BACKGROUND AND PURPOSE:

• There have been few studies on infants born to mothers with COVID-19
• Zeng et al. (JAMA Pediatrics, 2020) reviewed the clinical course of neonates born to mothers with COVID-19

METHODS:

• Cohort study
• Setting
  • Wuhan Children’s Hospital from January 2020 to February 2020
• Participants
  • Neonates born to mothers with COVID-19
• Study design
  • Neonates were tested for SARS-CoV-2 using standard RT-PCR (nasopharyngeal and anal swabs)
  • Medical records were used to obtain data on demographic, epidemiologic, and clinical features

RESULTS:

• 33 neonates were born to women with COVID-19
  • Strict infection control and prevention procedures in place during delivery
  • 3 male neonates were COVID-19 positive
  • Maternal pneumonia: All mothers with COVID-19 had pneumonia on CT
• Neonatal clinical features
  • Most common symptom: Shortness of breath (4 neonates)
  • Neonatal deaths: 0 neonates
• Patient 1
  • Cesarean delivery at 40 weeks
  • Presenting symptoms: Lethargy and fever
  • Chest radiographic images: Pneumonia
  • Lab tests: All normal except procalcitonin
  • Nasopharyngeal and anal swabs: Positive on days 2 and 4, and negative on day 6
  • ICU LOS 2 days | Stable vitals at day 10
• Patient 2
  • Cesarean delivery at 40+ weeks
  • Symptoms: Lethargy, vomiting, and fever
  • Chest radiographic images: Pneumonia
  • Lab tests: Leukocytosis, | Lymphocytopenia | Elevated CK-MB
  • Nasopharyngeal and anal swabs: Positive days 2 and 4 and negative on day 6
  • ICU LOS 4 days | Vital signs stable at day 12
• Patient 3
  • Cesarean delivery at 31+ weeks
    • Resuscitation required | Apgars were 3 (1 min), 4 (5 min) and 5 (10 min)
  • Diagnosis: RDS, suspected sepsis and pneumonia (confirmed with chest radiographic imaging)
    • Resolved at day 14
    • Treated with noninvasive ventilation, caffeine, and antibiotics
  • Lab tests
    • Blood cultures: Enterobacter
    • Leukocytosis
    • Thrombocytopenia
    • Coagulopathy (PT 21 seconds; aPTT 81.9 seconds) leading to DIC with active rescue
  • Nasopharyngeal and anal swabs: Positive days 2 and 4 and negative on day 7
  • ICU LOS 11 days | Vital signs stabilizing by day 14

CONCLUSION:

• Neonates with relatively mild symptoms recovered
• The authors point out that patient 3 may have had a more complicated course due prematurity, asphyxia and sepsis, rather than COVID-19
• The authors do not rule out vertical transmission in this cohort

Learn More – Primary Sources:

Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China

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