Neonates With Complex Cardiac Malformation and Congenital Diaphragmatic Hernia Born to SARS-CoV-2 Positive Women—A Single Center Experience

Abstract

Background: Our understanding of the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnancies and perinatal outcomes is limited. The clinical course of neonates born to women who acquired coronavirus disease 2019 (COVID-19) during their pregnancy has been previously described. However, the course of neonates born with complex congenital malformations during the COVID-19 pandemic is not known. Methods: We report a case series of seven neonates with congenital heart and lung malformations born to women who tested positive for SARS-CoV-2 during their pregnancy at a single academic medical center in New York City. Results: Six infants had congenital heart disease and one was diagnosed with congenital diaphragmatic hernia. In all seven infants, the clinical course was as expected for the congenital lesion. None of the seven exhibited symptoms generally associated with COVID-19. None of the infants in our case series tested positive by nasopharyngeal test for SARS-CoV-2 at 24 hours of life and at multiple points during their hospital course. Conclusions: In this case series, maternal infection with SARS-CoV-2 during pregnancy did not result in adverse outcomes in neonates with complex heart or lung malformations. Neither vertical nor horizontal transmission of SARS-CoV-2 was noted.

Outcomes of SARS‐CoV‐2 infection in early pregnancy—A systematic review and meta‐analysis

“…But the larger controlled cohort studies observed an increased risk for early delivery, low birthweight, and stillbirth compared with the control groups. 20,22,33,34 This is consistent with a large study by Iannaccone et Case descriptions of congenital malformations after SARS-CoV-2 infection have been sporadically reported, 41,42 and examples from this review include a neonate diagnosed with unilateral microphthalmia, microcornea, and hypoplasia of both the optic nerve and the neurosensory retina at birth, 32 and a cardiac malformation associated with pigmented lesion of the retina. 16 Data on miscarriage rate during previous coronavirus outbreaks have been worrisome, and early on in the pandemic, concerns were raised from international societies for reproductive medicine suggesting a precautionary approach including recommendations to pause fertility treatments for infertile patients.…”

“…Case descriptions of congenital malformations after SARS‐CoV‐2 infection have been sporadically reported, 41 , 42 and examples from this review include a neonate diagnosed with unilateral microphthalmia, microcornea, and hypoplasia of both the optic nerve and the neurosensory retina at birth, 32 and a cardiac malformation associated with pigmented lesion of the retina. 16 Teratogenic effects of certain viral infections are well documented, and a recent study reported a significantly increased incidence of congenital birth anomalies during the COVID‐19 pandemic compared with before COVID‐19 ( p < 0.00001); 43 however, it should be noted that all but one study in this systematic review only report case descriptions and the high incidence of SARS‐CoV‐2 infections among pregnant women increases the chance of co‐incidental observations.…”

COVID-19 Exposure: A Possible Association with Congenital Anomalies and Adverse Neonatal Outcomes

“…Of the articles found, most did not mention the presence of congenital anomalies within their study populations and thus were not able to aid in answering our primary aim ( There were isolated reports of congenital anomalies. Perveen reported a case of a preterm neonate born with purpuric lesions of the left upper limb, progressing to necrotic plaques, and requiring amputation (Perveen et al, 2020) and Goldshtrom reported a case series of infants born to COVID-19 positive mothers, of which six infants were born with heart disease and one infant was born with a congenital diaphragmatic hernia (Goldshtrom et al, 2020). However, since these congenital anomalies were not detected by the larger studies, it is fair to assume that these occurred independently of COVID-19 exposure.…”

A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19

“…In a large American cohort, perinatal COVID-19 infection was estimated at 2.6% [108]. Most studies, however, report an infrequency of neonatal SARS-CoV-2 infection at birth or thereafter despite maternal infection of varying severity [1-3, 13, 16, 19, 20, 188,191,193,196,197,213,222,228,[237][238][239][240][241][242][243][244]. The latter has also been evident despite some newborn exposure to maternal breastfeeding [82,118,127,136,241].…”