Necrotizing Enterocolitis in Preterm Infants Born to Mother with COVID-19

Abstract

Background: The COVID-19 pandemic has had a wide impact on both pregnant women and their babies. Necrotizing enterocolitis (NEC) is a gastrointestinal emergency in neonates with high morbidity and mortality.
 Objective: This study aims to investigate the incidence of NEC in preterm infants born to mothers with confirmed COVID-19.
 Methods: This observational study was conducted in neonatal intensive care unit at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from May 2020 to April 2021. All preterm infants born to mothers with positive COVID-19 based on swab examination were included as study participants. PCR swab examination was performed within 48 hours after birth. The diagnosis of COVID-19 was defined as positive if the swab test result could detect the SARS-CoV-2 virus. The diagnosis of NEC was established by clinical symptoms and confirmed by abdominal radiography.
 Results: Out of 45 preterm infants included in this study, 6 infants experienced NEC. Factors that were significantly associated with the incidence of NEC included asphyxia and intubated mother. Positive PCR results from the infants alone did not significantly increase the risk of NEC. The combination of asphyxia and intubated mother (Odds Ratio [OR]=10.000, 95% Confidence Interval [CI]=1.056-94.677, P=0.020) and the combination of positive PCR result, asphyxia, and intubated mother (OR=2.438, 95% CI=1.673-3.551, P=0.007) were found to be significantly associated with the incidence of NEC
 Conclusion: Significant factors associated with the incidence of NEC in preterm infants born to mothers with COVID-19 included asphyxia and intubated mothers prior to delivery. A positive PCR result alone did not significantly increase the risk of NEC.