Neonates Hospitalized with Community-Acquired SARS-CoV-2 in a Colorado Neonatal Intensive Care Unit

Abstract

Importance: The novel coronavirus 2019 (SARS-CoV-2) has been well described in adults. Further, the impact on older children and during the perinatal time is becoming better studied. As community spread increases, it is important to recognize that neonates are vulnerable to community spread as well. The impact that community-acquired SARS-CoV-2 has in the neonatal time period is unclear, as this population has unique immunity considerations. Objective: To report on a case series of SARS-CoV-2 in neonates through community acquisition in the USA. Design: This is an early retrospective study of patients admitted to the Neonatal Intensive Care Unit (NICU) identified as having SAR-CoV-2 through positive real-time polymerase chain reaction assay of nasopharyngeal swabs. Findings: Three patients who required admission to the NICU between the ages of 17 and 33 days old were identified. All 3 had ill contacts in the home or had been to the pediatrician and presented with mild to moderate symptoms including fever, rhinorrhea, and hypox-ia, requiring supplemental oxygen during their hospital stay. One patient was admitted with neutropenia, and the other 2 patients became neutropenic during hospitalization. None of the patients had meningitis or multiorgan failure. Conclusions and Relevance: Infants with community-acquired SARS-CoV-2 may require hospitalization due to rule-out sepsis guidelines if found to have fever and/or hypoxia. Caregivers of neonates should exercise recommended guidelines before contact with neonates to limit community spread of SARS-CoV-2 to this potentially vulnerable population, including isolation, particularly as asymptomatic cases become prevalent.

Case report of a neonate with high viral SARSCoV-2 loads and long-term virus shedding

“…The mother had not previously been infected and was not infected by this neonate during the period of viral shedding despite the high viral load. As described in current literature, symptoms of COVID-19 in newborns were mild, or even none with complete recovery; which is consistent in our case report [ 7 , 10 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ]. In most cases, the mother was infected and probably transmitted horizontally to the neonate.…”

“…Eligible studies (including case reports, case series, cohort studies and retrospective studies) published in English-language journals that have described neonates diagnosed with COVID-19 were included for analysis. We summarized the studies involving neonates in Table 2A , Table 2B [ 10 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ]. Most of these neonates had an infected mother and were asymptomatic (n = 7) or became symptomatic after 16 hours until 17 days after birth (n = 20).…”

Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

“…Only two neonatal infections were diagnosed by the presence of IgM in newborn blood 29,82 : these cases qualified as possible congenital and probable postpartum acquired infections, respectively, according to the classification system 16 ; all the other cases had at least one positive RT-PCR. Nine (5.1%) neonates required delivery room resuscitation 19,20,38,41,44,69,77,87 and 67 (38.3%) needed to be admitted to the NICU 17,18,20,27,31,33,35,36,38,41,44,45,[47][48][49][51][52][53][57][58][59]61,62,[64][65][66][69][70][71][72][73]77,[80][81][82][85][86][87]<...>…”

“…Clinical features of neonatal SARS-CoV-2 infections. Ninetyseven neonates presented with clinical features related to COVID-19: 18,20,[26][27][28]30,32,[34][35][36][38][39][40][41]44,45,[50][51][52]55,56,58,60,61,[65][66][67][70][71][72]77,78,80,81,[85][86][87][88]90 their distribution is shown in Table 3. Respiratory manifestations mainly consisted of signs of respiratory failure, such as tachypnoea, intercostal retractions, and rhinitis; neonatal ARDS was not diagnosed in any case.…”

Comparison of Clinical and Epidemiologic Characteristics of Young Febrile Infants with and without Severe Acute Respiratory Syndrome Coronavirus-2 Infection

“…This finding also could reflect the high prevalence of SARS-CoV-2 among women presenting in labor during this pandemic with transmission from the infant's mother or another household member. 26 Infants with COVID-19 presented with lethargy and feeding difficulty more 9,11,27 Although lymphopenia has been observed commonly in adults and older children with COVID-19, neutropenia has not been reported commonly in these older populations. 14,28,29. There was a significantly smaller proportion of febrile infants with a SBI during March-April with SARS-CoV-2 infection among infants younger than 90 days of age.…”