Infants With Neonatal COVID-19 Seem To Have Mild Course, Favorable Outcome

The clinical symptoms of newborns with or at risk for coronavirus disease (COVID-19) appear to be mild and outcomes "favorable," researchers from China said today.

In a research letter in JAMA Pediatrics, Dr. Wenhao Zhou from National Children's Medical Center, Children's Hospital of Fudan University, and colleagues report on 33 newborns born to mothers with COVID-19 in Wuhan, the epicenter of the outbreak in China.

In general, for the overall cohort, shortness of breath was the most common symptom, radiographic findings were nonspecific and none of the babies died, they report.

Three of the 33 neonates (9%), all male, presented with early-onset SARS-CoV-2 infection. The most seriously ill baby may have been symptomatic due to prematurity, asphyxia, and sepsis, rather than SARS-CoV-2 infection, the clinicians say. They provide the following specific details on the three cases:

Baby number one was born at term by cesarean section because of meconium-stained amniotic fluid and confirmed maternal COVID-19 pneumonia. He experienced lethargy and fever 2days after birth. Results of physical examination were "unremarkable" and the baby was moved to the neonatal ICU. Chest X-ray showed pneumonia, but other laboratory tests (except procalcitonin) were normal. Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days two and four of life and negative on day six.

Baby number two was also born at term by cesarean section due to confirmed maternal COVID-19 pneumonia. He presented with lethargy, vomiting, and fever. The physical exam was unremarkable; lab tests showed leukocytosis, lymphocytopenia, and elevated creatine kinase-MB fraction. Chest X-ray showed pneumonia. Nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days two and four of life and negative on day six.

The third baby (most seriously ill) was born premature at 31 weeks' and 2 days' gestation by cesarean delivery due to fetal distress and confirmed maternal COVID-19 pneumonia. He required resuscitation. The baby's Apgar scores were 3, 4, and 5 at 1, 5, and 10 minutes after birth. Neonatal respiratory distress syndrome and pneumonia confirmed by X-ray resolved on day 14 of life following noninvasive ventilation, caffeine, and antibiotics. Sepsis was suspected based on Enterobacter agglomerates-positive blood culture, leukocytosis, thrombocytopenia and coagulopathy, which improved with antibiotic therapy. Like his peers, nasopharyngeal and anal swabs were positive for SARS-CoV-2 on days two and four of life and negative on day seven.

Dr. Zhou and colleagues say, "Because strict infection control and prevention procedures were implemented during the delivery, it is likely that the sources of SARS-CoV-2 in the neonates' upper respiratory tracts or anuses were maternal in origin."

"Although two recent studies have shown that there were no clinical findings or investigations suggestive of COVID-19 in neonates born to affected mothers, and all samples, including amniotic fluid, cord blood, and breast milk, were negative for SARS-CoV-2, the vertical maternal-fetal transmission cannot be ruled out in the current cohort. Therefore, it is crucial to screen pregnant women and implement strict infection control measures, quarantine of infected mothers, and close monitoring of neonates at risk of COVID-19," they conclude in their report.

Dr. Zhou did not respond to a request for comment by press time.

—Reuters Staff

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