Outcomes in COVID-19 Positive Neonates and Possibility of Viral Vertical Transmission: A Narrative Review
Objective Novel coronavirus disease 2019 (COVID-19) seems to affect adults and pediatric patients differently. While neonates are a special population, little is known about the neonatal outcomes. This study aimed to investigate the outcomes in COVID-19 positive neonates and incidence of vertical transmission of the virus by reviewing available literature.
Study Design This study is a narrative review of available literature on “COVID-19 in neonates,” for which PubMed and Google Scholar were used to search the published articles.
Results We summarized the data from 39 published studies that are comprised of 326 COVID-19 positive peripartum mothers with respective neonatal outcomes. Twenty-three neonates have been reported to be COVID-19 positive. Male neonates were affected significantly more (79%) than female neonates. Approximately 3% neonates acquired infection through suspected vertical transmission. Strict infection prevention measures during the perinatal time can significantly reduce the chance of horizontal transmission of the virus. Overall, neonates were asymptomatic or mildly symptomatic regardless of gestational age at birth and required only supportive measures. There was 0% mortality in COVID-19 positive neonates.
Conclusion From available published data to date, we can conclude that the prognosis of COVID-19 positive neonates is good with no mortality. There appears to be minimal vertical transmission of the infection.
Majority of COVID-19 positive neonates showed mild clinical signs and symptoms with no mortality.
Most COVID-19 positive neonates require only supportive measures.
Possibility of viral vertical transmission is very low.
KeywordsCOVID-19 - novel coronavirus 2019 - SARS-CoV-2 - neonates - neonatal outcomes - vertical transmission
* These authors contributed equally to this work.
Received: 02 June 2020
Accepted: 07 July 2020
31 July 2020 (online)
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers
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- 1 The first COVID-19 case originated on November 17, according to Chinese officials searching for “Patient Zero.”. Available at: https://www.msn.com/en-us/news/world/the-first-covid-19-case-originated-on-november-17-according-to-chinese-officials-searching-for-patient-zero/ar-BB119fWJ . Accessed June 18, 2020
- 2 World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19: 11 March 2020. Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020 . Accessed June 18, 2020
- 3 World Health Organization coronavirus disease (COVID-19) dashboard. Available at: https://covid19.who.int/ . Accessed June 18, 2020
- 4 Dong Y, Mo X, Hu Y. , et al. Epidemiology of COVID-19 among children in China. Pediatrics 2020; 145 (06) e20200702
- 5 Lu X, Zhang L, Du H. , et al; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382 (17) 1663-1665
- 6 Xu Y, Li X, Zhu B. , et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. Nat Med 2020; 26 (04) 502-505
- 7 Hageman JR. The coronavirus disease 2019 (COVID-19). Pediatr Ann 2020; 49 (03) e99-e100
- 8 Kamali Aghdam M, Jafari N, Eftekhari K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect Dis (Lond) 2020; 52 (06) 427-429
- 9 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; 37 (08) 861-865
- 10 Díaz CA, Maestro ML, Pumarega MTM, Antón BF, Alonso CP. [First case of neonatal infection due to COVID 19 in Spain] (in Spanish). An Pediatr (Engl Ed) 2020; 92 (04) 237-238
- 11 Kirtsman M, Diambomba Y, Poutanen SM. , et al. Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection. CMAJ 2020; 192 (24) E647-E650
- 12 Lorenz N, Treptow A, Schmidt S. , et al. Neonatal early-onset infection with SARS-CoV-2 in a newborn presenting with encephalitic symptoms. Pediatr Infect Dis J 2020; (e-pub ahead of print) DOI: 10.1097/INF.0000000000002735.
- 13 Coronado Munoz A, Nawaratne U, McMann D, Ellsworth M, Meliones J, Boukas K. Late-onset neonatal sepsis in a patient with COVID-19. N Engl J Med 2020; 382 (19) e49
- 14 Piersigilli F, Carkeek K, Hocq C. , et al. COVID-19 in a 26-week preterm neonate. Lancet Child Adolesc Health 2020; 4 (06) 476-478
- 15 Wang S, Guo L, Chen L. , et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis 2020; (e-pub ahead of print) DOI: 10.1093/cid/ciaa225.
- 16 Zamaniyan M, Ebadi A, Aghajanpoor Mir S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn 2020; (e-pub ahead of print) DOI: 10.1002/pd.5713.
- 17 Zeng LK, Tao XW, Yuan WH, Wang J, Liu X, Liu ZS. [First case of neonate with COVID-19 in China]. Zhonghua Er Ke Za Zhi 2020; 58 (04) 279-280
- 18 Buonsenso D, Costa S, Sanguinetti M. , et al. Neonatal late onset infection with severe acute respiratory syndrome coronavirus 2. Am J Perinatol 2020; 37 (08) 869-872
- 19 Ferrazzi E, Frigerio L, Savasi V. , et al. Vaginal delivery in SARS-CoV-2-infected pregnant women in Northern Italy: a retrospective analysis. BJOG 2020; (e-pub ahead of print) DOI: 10.1111/1471-0528.16278.
- 20 Hu X, Gao J, Luo X. , et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vertical transmission in neonates born to mothers with coronavirus disease 2019 (COVID-19) pneumonia. Obstet Gynecol 2020; 136 (01) 65-67
- 21 McLaren SH, Dayan PS, Fenster DB. , et al. Novel coronavirus infection in febrile infants aged 60 days and younger. Pediatrics 2020; (e-pub ahead of print) DOI: 10.1542/peds.2020-1550.
- 22 Sun M, Xu G, Yang Y. , et al. Evidence of mother-to-newborn infection with COVID-19. Br J Anaesth 2020; (e-pub ahead of print) DOI: 10.1016/j.bja.2020.04.066.
- 23 Yu N, Li W, Kang Q. , et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis 2020; 20 (05) 559-564
- 24 Zeng L, Xia S, Yuan W. , et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; (e-pub ahead of print) DOI: 10.1001/jamapediatrics.2020.0878.
- 25 Algarroba GN, Rekawek P, Vahanian SA. , et al. Visualization of SARS-CoV-2 virus invading the human placenta using electron microscopy. Am J Obstet Gynecol 2020; (e-pub ahead of print) DOI: 10.1016/j.ajog.2020.05.023.
- 26 Baergen RN, Heller DS. Placental pathology in COVID-19 positive mothers: preliminary findings. Pediatr Dev Pathol 2020; 23 (03) 177-180
- 27 Breslin N, Baptiste C, Gyamfi-Bannerman C. , et al. COVID-19 infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM 2020; 2 (02) 100118 ; (e-pub ahead of print) DOI: 10.1016/j.ajogmf.2020.100118.
- 28 Chen Y, Peng H, Wang L. , et al. Infants Born to Mothers With a New Coronavirus (COVID-19). Front Pediatr 2020; 8: 104
- 29 Chen H, Guo J, Wang C. , et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
- 30 Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients. Can J Anaesth 2020; 67 (06) 655-663
- 31 Dong L, Tian J, He S. , et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.4621.
- 32 Griffin I, Benarba F, Peters C. , et al. The impact of COVID-19 infection on labor and delivery, newborn nursery, and neonatal intensive care unit: prospective observational data from a single hospital system. Am J Perinatol 2020; (e-pub ahead of print) DOI: 10.1055/s-0040-1713416.
- 33 Jain P, Thakur A, Kler N, Garg P. Manifestations in neonates born to COVID-19 positive mothers. Indian J Pediatr 2020; (e-pub ahead of print) DOI: 10.1007/s12098-020-03369-x.
- 34 Khan S, Peng L, Siddique R. , et al. Impact of COVID-19 infection on pregnancy outcomes and the risk of maternal-to-neonatal intrapartum transmission of COVID-19 during natural birth. Infect Control Hosp Epidemiol 2020; 41 (06) 748-750
- 35 Lee DH, Lee J, Kim E, Woo K, Park HY, An J. Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) confirmed patient. Korean J Anesthesiol 2020; (e-pub ahead of print) DOI: 10.4097/kja.20116.
- 36 Li Y, Zhao R, Zheng S. , et al. Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China. Emerg Infect Dis 2020; 26 (06) 1335-1336
- 37 Li N, Han L, Peng M. , et al. Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study. Clin Infect Dis 2020; (e-pub ahead of print) DOI: 10.1093/cid/ciaa352.
- 38 Liu W, Wang J, Li W, Zhou Z, Liu S, Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med 2020; 14 (02) 193-198
- 39 Lowe B, Bopp B. COVID-19 vaginal delivery - A case report. Aust N Z J Obstet Gynaecol 2020; 60 (03) 465-466
- 40 Penfield CA, Brubaker SG, Limaye MA. , et al. Detection of SARS-COV-2 in placental and fetal membrane samples. Am J Obstet Gynecol MFM 2020; (e-pub ahead of print) DOI: 10.1016/j.ajogmf.2020.100133.
- 41 Qiancheng X, Jian S, Lingling P. , et al; sixth batch of Anhui medical team aiding Wuhan for COVID-19. Coronavirus disease 2019 in pregnancy. Int J Infect Dis 2020; 95: 376-383
- 42 Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis 2020; (e-pub ahead of print) DOI: 10.1093/cid/ciaa200.
- 43 Xiong X, Wei H, Zhang Z. , et al. Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID--19. J Med Virol 2020; (e-pub ahead of print) DOI: 10.1002/jmv.25857.
- 44 Zambrano LI, Fuentes-Barahona IC, Bejarano-Torres DA. , et al. A pregnant woman with COVID-19 in Central America. Travel Med Infect Dis 2020; (e-pub ahead of print) DOI: 10.1016/j.tmaid.2020.101639.
- 45 Zeng H, Xu C, Fan J. , et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.4861.
- 46 Zhu H, Wang L, Fang C. , et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020; 9 (01) 51-60
- 47 Dramé M, Teguo MT, Proye E. , et al. Should RT-PCR be considered a gold standard in the diagnosis of Covid-19?. J Med Virol 2020; (e-pub ahead of print) DOI: 10.1002/jmv.25996.
- 48 Cassaniti I, Novazzi F, Giardina F. , et al; Members of the San Matteo Pavia COVID-19 Task Force. Performance of VivaDiag COVID-19 IgM/IgG rapid test is inadequate for diagnosis of COVID-19 in acute patients referring to emergency room department. J Med Virol 2020; (e-pub ahead of print) DOI: 10.1002/jmv.25800.
- 49 CDC. Using antibody tests for COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests.html . Accessed on June 18, 2020
- 50 FAQs: management of infants born to mothers with suspected or confirmed COVID-19. Available at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/faqs-management-of-infants-born-to-covid-19-mothers/ . Accessed on June 18, 2020
- 51 Kimberlin DW, Stagno S. Can SARS-CoV-2 infection be acquired in utero?: More definitive evidence is needed. JAMA 2020; (e-pub ahead of print) DOI: 10.1001/jama.2020.4868.
- 52 Yagnik PJ, Umscheid J, Khan AW, Ali M, Bhatt P, Desai PH. Pediatric characteristics of 2019 novel coronavirus: review of available published literature. Clin Pediatr (Phila) 2020; (e-pub ahead of print) DOI: 10.1177/0009922820920017.
- 53 Peltola V, Waris M, Osterback R, Susi P, Hyypiä T, Ruuskanen O. Clinical effects of rhinovirus infections. J Clin Virol 2008; 43 (04) 411-414
- 54 Mimouni F, Lakshminrusimha S, Pearlman SA, Raju T, Gallagher PG, Mendlovic J. Perinatal aspects on the covid-19 pandemic: a practical resource for perinatal-neonatal specialists. J Perinatol 2020; 40 (05) 820-826
- 55 Rawat M, Chandrasekharan P, Hicar MD, Lakshminrusimha S. COVID-19 in newborns and infants-low risk of severe disease: silver lining or dark cloud?. Am J Perinatol 2020; 37 (08) 845-849
- 56 Chandrasekharan P, Vento M, Trevisanuto D. , et al. Neonatal resuscitation and postresuscitation care of infants born to mothers with suspected or confirmed SARS-CoV-2 infection. Am J Perinatol 2020; 37 (08) 813-824
- 57 Gonzalez-Brown VM, Reno J, Lortz H, Fiorini K, Costantine MM. Operating room guide for confirmed or suspected COVID-19 pregnant patients requiring cesarean delivery. Am J Perinatol 2020; 37 (08) 825-828
- 58 Stephens AJ, Barton JR, Bentum NA, Blackwell SC, Sibai BM. General guidelines in the management of an obstetrical patient on the labor and delivery unit during the COVID-19 pandemic. Am J Perinatol 2020; 37 (08) 829-836
- 59 Breastfeeding guidance post hospital discharge for mothers or infants with suspected or confirmed SARS-Co V-2 infection. Available at: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/breastfeeding-guidance-post-hospital-discharge/ . Accessed on June 18, 2020
- 60 Evaluation and management considerations for neonates at risk for COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html . Accessed on June 18, 2020
- 61 NPC-19 Registry Update (National Registry for Surveillance and Epidemiology of Perinatal COVID-19 Infection). Available at: https://my.visme.co/view/ojq9qq8e-npc-19-registry . Accessed on June 18, 2020