Coronavirus infection in neonates: a systematic review

Abstract

ObjectiveTo summarise currently reported neonatal cases of SARS-CoV-2 infection.MethodsA search strategy was designed to retrieve all articles published from 1 December 2019 to 12 May 2020, by combining the terms ‘coronavirus’ OR ‘covid’ OR ‘SARS-CoV-2’) AND (‘neonat*’ OR ‘newborn’) in the following electronic databases: MEDLINE/Pubmed, Scopus, Web of Science, MedRxiv, the Cochrane Database of Systematic Review and the WHO COVID-19 database, with no language restrictions. Quality of studies was evaluated by using a specific tool for assessment of case reports and/or case series.ResultsTwenty-six observational studies (18 case reports and 8 case series) with 44 newborns with confirmed SARS-CoV-2 infection were included in the final analysis. Studies were mainly from China and Italy. Half of neonates had a documented contact with the infected mother and one out of three infected neonates was admitted from home. Median age at diagnosis was 5 days. One out of four neonates was asymptomatic, and the remaining showed mild symptoms typical of acute respiratory infections and/or gastrointestinal symptoms. The majority of neonates were left in spontaneous breathing (room air) and had good prognosis after a median duration of hospitalisation of 10 days.ConclusionsMost neonates with SARS-CoV-2 infection were asymptomatic or presented mild symptoms, generally were left in spontaneous breathing and had a good prognosis after median 10 days of hospitalisation. Large epidemiological and clinical cohort studies, as well as the implementation of collaborative networks, are needed to improve the understanding of the impact of SARS-CoV-2 infection in neonates.

Breastfeeding, Human Milk and COVID-19—What Does the Evidence Say?

“…Transmission was reported for term and preterm infants and for vaginal and c-section modes of delivery. These data were supported by other reviews which concluded that neonatal COVID-19 infection is uncommon, almost never symptomatic, and that the rate of infection is no greater when the baby is born vaginally, breastfed, or allowed contact with the mother (16,17).…”

“…Indeed, the main concern in this instance is the mother's ability to follow the strict contact precautions to avoid spreading the virus via the recognized horizontal routes. Therefore, it is important that mothers be counseled on suitable protocols for breastfeeding and breast pump usage (12,17,26,32).…”

Coronavirus disease 2019 in neonates

“…Other findings may include mild thrombocytopenia, normal or mildly raised inflammatory markers (C-reactive proteins, procalcitonin), as well as elevated liver enzymes, creatine kinase, alkaline phosphatase, and lactate dehydrogenase. 9,13,15,16 There were no specific radiologic features although it appeared milder compared to adults, with unilateral or bilateral infiltrates. The ground-glass opacities, multiple bilateral lobular and segmental consolidations in the peripheral lung particularly are shown more clearly by chest computer tomography than the chest x-ray.…”

“…Predominant observed symptoms were fever or temperature instability, followed by gastrointestinal symptoms such as diarrhea and vomiting, abdominal distention, and poor feeding. 15,16 The majority of neonates that were experiencing respiratory symptoms did not require intubation and mechanical ventilation. 16 A study from Italy stated that only 1 out of 10 neonates with respiratory symptoms needed mechanical ventilation, but concomitant condition (prematurity) may have contributed to the clinical status, thus, cannot be excluded.…”

“…16 A study from Italy stated that only 1 out of 10 neonates with respiratory symptoms needed mechanical ventilation, but concomitant condition (prematurity) may have contributed to the clinical status, thus, cannot be excluded. 15 Other symptoms are lethargy, poor feeding, and also rash with varied distributions. 17 Neonates have been reported to have more severe cases (10%-12%) compared to older children (3-4.8%).…”