diagnosed near the time of delivery. Methods: Prospective, multicenter case series from Suriname. We collected clinical data of neonates born to mothers with COVID-19 infection between June and August 2021. COVID-19 swabs were taken within 5 days and 2 weeks after birth. Follow-up took place at 3 months. Results: We enrolled 18 neonates. However, 18/18 (100%) mothers were infected in the third trimester and 10/18 (55.6%) had severe COVID-19 infection requiring ICU admission and 2/10 (20%) died. In total 16/18 (77.8%) neonates were born after cesarean section and 13/18 (72.2%) were born preterm (median 35 weeks, Interquartile range 32 + 4–38 + 0). Neonatal intensive care unit admission was needed in 7/18 (38.9%) neonates. Respiratory symptoms occurred in 12/18 (66.7%), 5/18 (27.8%) were suspected of early-onset sepsis and 1/18(5.6%) of late-onset sepsis. One preterm neonate developed necrotizing enterocolitis. A nasopharyngeal swab was positive in 1/18 (5.5%) neonates within 5 days of life and in 0/11 (0%) neonates after 2 weeks. Follow-up showed mild neurodevelopmental delay in 2/14 (14.3%) patients. Conclusion: We describe a high proportion of severely ill mothers due to COVID-19 infection with subsequent cesarean delivery and prematurity. Accounting for gestational age at birth, the neonatal clinical course and findings at follow-up appeared similar to neonates born to COVID-19-negative mothers. Maternal vaccination is recommended to prevent neonatal risks associated with prematurity and cesarean delivery.

Scanning electron microscopy and EDX spectroscopy of commercial swabs used for COVID-19 lateral flow testing

“…If we consider the highest value of silicon detected in one of the COVID test swab brands here analysed, undergoing seven to eight COVID test swabbing events in one year (approximately every 48 days) would exceed the lowest estimated cumulative exposure range of silicon for an adult of 70 kg, and the impact would be even worse for children or babies, which have been sampled even as early as 5 days from birth. 55 The toxic effects of cumulative inhalation of silica is not trivial. Death due to silicosis was observed in 3.8% of mining and pottery workers in China, all of which were cumulatively exposed to a range of 0.1-1.23 mg/m 3 /year.…”

Programming Factors of Neonatal Intestinal Dysbiosis as a Cause of Disease

“…The SARS-CoV-2 virus infects all age groups, including infants and pregnant women. The placental tissue of pregnant women with COVID-19 infection is associated with histological changes, which may compromise the fetal environment, and this may later lead to adverse neonatal outcomes [ 44 ]. Despite the viral nature of the disease, antibiotics are often prescribed to patients with COVID-19, mainly because of suspected bacterial coinfection [ 45 ].…”

Comparison of Clinical, Laboratory Parameters, and Outcome of COVID-19-Positive and Negative Neonates Delivered from COVID-19-Positive Mothers

“…The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the coronavirus disease higher in symptomatic individuals as compared to asymptomatic individuals as reported in the Netherlands and India. 2,3 In neonates born to mothers who had COVID-19 infection, most of them were symptomatic and a significant proportion of them required neonatal intensive care unit (NICU) admission. 3 Few other studies reported the frequency of fatal complications was higher in newborns delivered by mothers who was tested positive for COVID-19.…”

“…5,6 In previous study, most of the COVID-19 positive neonates were symptomatic and a significant proportion of them required intensive care admission. 2 According to Centre for Disease Control and Prevention (CDC), the risk of a newborn getting COVID-19 from its mother is low, especially if she uses appropriate precautions before and during care of the newborn. 7,8 Hematological and biochemical assessments are essential diagnostic tools that provide valuable understanding into the general health and physiological state of newborns.…”

“…Few recent studies found that the positivity of COVID-19 infection was quite higher in symptomatic individuals as compared to asymptomatic individuals as reported in the Netherlands and India. 2 3 In neonates born to mothers who had COVID-19 infection, most of them were symptomatic and a significant proportion of them required neonatal intensive care unit (NICU) admission. 3…”