Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

Roberto Raschetti,Alexandra Benachi,Christelle Vauloup-Fellous,Alexandre J Vivanti,Barbara Loi,Daniele De Luca

doi:10.1038/s41467-020-18982-9

Abstract

A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70% and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother–neonate separation from birth is associated with late SARS-CoV-2 infection (OR 4.94 (95% CI: 1.98–13.08), p = 0.0002; adjusted OR 6.6 (95% CI: 2.6–16), p < 0.0001), while breastfeeding is not (OR 0.35 (95% CI: 0.09–1.18), p = 0.10; adjusted OR 2.2 (95% CI: 0.7–6.5), p = 0.148). Our findings add to the literature on neonatal SARS-CoV-2 infections.

Highlights

A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates
With the pandemic spreading around the world, some cases of SARS-CoV-2 infection in the first month of life have been reported in the literature or in the mass media[9], and it has been hypothesized that neonatal COVID-19 might occasionally become clinically apparent
The paper characteristics are reported in Table 1: the methodological quality of case reports and series was estimated as intermediate

Summary

Introduction

A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. COVID-19 is more frequent and tends to be more severe with increasing age and in patients with certain characteristics, some of which are represented by comorbidities typical of older adults (such as cardiovascular disorders and diabetes)[7,8] These risk factors have a role both in the disease occurrence and in the progression towards greater clinical severity and mortality[7,8]. With the pandemic spreading around the world, some cases of SARS-CoV-2 infection in the first month of life have been reported in the literature or in the mass media[9], and it has been hypothesized that neonatal COVID-19 might occasionally become clinically apparent. Our secondary objective was to clarify the effect of mother-neonate separation and breastfeeding on the incidence of late-onset neonatal infections

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Discussion

Conclusion