Clinical Profile and Outcomes of Neonates Exposed to Maternal COVID-19 Infection in a Tertiary Care Centre—A Cohort Study (NeOCoM Study)

Abstract

Background COVID-19 infection during pregnancy was reported to cause adverse outcomes. Such knowledge stands low quality evidence due to lack of internal controls and inferential statistics. Objectives To assess impact of COVID-19 in pregnancy on fetal and neonatal outcomes. Study Design Prospective analytical cohort study (July 2020 to March 2021). Setting Level III NICU of teaching hospital in India. Participants COVID positive mothers (exposed = 239) each matched with 2 women delivered consecutively by same mode without COVID (unexposed = 478) and enrolled at admission during delivery. Procedure Maternal demographic, comorbidities, and obstetric characteristics; fetal growth, pregnancy complications, and neonatal details of 242 and 482 neonates born to exposed and unexposed mothers respectively were analyzed. Infants were followed until neonatal period. Outcomes Incidence of prematurity was primary outcome. Secondary outcomes were incidence of abortions, IUD, stillbirth, neonatal mortality, neonatal resuscitation at birth, SFD, NICU admission, neonatal morbidities, length of hospitalization, in-hospital mortality, infant positivity rate for SARS COV-2. Results Incidence of prematurity was not significantly different between mothers with and without COVID-19 infection [42(17.3%) vs 94(19.3%), IRR (95%CI) 1.04(0.83,1.31), P = .833]. Neonatal mortality, adverse fetal outcomes, PROM, fetal distress, SGA, neonatal resuscitation, NICU admission did not differ significantly between groups. Gestational hypertension was associated with COVID-19 infection [14(5.9%) vs 11(2.3%), (p=0.014)]. Infant swab positivity was 7%. Swab positivity and neonatal symptoms were associated significantly (10/17(58.8%) vs 7/17(41.1%), P = .0001). Conclusion Asymptomatic COVID-19 infection during pregnancy does not increase adverse fetal and neonatal outcomes. COVID positive neonates become symptomatic and hence need monitoring in health-care facility.