Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review

Abstract

Objective Novel coronavirus disease 2019 (COVID-19) seems to affect adults and pediatric patients differently. While neonates are a special population, little is known about the neonatal outcomes. This study aimed to investigate the outcomes in COVID-19 positive neonates and incidence of vertical transmission of the virus by reviewing available literature. Study Design This study is a narrative review of available literature on “COVID-19 in neonates,” for which PubMed and Google Scholar were used to search the published articles. Results We summarized the data from 39 published studies that are comprised of 326 COVID-19 positive peripartum mothers with respective neonatal outcomes. Twenty-three neonates have been reported to be COVID-19 positive. Male neonates were affected significantly more (79%) than female neonates. Approximately 3% neonates acquired infection through suspected vertical transmission. Strict infection prevention measures during the perinatal time can significantly reduce the chance of horizontal transmission of the virus. Overall, neonates were asymptomatic or mildly symptomatic regardless of gestational age at birth and required only supportive measures. There was 0% mortality in COVID-19 positive neonates. Conclusion From available published data to date, we can conclude that the prognosis of COVID-19 positive neonates is good with no mortality. There appears to be minimal vertical transmission of the infection. Key Points

A single-center observational study on clinical features and outcomes of 21 SARS-CoV-2-infected neonates from India

“…Furthermore, the report suggested the resemblance of clinical spectrum in neonates to adult population; however, the outcomes were more favorable [3]. Another review of 23 SARS-CoV-2-positive neonates found a male predominance and prematurity in one-third of cases [4].…”

“…Laboratory investigations in neonates with COVID-19 were often normal, though leucopenia or leukocytosis, lymphopenia, and raised lactate dehydrogenase (LDH) and creatine kinase (CK) have been reported [4,5]. A large review on neonatal COVID-19 described lymphopenia (14.4%) and transaminitis (4.1%) and raised inflammatory markers (Creactive protein) (15.5%) [3].…”

“…As the pandemic continues, there is a growing body of evidence on SARS-CoV-2 infection, but most data originates from the adult population. Current scientific literature in neonates comprises of scattered case reports, case series, and retrospective studies from across the globe [4][5][6][7], with a striking lack of evidence from the Indian subcontinent which has a considerable share of COVID-19 cases. In this study, the clinical characteristics, laboratory findings, management, and outcomes of SARS-CoV-2-infected neonates from high burden settings are described, which may contribute to the evolving literature in neonates.…”

Parental perceptions of the impact of neonatal unit visitation policies during COVID-19 pandemic

“…Open access transmission in neonates with SARS-CoV-2 published in the literature. [11][12][13][14] The American Academy of Pediatrics (AAP) neonatal-perinatal COVID-19 registry update of 3 October 2020 reported that, among 3722 mother/infant dyads and 3359 COVID-19 positive mothers, only 52 (1.6%) of 3198 infants tested positive for SARS-CoV-2. 15 Social distancing and wearing face masks/coverings have been shown to mitigate the spread of viral transmission.…”

Gambaran Klinis dan Karakteristik Neonatus dari Ibu Terkonfimasi Covid-2019 di Rumah Sakit Dr. Soetomo

“…Rekomendasi AAP untuk petugas medis agar menggunakan alat pelindung diri selama resusitasi neonatus termasuk gaun, sarung tangan, masker pernapasan N 95, dan kacamata pelindung mata atau alat bantu pernapasan penyaring udara. 8 Penerapan protokol pencegahan infeksi yang ketat saat periode perinatal dapat mengurangi insiden penularan horizontal virus COVID-19 secara bermakna. 7 Penularan melalui kontak kulit-ke-kulit masih kontroversial sehingga kontak kulit-ke-kulit dapat diizinkan jika ibu menggunakan masker dan mencuci tangan.…”