Neonatal Infection Due to SARS-CoV-2: An Epidemiological Study in Spain.

Belén Fernández Colomer,Miryam Hortelano López,Concepción De Alba Romero,Carmen Ribes Bautista,Ana Alarcón,Isabel Pescador Chamorro,Clara Alonso Díaz,Dolores Sabina Romero Ramírez,Isabel De Las Cuevas Terán,Luis Arruza Gómez,José Luis Fernández Trisac,Fátima Camba Longueira,Adelina Pellicer,Ana Baña Souto,Zenaida Galve Pradell,Susana Larrosa Capacés,Vanesa Matías Del Pozo,María González López,Raquel González Sánchez,Sílvia Zambudio Sert,Natalio Hernández González,Laura Sánchez García,Marta Nicolás López,Mónica Riaza Gómez,Luis Miguel Cardo Fernández,María Cernada,María Cruz López Herrera ,Elena Zamora-Flores ,Ma Jesús García García ,C Herráiz Perea ,Manuel Sánchez‐Luna

doi:10.3389/fped.2020.580584

Abstract

Objective: Coronavirus disease 2019 (COVID-19) cases caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to increase worldwide. Although some data from pediatric series are available, more evidence is required, especially in neonates, a group with specific characteristics that deserve special attention. This study aimed to describe general and clinical characteristics, management, and treatment of postnatal-acquired (community and nosocomial/hospital-acquired) COVID-19 neonatal cases in Spain.Methods: This was a national prospective epidemiological study that included cases from a National Registry supported by the Spanish Society of Neonatology. Neonates with postnatal SARS-CoV-2 infection were included in this study. General data and infection-related information (mode and source of transmission, age at diagnosis, clinical manifestations, need for hospitalization, admission unit, treatment administered, and complementary studies performed, hospital stay associated with the infection) were collected.Results: A total of 40 cases, 26 community-acquired and 14 nosocomial were registered. Ten were preterm newborns (2 community-acquired and 8 nosocomial COVID-19 cases). Mothers (in both groups) and healthcare workers (in nosocomial cases) were the main source of infection. Hospital admission was required in 22 community-acquired cases [18 admitted to the neonatal intermediate care unit (NIMCU) and 4 to the neonatal intensive care unit (NICU)]. Among nosocomial COVID-19 cases (n = 14), previously admitted for other reasons, 4 were admitted to the NIMCU and 10 to the NICU. Ten asymptomatic patients were registered (5 in each group). In the remaining cases, clinical manifestations were generally mild in both groups, including upper respiratory airways infection, febrile syndrome or acute gastroenteritis with good overall health. In both groups, most severe cases occurred in preterm neonates or neonates with concomitant pathologies. Most of the cases did not require respiratory support. Hydroxychloroquine was administered to 4 patients in the community-acquired group and to 2 patients in the nosocomial group. Follow-up after hospital discharge was performed in most patients.Conclusions: This is the largest series of COVID-19 neonatal cases in Spain published to date. Although clinical manifestations were generally mild, prevention, treatment, and management in this group are essential.

Highlights

The first cases of pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were detected in December 2019 in Hubei Province, China, and spread rapidly throughout the country and the world [1]
The reason why children are less susceptible to COVID-19 than adults remains unclear [5], but new concerns about a novel severe Kawasaki-like disease related to COVID-19 have emerged [6], demonstrating that the infection and its putative long-term consequences in this population, including neonates, should be carefully studied
Since positivity could not be confirmed in the cord tissue, the authors determined this case to be a probable case of congenital SARS-CoV-2 infection

Summary

Introduction

The first cases of pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were detected in December 2019 in Hubei Province, China, and spread rapidly throughout the country and the world [1]. COVID-19 infections among pregnant women [7, 8] and newborns [9] have been reported, vertical intrauterine transmission is still a controversial issue [10, 11]. In certain cases, such as the one described by Kirtsman et al [12], SARS-CoV-2 RNA was detected from a nasopharyngeal swab sample collected on the day of birth before skin-to-skin contact with the mother. Shah et al have established a classification system for maternal-fetal-neonatal SARS-CoV-2 infections, defining the criteria that infections should meet to be classified as congenital, intrapartum, or postpartum [16]

Methods

Results

Conclusion