Outcome of Neonates Born to SARS-CoV-2-Infected Mothers: Tertiary Care Experience at US–Mexico Border

Abstract

Background: SARS-CoV-2 has affected millions of people around the world. There is a need for data on the effects of this infection on neonates admitted to neonatal intensive care (NICU) units born to infected mothers. Here, we decided to analyze neonates born to mothers who tested positive for SARS-CoV-2 and admitted to NICU compared with neonates who remained with their mothers. Methods: All pregnant mothers who tested positive for SARS-CoV-2 during pregnancy between 1 June 2020 and 30 June 2021, along with all neonates born to infected pregnant women, were included in this study. We then compared the neonates admitted to NICU with the neonates who remained with their mothers. Results: Eighty-eight neonates were born to eighty-eight SARS-CoV-2-positive mothers. Fifteen of these neonates were admitted to the NICU. The mothers of the neonates admitted to the NICU were more likely to have received prenatal care outside of the USA. In addition, the neonates admitted to the NICU were more likely to have needed significant resuscitation at birth. Respiratory distress was the most common reason for NICU admission. None of the NICU-admitted neonates were SARS-CoV-2-positive. There were no differences between the values of the complete blood counts, morbidities at discharge, lengths of hospitalization, or rates of readmission to hospital in the first month of life observed between the two groups. Conclusions: The vertical transmission of the SARS-CoV-2 infection remains rare; there was no difference in the hospital outcomes in the neonates of infected mothers. Unlike other studies, which show an increased tendency toward preterm birth in SARS-CoV-2-positive mothers, our study indicates no such association.

Effect of Maternal Coronavirus Disease on Preterm Morbidities

“…In parallel, a recent study conducted in the United States comparing infants admitted to the NICU with those who were not concluded that vertical transmission was rare. 38 A multicenter cohort study conducted in Massachusetts, United States, reported that 5 of the 225 neonates tested positive for COVID-19. Although none of the results was statistically significant, it was speculated in the said study that vertical transmission was more likely in the case of symptomatic mothers.…”

“…Some studies reported that the severity of maternal disease increased the risk for preterm delivery and neonatal morbidities. 27 37 38 One of these studies, a matched case-control study, found that severe and critical maternal COVID-19 was associated with significantly lower BW and higher rates of NICU admission, RDS, and IVH compared with the control group (27). In comparison, in this study, RDS, PDA, late neonatal sepsis, and mortality rates were significantly higher in the group with severe maternal COVID-19 disease than in the control group.…”

Maternal and neonatal complications in pregnancy with COVID-19: a systematic review

“…The immature fetal immune system, including both the innate and adaptive arms, makes fetuses particularly susceptible to the adverse effects of viral infections. Additionally, complement system and cytokine imbalances can interfere with fetal development and cause signi cant harm in utero [13,14]. The pathophysiology of COVID-19 is particularly concerning in this context, as the virus is known to unbalance immune responses, including promoting the development of a "cytokine storm" (cytokine release syndrome), which can increase the risk of harm to both fetus and mother and may result in premature birth, abortion, and other fetal anomalies.…”