Epidemiological Features of Neonates With COVID-19 Infection in Iran

Abstract

Objective: Although, the COVID-19 Pandemic has drawn the attention of physicians and researchers from all corners of the globe since it has been out broken in different countries, we have also started to invest more about the epidemiological features of neonates that had been affected by COVID-19 in Iran till now.Method: This is a cross-sectional retrospective study including all neonates from a National Registry supported by Iranian Maternal and Neonatal Network (IMaN). Since February 2020 till February 2021, data of neonates under 28 days who were diagnosed with suspected or confirmed COVID-19 has been registered in this network were collected. General data including epidemiological, clinical outcomes and infection-related information were collected. Results: In our retrospective study, data of 4015 neonates admitted to hospital all over the country and reported in IMAN is included. Totally 3725 PCR tests were performed (92.8% of admitted neonates) and from these neonates 825 (20.5%) showed positive PCR test. There were no differences between gender, weight and gestational age in neonates with positive and negative PCR test. Neonatal clinical findings were dependent to the type of admission. Respiratory distress was the most common sign in neonates, who were admitted immediately after birth (63.9%), and who were transferred from another hospital (17%); however in those who were admitted after one to several days after discharge (19.1%), the most common sign were sepsis like syndrome (31.8%) and fever (27.4%). Almost 50% of admitted neonate`s mothers had positive PCR test (25% during pregnancy and 24.3% after delivery). The most important factor of neonatal death was need for respiratory support (aOR=18.17, 95% CI; 9.24– 35.69). Gestational age of <32 weeks (aOR=2.35, 95% CI; 1.35-4.10) and birth weight of <1500 grams (aOR= 3.47, 95% CI; 1.96-6.17) were the other two factors that correlated to death. Conclusion: This is the largest study of neonatal COVID-19 diseases in Iran published to date. The most common signs of COVID-19 diseases found in neonates are respiratory distress and sepsis-like syndrome.

Incidence, Clinical Features, and Outcomes of the Confirmed Neonatal COVID-19 Infection in the Southwest Iran

“…Also, UK databases have reported no deceased neonatal cases with a related cause to COVID-19 infection till April 2020 [15]. Meanwhile, the largest epidemiological study on 825 PCR-positive COVID-19 neonates in Iran reported a mortality rate of 10.3% with the need for respiratory support as the most important factor for neonatal death [18]. This is in line with our findings as all five deceased cases required respiratory support during hospitalization.…”

“…Neonatal laboratory tests in this study, including WBC count, lymphocyte percentages, platelet count, and Creactive protein, indicated that the majority of the cases were within the normal ranges, which confirms the findings of Al-Matary et al [14]. However, other studies are reporting elevated WBC count, C-reactive protein, lymphopenia, and thrombocytopenia [18,19,31,32].…”

“…From a different perspective, there is supportive evidence for asymptomatic COVID-19 infection in general in children as well as infants due to a more effective innate immune response, higher respiratory reserve, and less underlying disease [21][22][23]. Nevertheless, consistent with our findings, the majority of the studies report fever, respiratory and gastrointestinal symptoms, distress, and poor feeding among the manifested symptoms in symptomatic neonates with COVID-19 infection [9,18,24,25].…”

“…However, this study is outdated, and there is a lack of current knowledge about neonatal COVID-19 infection rates. Using a national survey, a recent preprint study, which claimed to be the largest study on neonatal COVID-19 infection in Iran, reported 825 positive PCR tests from February 2020 to February 2021 [18]. While data on incidence rates in different provinces of Iran were not specified, this study was generally reported to recruit cases from a national registry system.…”