Neonates Born to COVID-19 Mother and Risk in Management within 4 Weeks of Life: A Single-Center Experience, Systematic Review, and Meta-Analysis

Abstract

Objective The new coronavirus infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been recognized as a global public health emergency, and neonates may be more vulnerable due to their immature immune system. The first aim of this study was to report our experience on the management of neonates from mothers with SARS-CoV-2 infection focusing on a 28-day follow-up since birth. The second aim is to assess how many data on neonatal outcomes of the first month of life are reported in literature, performing a systematic review and meta-analysis. Study design We report our experience based on routine management of neonates born to mothers with SARS-CoV-2 infection and follow-up until 28 days of life. Results In our experience at discharge, 1/48 (2.08%) of entrusted (mother refusing personal protective equipment) and none of separated presented positive nasopharyngeal swab (p = NS). All babies show good outcome at 28 days of life. The literature data show that the percentage of positive separated infants is significantly higher than the percentage of infants entrusted to positive mothers with appropriate control measures (13.63 vs. 2.4%; p = 0.0017). Meta-analysis of studies focused on follow-up showed a 2.94% higher risk of incidence of SARS-CoV-2 infection in entrusted newborns than in separated newborns (95% confidence interval: 0.39–22.25), but this was not significant (p = 0.30). Conclusion A vertical transmission in utero cannot be totally excluded. Since in newborns, the disease is often ambiguous with mild or absent symptoms, it is important to define the most efficient joint management for infants born to COVID-19 positive mothers, being aware that the risk of horizontal transmission from a positive mother, when protective measures are applied, does not seem to increase the risk of infection or to affect the development of newborns from birth to first four weeks of life, and encourages the benefits of breastfeeding and skin-to-skin practice. Key Points

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

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Coronavirus disease 2019 convalescent children: outcomes after congenital heart surgery

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Clinical characteristics, outcomes, & mortality in pregnant women with COVID-19 in Maharashtra, India: Results from PregCovid registry

“…A systematic review of available systematic reviews suggests that the risk of maternal death, stillbirth and neonatal death is around one per cent of pregnancies complicated with SARS-CoV-2 infection 9 . In addition, 2-6 per cent of infants born to mothers with COVID-19 are positive for SARS-CoV-2, and a proportion of these could be due to placental infection 10 11 12 .…”