#49: Management and Outcomes of Infants Born to Mothers with SARS-CoV-2 Infection in Pregnancy

Abstract

BackgroundSARS-CoV-2 infections during pregnancy continue in this ongoing pandemic. Care of mother-infant dyads affected by SARS-CoV-2 infection in pregnancy has evolved. Perinatal viral transmission is rare. However, there remain few detailed reports on characteristics and management of these infants during neonatal hospitalization. Our objective was to investigate management and outcomes of infants born to women with laboratory-confirmed SARS-CoV-2 infection in pregnancy including resuscitation, NICU care, separation, and breastfeeding.MethodsThis is a study of mother-infant dyads with SARS-CoV-2 in pregnancy at Prentice Women’s Hospital in Chicago, IL (3/2020-11/2020). Dyads were tracked prospectively with data obtained by review of electronic medical records including demographics, maternal clinical history, COVID symptoms, and neonatal course. Women were universally screened with SARS-CoV-2 PCR at admission. Mothers were categorized as 1) acute infection (-14–0 days from delivery) vs. previous infection (>14 days), and 2) symptomatic vs. asymptomatic (defined by CDC criteria). Infants of mothers with acute infection were tested for SARS-CoV-2.ResultsWe report a diverse cohort of 210 women with SARS-CoV-2 in pregnancy, 114 acute and 96 previous infection (range 0–229 days between positive PCR and delivery) [Table 1]. Over half (56%) of women were symptomatic, 29/114 (25%) with acute infection, 89/96 (93%) with previous infection. Of 211 infants, one asymptomatic infant tested positive for SARS-CoV-2. The overall rate of preterm birth was 10.9% in this cohort. The rate of preterm birth was 26.6% (8/30) in the symptomatic acute infection group (p=0.055) and birthweight was significantly lower (p=0.03). There was no apparent increased need for resuscitation at delivery. APGARs were 8 (8–9) and 9 (8–9) at 1 and 5 minutes, respectively. Six percent of infants >35 weeks had respiratory distress. About 7% had failed hearing screen (historic Prentice rate ~4%). Separation of infants from mothers with acute infection decreased over time due to policy changes based on available safety data for rooming in (Cuzick’s test for trend p<0.001). Most infants (75%) received breastmilk in the hospital over this timeframe; this was low initially and increased over this timeframe (p<0.001). For example, 45% of mothers with acute infection provided breastmilk in May compared to nearly 100% in November. Twelve women were diagnosed with chorioamnionitis due to fever in labor and also had acute SARS-CoV-2 infection.ConclusionInfants of mothers with SARS-CoV-2 in pregnancy had favorable short-term outcomes, with decrease in separation and increase in breastfeeding over this timeframe. Complex factors likely contribute to differences in birthweight and prematurity in the acute symptomatic group. Isolated fever in the setting of acute SARS-CoV-2 presents a dilemma regarding maternal chorioamnionitis, resulting in antibiotic exposure. Longitudinal follow-up is needed to determine infant outcomes (true hearing loss, development) following maternal SARS-CoV-2 infection.Table 1:Characteristics and Outcomes of Infants of Women with SARS-CoV-2 Infection in PregnancyTotal N=211 1 twinAcute Infection(n= 115)Previous Infection(n = 96)Symptomatic# Acute Infection(n = 30)Symptomatic# Previous Infection(n = 89)p-value*Agemean (std)30.5 (6.2)29. 8 (6.1)31.4 (6.2)30.5 (6.3)31.7 (6.1)0.06 0.36Maternal Racen (%)<0.01 0.20Black/African American45 (21%)35 (30%)10 (10%)7 (23%)10 (11%)White61 (29%)30 (26%)31 (32%)7 (23%)29 (33%)Asian8 (4%)5 (4%)3 (3%)2 (7%)3 (3%)American Indian or Alaskan Native1 (0.5%)1 (1%)01 (3.5%)0Other96 (46%)44 (38%)52 (54%)13 (43%)47 (53%)Latina/Hispanicn (%)110 (52%)51 (44%)59 (62%)15 (50%)53 (60%).03 .39Days between test and delivery0 - 3 days91 (43%)91 (79%)14 (47%)4 - 14 days24 (11%)24 (21%)15 (50%)15 - 60 days49 (23%)49 (51%)49 (55%)61 - 120 days31 (15%)31 (32%)28 (32%)121+16 (8%)16 (17%)15 (17%)Vaginal delivery147 (70%)79 (69%)68 (71%)18 (60%)63 (71%)0.81 0.38Gestational age at birth0.67^ 0.055^<32 weeks2 (1%)1 (1%)1 (1%)1 (4%)1 (1%)32–36 weeks21 (10%)11 (10%)10 (10%)7 (23%)8 (9%)37+ weeks188 (89%)103 (90%)85 (89%)22 (73)80 (90%)Birth weight (g) mean (std dev)3263 (550)3264 (583)3263 (511)2997 (640)3260 (517)0.88 0.03NICU admission39 (18%)23 (20%)16 (17%)10 (31%)15 (17%)0.53 0.06ResuscitationDry and Stimulation151 (72%)96 (83%)55 (57%)24 (79%)52 (58%)<0.01 0.04Oxygen/Positive pressure19 (9%)9 (7%)10 (10%)5 (14%)10 (11%)0.46 0.74Intubation4 (2%)3 (2%)1 (1%)1 (4%)1 (1%)0.62 0.43Volume Expansion1 (0.5%)1 (1%)000Hearing screen failed196 (93%)109 (96%)87 (91%)28 (97%)80 (90%)0.26 0.58Respiratory distress17 (8%)12 (8%)5 (5%)7 (21%)5 (6%).21 .01Infants >35 weeks gestation12/199 (6%)7/108 (7%)5/87 (6%)4/27 (15%)5/84 (6%)1 0.21Administration of antibiotics30 (14%)20 (17%)10 (10%)9 (30%)9 (10%)0.15 <0.01Maternal chorioamnionitis20 (10%)12 (10%)8 (8%)2 (7%)8 (9%)0.64 0.99#Symptomatic infection was defined as any symptom consistent with SARS-CoV-2 infection/COVID-19 including fever, upper or lower respiratory symptoms, nausea, vomiting, diarrhea, myalgia/fatigue, anosmia*The top p-value listed comapres pregnancies affected by acute vs. previous infection. Bottom p-value listed compares only symptomatic acute vs. symptomatic previous infection. Comparisons were by Chi-square and Fisher’s exact tests.^Comparing dichotomized preterm (<37 weeks) vs full term