Clinical profiles of neonates born to mothers with COVID-19
Abstract
Background The risk of congenital infections in neonates born to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected mothers and those breastfed by infected mothers remains largely unknown.
Objective To describe the outcomes and clinical features of neonates born to mothers infected with SARS-CoV-2 during pregnancy, to follow up neonates who were positive for SARS-CoV-2 at the time of delivery for a period of 1 month, and to identify potential risk factors associated with disease transmission.
Methods This prospective observational study on neonates born to SARS-CoV-2-infected mothers between June 2020 and January 2021 was carried out after getting written informed consent in a tertiary care government hospital (Government Medical college Kannur, North Kerala, India). The clinical and demographic characteristics of infected mothers were reviewed. Neonates were tested for SARS-CoV-2 infection within 24 hours of birth, with repeat testing on day 5 for those who were negative at birth. The demographic and clinical characteristics as well as potential risk factors for disease transmission in these neonates were evaluated.
Results A total of 342 neonates (95.3%) were tested for SARS-CoV-2 infection at birth. Rooming-in and breastfeeding was practiced in 75% of at-risk neonates. Fifty neonates tested positive for SARS-CoV-2 infection at birth (14.3%); 293 neonates who tested negative at birth remained so on day 5, except one baby isolated with a caretaker who also tested positive, indicating postnatal infection. There was no statistically significant increased risk of infection in neonates born to SARS-CoV-2-positive mothers compared to those born to mothers who had already become negative at delivery. Mild symptoms were present in 8% of positive neonates. On one-month follow up, all neonates were well and gaining weight.
Conclusion Vertical transmission, in particular transplacental, may be possible in SARS-CoV-2-infected mothers. Maternal infection at the time of delivery is not a predictor for increased vertical transmission compared to mothers whose infections had resolved prior to delivery. Breastfeeding with appropriate hygiene measures is not a risk factor for horizontal transmission.
References
2. Chen ZM, Fu JF, Shu Q, Chen YH, Hua CZ, Li FB, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr. 2020;16:240-6. DOI: 10.1007/s12519-020-00345-5.
3. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics Jun 2020; 145 (6) e20200702. DOI: 10.1542/peds.2020-0702.
4. Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020;37:861-5. DOI: 10.1055/s-0040-1710050.
5. Chawla D, Chirla D, Dalwai S, Deorari AK, Ganatra A, Gandhi A, et al. Perinatal-neonatal management of COVID-19 infection - Guidelines of the Federation of Obstetric and Gynecological Societies of India (FOGSI), National Neonatology Forum of India (NNF) and Indian Academy of Pediatrics (IAP). Indian Pediatrics. DOI: 10.1007/s13312-020-1852-4.
6. Kalamdani P, Kalathingal T, Manerkar S, Mondkar J. Clinical profile of SARS-CoV-2 infected neonates from a tertiary government hospital in Mumbai, India. Indian Pediatr. 2020;57:1143-6. DOI: 10.1007/s13312-020-2070-9.
7. Dhir SK, Kumar J, Meena J, Kumar P. Clinical features and outcome of SARS-CoV-2 infection in neonates: a systematic review. J Trop Pediatr. 2021;67:fmaa059. DOI: 10.1093/tropej/fmaa059.
8. Anand P, Yadav A, Debata P, Bachani S, Gupta N, Gera R. Clinical profile, viral load, management and outcome of neonates born to COVID 19 positive mothers: a tertiary care centre expe.rience from India. Eur J Pediatr. 2021;180:547-59. DOI: 10.1007/s00431-020-03800-7
9. Oncel MY, Ak?n IM, Kanburoglu MK, Tayman C, Coskun S, Narter F, et al. A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society. Eur J Pediatr. 2021;180:733-42. DOI: 10.1007/s00431-020-03767-5.
10. Zamaniyan M, Ebadi A, Aghajanpoor S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery, maternal death, and vertical transmission in pregnant woman with COVID-19 infection. Prenat Diagn. 2020;40:1759-61. DOI: 10.1002/pd.5713.
11. Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS?CoV?2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand. 2020;99:565–8. DOI: 10.1111/aogs.13870.
12. Kumar PS, Kumar B, Saha MM. Development of intrauterine growth restriction following COVID-19 infection in third trimester of pregnancy. J West Bengal Univ Health Sci. 2021;1:71-5.
13. World Health Organization. Coronavirus disease (COVID-19): Pregnancy and childbirth; 2 September 2020 [cited 2021 August 30]. Availablefrom:https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-pregnancy-and-childbirth .
14. Panahi L, Amiri M, Pouy S. Risks of novel coronavirus disease (COVID-19) in pregnancy; a narrative review. Arch Acad Emerg Med. 2020;8:e34. PMID: 32232217.
15. Salvatore CM, Han JY, Acker KP, Tiwari P, Jin J, Brandler M, et al. Neonatal management and outcomes during the COVID-19 pandemic: an observation cohort study. Lancet Child Adolesc Health. 2020;4:721-7. DOI: 10.1016/S2352-4642(20)30235-2.
Copyright (c) 2021 Ambili Susan Jacob, Mohammed MTP, Reetha Gopinath, Binoo Divakaran, Tariq Harris
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Accepted 2021-09-20
Published 2021-09-20
