Ocular Assessments of a Series of Newborns Gestationally Exposed to Maternal COVID-19 Infection

Abstract

IMPORTANCE Congenital viral infections leading to ocular abnormalities are frequent and devastating. As ophthalmological manifestations of COVID-19 in newborns are still unknown, it is important to clarify if SARS-CoV-2 could be associated with ocular abnormalities.OBJECTIVE To determine whether exposure to SARS-CoV-2 is associated with outcomes in 4the eyes of newborns. DESIGN, SETTING, AND PARTICIPANTSThis case series enrolled newborns from April to November 2020 from 3 different maternity hospitals in São Paulo, Brazil. The diagnosis of COVID-19 in mothers and newborns was based on real-time reverse transcriptasepolymerase chain reaction assays with material obtained from oronasopharyngeal swab sample; positive IGM serology was also considered as a diagnostic test for mothers. Newborns were excluded if they had any evidence of another congenital infection. All infants underwent external ocular examination and binocular indirect ophthalmoscopy.EXPOSURES Serology test for COVID-19 and detection of SARS-CoV-2 from oronasopharyngeal specimen using a real-time reverse transcriptase-polymerase chain reaction assay on both mothers and newborns. MAIN OUTCOMES AND MEASURES Screening for ophthalmologic manifestation in newborns after maternal COVID-19 infection.RESULTS A total of 165 newborns (age range at examination, 1 to 18 days) were evaluated. Of these, 123 (74.5%) were born at full term, and 42 (25.4%) were born preterm. Maternal gestational age at the time of COVID-19-positive test varied from first to 40th gestational weeks. Six newborns (3.6%) had positive polymerase chain reaction findings for SARS-CoV-2. One newborn tested positive within 18 days (horizontal transmission), and 5 newborns tested positive in the first day of life (possible vertical transmission). None had ocular abnormalities. Concerning exposed newborns with negative test results, 1 presented with venous engorgement and vascular tortuosity, 7 had intraretinal hemorrhages, and 2 were diagnosed as having retinopathy of prematurity. CONCLUSIONS AND RELEVANCEIn this uncontrolled case series of Brazilian newborns of mothers with COVID-19 infection, a low rate of COVID-19 infection was found among newborns, and none had ocular abnormalities. Additional controlled studies may be warranted to confirm these findings.

Ocular manifestations of COVID-19

“…A low incidence of COVID-19 infection was identified among babies in an uncontrolled case series of Brazilian newborns of women with COVID-19 infection, and none exhibited ocular abnormalities. 84 …”

Ocular and Systemic Complications of COVID-19: Impact on Patients and Healthcare

“…7 The virus is primarily transmitted via respiratory droplets, 8 but rare cases of vertical transmission from pregnant mothers to their children have also been reported. 9 A systemic review found that 6.3% of babies born to mothers with COVID-19 tested positive for the infection at birth. 10…”

“… 55 In contrast, a study of 165 newborns exposed to SARS-CoV-2 in Brazil found that only 6 patients had polymerase chain reaction (PCR)-confirmed COVID-19, and none had vascular abnormalities that were attributed to SARS-CoV-2. 9 Some ocular findings in children with COVID-19 may be related to their underlying systemic health.…”

A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research

“…An uncontrolled case series of Brazilian newborns of mothers with COVID-19 infection showed that none of the babies with a COVID-19-positive PCR test had ocular manifestations [ 28 ]. However, while this particular report may refute the association between SARS-CoV-2 and ophthalmic manifestations, many other studies have reported this association.…”