Perinatal Transmission of SARS-CoV-2 Infection and Its Clinical Attributes: A Single-Center Study From Western Uttar Pradesh

Abstract

Background Globally, severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has infected millions of people to date. The morbidity and mortality associated with SARS-CoV-2 are higher in diabetics than those with chronic kidney disease and in the elderly. In pregnant women, it causes an increased risk for preeclampsia/eclampsia, infections, intensive care unit (ICU) admission, maternal mortality, and preterm birth. In neonates, SARS‑CoV‑2 infection has been found to cause stillbirths, growth retardation, premature delivery, increased neonatal intensive care unit (NICU) admission, and need for oxygen support. The neonate can get infected by vertical or horizontal transmission. As most studies have focussed on transmission at the time of birth only, in this study, we explored both vertical and horizontal transmission along with the clinical attributes of those born to mothers with SARS‑CoV‑2 infection. Methodology A prospective observational study was conducted in the Department of Pediatrics of a tertiary care hospital over 12 months from October 2020 to October 2021. All reverse transcription-polymerase chain reaction (RT-PCR) SARS-CoV-2-positive pregnant females admitted to the facility during the study duration were included. The enrolled mothers were followed till delivery. The mothers and neonates were managed per standard guidelines. Delivery details and neonatal outcomes were recorded. Coronavirus disease 2019 sampling in newborn babies was done at birth (within 24 hours) using a nasopharyngeal swab sample for RTPCR along with cord blood for SARS-CoV-2 immunoglobulin M (IgM). Complete blood count, C-reactive protein, serum electrolytes, random blood sugar, and chest X-ray were obtained for all babies at birth and thereafter according to requirement. In those roomed in with their mother, RT-PCR was repeated at the time of discharge or if they became symptomatic. Results A total of 44 mother-neonate dyads were included in the study. Cord blood IgM for SARS‑CoV‑2 was negative for all neonates, while throat swab RT-PCR was positive for two (4.5%) neonates immediately after birth. Overall, 13.6% of the neonates were premature, 27.2% of the neonates had low birth weight (<2,500 g), and 6.8% had very low birth weight (<1,500 g). Among those admitted to the NICU, 18.2% had respiratory distress; 4.5% had fever, lethargy, and poor feeding; and hyperbilirubinemia requiring phototherapy was observed in 11.3% of the neonates. Moreover, 4.5% of the neonates had hypocalcemia on initial investigations. Mortality was seen in 2.2% (1/44) of the neonates. Rooming-in and breastfeeding were seen in 68.2% of the neonates. The horizontal transmission was seen in one (3.3%) roomed-in neonate. Conclusions Perinatal transmission of SARS‑CoV‑2 infection does occur but its rate is not significant. Furthermore, with proper infection prevention and control measures, the risk of perinatal transmission can be decreased. Breastfeeding and rooming-in do ...

COVID-19 among infants: key clinical features and remaining controversies

“…For those infants infected within the first 3 months, many will have been breastfed [ 25 , 30 , 43 ]. However, the frequency of such breastfeeding does not carry a considerable risk [ 20 , 43 ]. Of further interest, when infected mothers are separated from newborns until postpartum discharge, the feeding of unpasteurized milk was not associated with proximal infant infections [ 137 ].…”

“…Of further interest, when infected mothers are separated from newborns until postpartum discharge, the feeding of unpasteurized milk was not associated with proximal infant infections [ 137 ]. When infected mothers and their infants room together, the use of infection control precautions including masking, appropriate hand hygiene, and contact vigilance are associated with negligible secondary infections [ 20 , 136 ]. In practical terms, maternal-infant dyads are not uncommonly separated at birth [ 25 ].…”

“…Nosocomial transmission is accepted and includes infants as young as those in the early postpartum period. 2,8,11,[18][19][20][21][22][23][24] Some groups have experienced a paucity of such transmis-sions, but institutional outbreaks, including infants, have been cited. 2,19) Furthermore, there may be a very high rate of secondary infec tions in the outbreak setting affecting newborns, mothers, and healthcare workers.…”

“…8) The practical experience is that mothers are quite likely to initiate breastfeeding during a postpartum hospital stay and continue thereafter, but they have been less likely to breastfeed if infected within 2 weeks before delivery. 20,135,136) For those infants infected within the first 3 months, many will have been breastfed. 25,30,43) However, the frequency of such breastfeeding does not carry a considerable risk.…”

“…25,30,43) However, the frequency of such breastfeeding does not carry a considerable risk. 20,43) Of further interest, when infected mothers are separated from newborns until postpartum discharge, the feeding of unpasteurized milk was not associated with proximal infant infections. 137) When infected mothers and their infants room together, the use of infection control precautions including masking, appropriate hand hygiene, and contact vigilance are associated with negligible secondary infections.…”