Abstract
BackgroundBabies differ from older children with regard to their exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, data describing the effect of SARS-CoV-2 in this group are scarce, and guidance is variable. We aimed to describe the incidence, characteristics, transmission, and outcomes of SARS-CoV-2 infection in neonates who received inpatient hospital care in the UK.MethodsWe carried out a prospective UK population-based cohort study of babies with confirmed SARS-CoV-2 infection in the first 28 days of life who received inpatient care between March 1 and April 30, 2020. Infected babies were identified through active national surveillance via the British Paediatric Surveillance Unit, with linkage to national testing, paediatric intensive care audit, and obstetric surveillance data. Outcomes included incidence (per 10 000 livebirths) of confirmed SARS-CoV-2 infection and severe disease, proportions of babies with suspected vertically and nosocomially acquired infection, and clinical outcomes.FindingsWe identified 66 babies with confirmed SARS-CoV-2 infection (incidence 5·6 [95% CI 4·3–7·1] per 10 000 livebirths), of whom 28 (42%) had severe neonatal SARS-CoV-2 infection (incidence 2·4 [1·6–3·4] per 10 000 livebirths). 16 (24%) of these babies were born preterm. 36 (55%) babies were from white ethnic groups (SARS-CoV-2 infection incidence 4·6 [3·2–6·4] per 10 000 livebirths), 14 (21%) were from Asian ethnic groups (15·2 [8·3–25·5] per 10 000 livebirths), eight (12%) were from Black ethnic groups (18·0 [7·8–35·5] per 10 000 livebirths), and seven (11%) were from mixed or other ethnic groups (5·6 [2·2–11·5] per 10 000 livebirths). 17 (26%) babies with confirmed infection were born to mothers with known perinatal SARS-CoV-2 infection, two (3%) were considered to have possible vertically acquired infection (SARS-CoV-2-positive sample within 12 h of birth where the mother was also positive). Eight (12%) babies had suspected nosocomially acquired infection. As of July 28, 2020, 58 (88%) babies had been discharged home, seven (11%) were still admitted, and one (2%) had died of a cause unrelated to SARS-CoV-2 infection.InterpretationNeonatal SARS-CoV-2 infection is uncommon in babies admitted to hospital. Infection with neonatal admission following birth to a mother with perinatal SARS-CoV-2 infection was unlikely, and possible vertical transmission rare, supporting international guidance to avoid separation of mother and baby. The high proportion of babies from Black, Asian, or minority ethnic groups requires investigation.FundingUK National Institute for Health Research Policy Research Programme.
Highlights
Children appear to be less severely affected by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) than adults.[1]
Babies were eligible for inclusion if they had a diagnosis of SARS-CoV-2 infection made on a sample taken in the first 28 days after birth and received inpatient care on a postnatal ward, neonatal unit, paediatric inpatient ward, or paediatric intensive care unit (PICU)
British Paediatric Surveillance Unit (BPSU) card returns were received from 3530 (87%) of 4063 UK paediatricians in March and 3480 (85%) of 4084 in April, 2020. 66 potentially eligible neonates were reported to the BPSU system over the study period and 23 additional babies were identified from other sources
Summary
Children appear to be less severely affected by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) than adults.[1]. Neonates are likely to differ from older groups in their exposure to the virus: they can contract SARS-CoV-2 through close personal contact in much the same way as other groups, they might contract the virus vertically before or at birth.[2] The neonatal response to infection differs from that of older children and adults,[3] and neonates might be more susceptible to infection or to severe disease. The scarce data available suggest that severe disease might be more common in infants[4] and neonates[5] than in older children. These data are largely from case reports and series and, to the best of our knowledge, are not population-based. The incidence of symptomatic neonatal SARS-CoV-2 infection and vertical transmission, features of presentation, severity, and outcomes at the population level are unknown
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