Since late December 2019, there has been an emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has to date infected over 12.2 million individuals across the globe and killed over 554,000 persons. One of the notable features of this virus is its particularly severe course among the elderly and those with comorbid conditions such as high blood pressure, diabetes, heart disease, and obesity. The infection and its manifestations in these individuals lead to hospitalization and necessitate intensive care and often ventilation. Children and newborn babies who contract the infection are relatively at a lower risk of such complications.
In a new study titled, “The clinical course of SARS-CoV-2 positive neonates,” Italian researchers led by Guiseppe De Bernado from Division of Pediatrics Neonatology and NICU, Ospedale Buon Consiglio Fatebenefratelli, Naples, explain the course of the infection among newborn babies. Their study is published in the latest issue of the Journal of Perinatology.
COVID-19 in newborn babies
Pneumonia caused by COVID-19 was first reported in Wuhan, China, and since then, it has become a global public health problem. The researchers wrote that it was expected that, like any viral infection, the newborns would be at a higher risk of complications when infected with the SARS-CoV-2. The team explains that neonates typically have under-developed immune systems and also have an immature respiratory and cardiovascular system, which makes them susceptible to infections and complications. They wrote, “During previous pandemics, they were reported cases of infants suffering from respiratory infection.” These infections led to complications in neonates such as “spontaneous abortions, preterm delivery, low birth weight, and congenital disabilities,” they wrote.
With COVID-19, there have been instances where the infection in the neonate has been acquired from the mother or caregiver. Still, detailed clinical reports on outcomes of these babies are not available. What data is available suggests that neonates and infants have a “benign” form of the infection even if they were prematurely born or had low birth weight. The team wrote, “Data available for SARS-CoV-2-positive preterm neonates suggest that neonates infected (even if extremely preterm) might not necessarily be susceptible to severe disease with clinically significant or major morbidity.”
Why was this study conducted?
The experts say that it is still too early, and there is too little evidence to show the definitive risk of this viral infection on neonates. This study was conducted to assess the literature and evidence available on the clinical course and outcome of COVID-19 among neonates.
What was done?
The researchers combed through all the published literature on journal databases such as the PubMed database (National Library of Medicine, Washington, DC) between December 2019 and 27th April 2020 to look for clinical notes on neonates and infants with COVID-19. All language articles were included, and neonates less than 28 days of age were included in the study analysis.
The researchers said that neonates with a false-negative and false-positive rate of antibodies IgM were 29.8% and 3.8%, respectively. Thus only babies testing positive for the SARS CoV-2 on RT PCR were included in the analysis. A total of 421 papers were initially found of which 345 had to be discarded because there was a duplication of the data. The analysis thus allowed only 76 articles. Of these 58 articles had to be removed from analysis due to their inability to meet the criteria set by the researchers. Finally, 18 articles were included in the analysis of the data.
For all the neonates included in the 18 articles, data such as gestational age (to determine if they were prematurely born), method of delivery, gender, Apgar score at birth, presence of other diseases, and epidemiological data were recorded. Over the course of the infection, their clinical reports were analyzed. These included clinical features, method of infection acquisition, diagnostic methods used, treatment protocol followed, duration of stay in the hospital or NICU (Neonatal ICU), and rate of death. Outcome measures checked were clinical signs and symptoms, route of infection, treatment, and course of the disease and outcome.
What was found?
A total of 25 neonates and their clinical outcome with COVID-19 was analyzed for this study. Of the 25 neonates, 11 were Chinese, 3, were Italian, 2 were Iranian, and the rest were from Spain, Belgium or South Korea, the team wrote. Of these 25 babies, 16 were born via Caesarean section (CS). The average gestational age of the babies was 37.4 weeks, and the average birth weight was 3,041 grams. The ratio of male babies to females was 2.8. This indicated the increased susceptibility of male babies to the infection.
Among the babies, 68 percent had mothers infected with SARS CoV-2, while 20 percent had both parents infected. In the rest of the cases, grandparents were found to be infected and may have transmitted it to the neonates. Among none of the cases, there was a risk of infection transmission from someone outside the family (third party), wrote the researchers.
The team found that there was no evidence that the babies could be infected while within the uterus from an infected mother (no vertical transmission, they wrote). The main symptoms found included fever, cough, vomiting, diarrhea, lethargy, and shortness of breath, they wrote. Manifestations of the condition usually appeared on the eighth day after birth on average. Some of the neonates (4 of 25) had no symptoms during their hospital stay. Among all the 25 neonates analyzed, 32 percent needed intensive care, and there were no deaths. Complications included pneumonia, respiratory distress, sepsis, and pneumothorax, wrote the researchers. On average, the hospital stay was around 15.8 days, they found.
Conclusions and implications
The researchers noted that the course of COVID-19 is usually free of severe life-threatening complications, and treatment should be supportive and symptomatic. They recommend, “After discharge, simple hygiene measures should be taken during home care as caregivers washing hands and face often, disinfecting the daily supplies of newborns with 75% medical alcohol and chlorine-containing disinfection water to wipe the floor and furniture, regular window ventilation, heat-resistant bottles, and pacifiers should be disinfected at high temperature.”
They added that further studies with a larger number of neonates and more extended follow-ups are needed to confirm their findings. They wrote in conclusion, “SARS-CoV-2-positive newborns show good prognosis, with a low rate of severe complications and without deaths.”