Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance

Abstract

Background Babies differ from older children with regard to their exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, data describing the effect of SARS-CoV-2 in this group are scarce, and guidance is variable. We aimed to describe the incidence, characteristics, transmission, and outcomes of SARS-CoV-2 infection in neonates who received inpatient hospital care in the UK. Methods We carried out a prospective UK population-based cohort study of babies with confirmed SARS-CoV-2 infection in the first 28 days of life who received inpatient care between March 1 and April 30, 2020. Infected babies were identified through active national surveillance via the British Paediatric Surveillance Unit, with linkage to national testing, paediatric intensive care audit, and obstetric surveillance data. Outcomes included incidence (per 10 000 livebirths) of confirmed SARS-CoV-2 infection and severe disease, proportions of babies with suspected vertically and nosocomially acquired infection, and clinical outcomes. Findings We identified 66 babies with confirmed SARS-CoV-2 infection (incidence 5·6 [95% CI 4·3–7·1] per 10 000 livebirths), of whom 28 (42%) had severe neonatal SARS-CoV-2 infection (incidence 2·4 [1·6–3·4] per 10 000 livebirths). 16 (24%) of these babies were born preterm. 36 (55%) babies were from white ethnic groups (SARS-CoV-2 infection incidence 4·6 [3·2–6·4] per 10 000 livebirths), 14 (21%) were from Asian ethnic groups (15·2 [8·3–25·5] per 10 000 livebirths), eight (12%) were from Black ethnic groups (18·0 [7·8–35·5] per 10 000 livebirths), and seven (11%) were from mixed or other ethnic groups (5·6 [2·2–11·5] per 10 000 livebirths). 17 (26%) babies with confirmed infection were born to mothers with known perinatal SARS-CoV-2 infection, two (3%) were considered to have possible vertically acquired infection (SARS-CoV-2-positive sample within 12 h of birth where the mother was also positive). Eight (12%) babies had suspected nosocomially acquired infection. As of July 28, 2020, 58 (88%) babies had been discharged home, seven (11%) were still admitted, and one (2%) had died of a cause unrelated to SARS-CoV-2 infection. Interpretation Neonatal SARS-CoV-2 infection is uncommon in babies admitted to hospital. Infection with neonatal admission following birth to a mother with perinatal SARS-CoV-2 infection was unlikely, and possible vertical transmission rare, supporting international guidance to avoid separation of mother and baby. The high proportion of babies from Black, Asian, or minority ethnic groups requires investigation. Funding UK National Institute for Health Research Policy Research Programme.

Maternal and Infant Outcomes Associated with Maternity Practices Related to COVID-19: The COVID Mothers Study

“…Our rate of SARS-CoV-2+ infants in the first 3 days of life, 7.4%, is higher than the AAP reported rate of 1.7%, 23 the United Kingdom Obstetric Surveillance System, 5%, 34 in the Spanish data, 5.2%, 27 and that seen in the worldwide review of infants of over 660 pregnant women with COVID-19, 4%, 35 but it is consistent with that seen in the Italian data, 6.1%, 33 and in another New York hospital (Elmhurst), 6.7%. 24 Although it may appear that our neonatal hospitalization rate is high compared with that reported in the literature (5.6 per 10,000 livebirths in the United Kingdom), 36 we do not have a true numerator, so that even if all 4 hospitalized neonates in our study were American (instead of from 31 countries), our hospitalization rate would be 0.01 per 10,000.…”

“…Our study is limited by neonatal sample size that did not allow for detection of noninferiority in neonatal outcomes by exposures of interest. The exceptionally low reported hospitalization rate in the literature 36 indicates it may be nearly impossible to demonstrate a clinical benefit from disrupting Baby-Friendly practices. We were also limited by our lack of ability to verify responses with IP addresses, which would have allowed us to verify the global location of a respondent and better confirm genuine responses and eliminate duplicate responses.…”

The ability of the neonatal immune response to handle SARS-CoV-2 infection

“…We read with interest the Article by Chris Gale and colleagues reporting data from active surveillance of neonatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the first COVID-19 wave in the UK. 1 The authors are to be commended for the detailed presentation of their data, and the overall carefully worded interpretation.…”

COVID-19: Considerations for Children and Families During the Pandemic

“…A synthesis and systematic review of 176 published cases reported recently that 70 and 30% of infections were due to environmental and vertical transmission, respectively, and suggested that a lack of mother-neonate separation from birth was associated with late SARS-CoV-2 infection, while breastfeeding was not ( 47 ). However, a population-based prospective national cohort study in the UK supported guidance to avoid the routine separation of mother and baby because neonatal SARS-CoV-2 infection was uncommon and most babies were only mildly affected ( 48 ). Moreover, it should be noticed that an excretion of SARS-CoV-2 has been found in COVID-19-infected mothers' breast milk ( 49 ), yet breastfeeding does not seem to significantly increase the risk of maternal-fetal transmission.…”