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

Abstract

A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70% and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother–neonate separation from birth is associated with late SARS-CoV-2 infection (OR 4.94 (95% CI: 1.98–13.08), p = 0.0002; adjusted OR 6.6 (95% CI: 2.6–16), p < 0.0001), while breastfeeding is not (OR 0.35 (95% CI: 0.09–1.18), p = 0.10; adjusted OR 2.2 (95% CI: 0.7–6.5), p = 0.148). Our findings add to the literature on neonatal SARS-CoV-2 infections.

Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2

“…In addition, increasing numbers of global cohort studies of pregnant women with COVID-19 that examine neonatal outcomes have demonstrated that a small percentage of newborn infants will test positive for SARS-CoV-2 following birth. In a recent meta-analysis of 74 publications, there were a total of 176 neonates from around the world who tested positive for SARS-Cov-2 [51]. Of these, 174 were diagnosed using RT-PCR methods, and 2 diagnosed by the presence of IgM in newborn blood.…”

“…Fortunately, transplacental vertical infection appears to be uncommon. In a recent analysis, Raschetti and colleagues have estimated that among neonates testing positive for COVID-19, 70% are due to postpartum environmental exposure, and 30% result from prenatal vertical infection [51]. The authors expounded on these metrics by estimating that among all neonates testing positive for COVID-19, approximately 9% represented confirmed prenatal vertical infections −3.3% for intrapartum acquisition and 5.7% for congenitally (intrauterine) transmitted infections.…”

Clinical Characteristics and Neonatal Outcomes of Pregnant Patients With COVID-19: A Systematic Review

“…Since, several articles have reported that the possibilities of vertical transmission (37,38), highlighting the importance of long-follow up of newborns (39). To clarify the vertical transmission and neonatal outcomes due to SARS-CoV-2 infection; we further compared our findings with other recently published systematic review and meta-analyses (38,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Raschetti et al (38) evaluated neonatal outcomes from 74 published articles in where 30% of neonates were reported in the possible vertical transmission and 70% were from environmental sources ( Table 4).…”

Perinatal COVID-19: review of current evidence and practical approach towards prevention and management

“…According to the initial available literature, the risk of vertical transmission is 5-30% but may be underreported due to lack of early diagnosis. ACE2 receptors and TMPRSS2 molecules are highly expressed in placenta and the expression peaks at term and the virus often invade the placenta and rarely cause miscarriage [16][17][18][19]. From two different case series, 4 infants had positive nasopharyngeal SARS-CoV-19 RT-PCR within 2 days of life, but cord blood, amniotic fluid and cord blood samples were negative in these infants [20,21].…”