Clinical Features and Outcome of SARS-CoV-2 Infection in Neonates: A Systematic Review

Abstract

Objective The objective of this study is to systematically synthesize the currently available literature on various modes of transmission (congenital, intrapartum, and postpartum), clinical features and outcomes of SARS-CoV-2 infection in neonates. Methods We conducted a comprehensive literature search using PubMed, EMBASE, and Web of Science until 9 June 2020. A combination of keywords and MeSH terms, such as COVID-19, coronavirus, SARS-CoV-2, 2019-nCoV, severe acute respiratory syndrome coronavirus 2, neonates, newborn, infant, pregnancy, obstetrics, vertical transmission, maternal–foetal transmission and intrauterine transmission, were used in the search strategy. We included studies reporting neonatal outcomes of SARS-CoV-2 proven pregnancies or neonatal cases diagnosed with SARS-CoV-2 infection. Results Eighty-six publications (45 case series and 41 case reports) were included in this review. Forty-five case series reported 1992 pregnant women, of which 1125 (56.5%) gave birth to 1141 neonates. A total of 281 (25%) neonates were preterm, and caesarean section (66%) was the preferred mode of delivery. Forty-one case reports describe 43 mother-baby dyads of which 16 were preterm, 9 were low birth weight and 27 were born by caesarean section. Overall, 58 neonates were reported with SARS-CoV-2 infection (4 had a congenital infection), of which 29 (50%) were symptomatic (23 required ICU) with respiratory symptoms being the predominant manifestation (70%). No mortality was reported in SARS-CoV-2-positive neonates. Conclusion The limited low-quality evidence suggests that the risk of SARS-CoV-2 infections in neonates is extremely low. Unlike children, most COVID-positive neonates were symptomatic and required intensive care. Postpartum acquisition was the commonest mode of infection in neonates, although a few cases of congenital infection have also been reported.

Clinical Profile of SARS-CoV-2 Infected Neonates From a Tertiary Government Hospital in Mumbai, India

“…The exact incidence of SARS-CoV-2 infection in neonates is largely unknown. The proportion of SARS-CoV-2 positive neonates in our study was 6.5% as compared to 3.9% in a meta-analysis of 58 neonates [1].…”

“…There is little literature available about the clinical features, outcomes and the mode of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in neonates, especially from India. Recently, a meta-analysis has described 58 SARS-CoV-2 positive neonates from across the globe [1]. We present the clinical and laboratory profile of SARS-CoV-2 positive neonates admitted to a tertiary-care public hospital.…”

Children were less frequently infected with SARS-CoV-2 than adults during 2020 COVID-19 pandemic in Warsaw, Poland

“…In children, the immune system is immature [13], thus aggressive cytokine response is rarely seen [28] resulting in milder COVID-19 symptoms. The severity of COVID-19 in children was recently reviewed by two meta-analyses [8,17]. Even though the reviews had large cohorts (7480, 4857 patients), the severity of illness was described only in 20-34% of all patients (1475 and 1666 respectively).…”

“…Children are mostly asymptomatic or experience much milder symptoms than the adults [1,7,9,12,15,19,21,41], although a low percentage of the infected children developed the pediatric multi-system inflammatory syndrome [34]. Severe (2-3%) or critical illness (0.61%) has been reported in pediatric patients analyzed in two systematic reviews and meta-analysis of data from several countries [8,17]. The purpose of our study was to establish if a lower frequency of infection, and lesser severity in children were also true for the 2020 COVID-19 pandemic in Warsaw, Poland.…”

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

“…However, following the subsequent progression of the pandemic to involve countries in the Western Hemisphere, Europe, and the Middle East, the spectrum of reported clinical manifestations of the infection in pregnancy appeared to worsen, with pregnant women developing severe and critical pneumonia, thrombosis, cardiomyopathy, multiorgan disease, need for intensive care, and mechanical ventilation which, in a small number of cases, resulted in maternal deaths [10][11][12][13]. In addition to reports of increases in maternal morbidity and mortality, there were increasing descriptions of newborn infants who tested positive for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the causative agent of COVID-19 [14][15][16][17]. Analysis of pooled data from multiple studies indicated that only a small percentage of neonates delivered to pregnant women with COVID-19 tested positive for the virus [18].…”