Clinical Profile of SARS-CoV-2-Infected Neonates

Abstract

BackgroundThere are conflicting data on the mother-to-child transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and few studies have described the clinical course of neonates infected with SARS-CoV-2. ObjectivesThis study investigates the mother-to-child transmission rate and clinical profile of SARS-CoV-2-infected newborns. MethodsData on 304 newborns of 301 mothers with coronavirus disease 2019 (COVID-19) were prospectively collected and analyzed. Reverse transcription-polymerase chain reaction (RT-PCR) determined the presence of SARS-CoV-2 in the placenta, umbilical cord stump, and nasopharyngeal swabs collected within 24h of birth. Clinical and laboratory data of SARS-CoV-2-infected newborns was entered in a structured proforma. ResultsA total of 20 neonates (6.5%) were positive for SARS-CoV-2, of which 12 were positive only in the nasopharyngeal swab, four cases had the umbilical stump positive, three were positive in the placenta, and one case was positive in all the three specimens collected. Six of the 20 SARS-CoV-2-positive neonates developed severe symptoms. The SARS-CoV-2-positive symptomatic neonates required a more extended stay in hospital compared to their non-symptomatic infected counterparts. ConclusionsA proportion of the babies born to SARS-CoV2-infected mothers tested positive and some of these newborns had severe symptoms.

Maternal and neonatal COVID-19 – the pandemic experience in a tertiary maternity unit in Romania – unicentric, prospective study

“…As most of the infants delivered by COVID-19infected mothers were delivered at term, the mean (SD) and median (IQR) values of BW and GA corre-sponded to normal values for term infants (Table 1). The median GA of our cohort (39 weeks) was lower compared to that reported by Kulkarni et al [56] (37.1 weeks) but the prematurity and LBW rates reported in the cited study were increased compared to our result. Lower mean GA (37,9±2,6 weeks) was also reported in the cohort of COVID-19 mothers described by Angelidou et al [58], again a cohort with significantly increased rates of preterm and LBW infants.…”

“…Only 14 infants delivered by SARS-CoV-2 positive mothers were born prematurely. Therefore, the rate of prematurity was lower in mothers diagnosed with COVID-16 (6.42%) as compared to the prematurity rate during the study period (7.42%) and different from the rates reported by other authors: 7.4-26.8% [14,20,21,37,43,[55][56][57]. A lower rate (4.54%) was reported by a recent study performed during Omicron variant dominance [51].…”

“…A lower rate (4.54%) was reported by a recent study performed during Omicron variant dominance [51]. Similarly, the rate of LBW infants found in our study (7.34%) was higher than the rate reported by Gerhart et al [53] in 2021 and Dos Santos et al [20] in 2023 (5,4% and 6.9%, respectively, in infants delivered by SARS-CoV-2 positive mothers during the third trimester of pregnancy) and lower compared to what other studies reported: 12.7-18.7 [48,56,57]. Differences between the study period (implying different dominant variants of SARS-CoV-2) and protocol for COVID-19 testing (moment, type of tests) may explain the lower rate of prematurity and LBW found in our study group as compared to other data reported in the literature.…”

“…Only 3 infants were found positive by repeated RT-PCR testing, corresponding to a rate of maternal-neonatal transmission of 1.38%. Various rates of maternal-neonatal SARS-CoV-2 transmission suggested by neonatal RT-PCR positive test are reported in the literature: 0% by Salvatore et al [59] in 2020, 0,9% by Mullins et al [60] in 2021, 2,2% by Angelidou et al [58] in 2021, 2,9% by Gerhart et al [53] in 2021, 1.9% by Ryan et al [14] in 2022, 1.8-2% by Molloy et al [5] in 2022, 6.5% by Kulkarni et al [56] in 2022, 2-8% by Caballero et al [38] in 2023 or 0% by Lee et al [57] in 2023. Even a recent meta-analysis performed by Morniroli et al [50] reported an odds ratio of maternal-neonatal transmission of SARS-CoV-2 of 2,3% (95% CI 1,4-3,2%), irrespective if the newborn is separated by the mother or cared for in rooming-in.…”

“…Most of the studies reported in the literature report an increased rate of complications and NICU admissions in infants delivered by SARS-CoV-2 mothers [9,21,23,24,29,30,38,48,56,64] as compared with infants not exposed to SARS-CoV-2, probably occurring as a consequence of maternal COVID-19 (prematurity, LBW, placental abnormalities, induced labor, C-section delivery, maternal respiratory failure, etc.) [3,14,19,21,24,32,55,56,58,72].…”