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Neonatal SARS-CoV-2 Infections: Systematic Review, Synthesis and Meta-Analysis of Reported Cases
31 Pages Posted: 12 Aug 2020
More...Abstract
BACKGROUND: It is unclear if COVID-19 affects neonates. Some cases of neonatal SARS-CoV-2 infections have been reported but not systematically analysed and classified according to clear diagnostic criteria. We aim to clarify the main transmission route, clinical features and outcomes of neonatal SARS-CoV-2 infections.
METHODS: Meta-analysis of cohort, cross-sectional and case-control studies, as well as case series/reports articles published between December 1,2019, and June 11,2020 on various databases, following PRISMA guidelines. Articles were eligible if they describe neonates infected by SARS-CoV-2 (demonstrated by: at least one positive nasopharyngeal swab and/or the presence of specific IgM). Variables of interests were: 1) frequency of vertically and environmentally transmitted SARS-CoV-2 infections; 2) frequency of different clinical features, imaging and laboratory abnormalities of neonatal COVID-19; 3) outcome of neonatal COVID-19.
FINDINGS: Forty-eight articles were included, accounting for 98 infected neonates. 65% and 35% of infections were due to environmental and vertical transmission, respectively. 50% of infected neonates developed clinically evident COVID-19. Commonest clinical features were fever (49%), gastrointestinal (44·9%), respiratory (32·6%) and neurological manifestations (22·4%). Lung imaging was abnormal in 61·2%. The lack of mother-neonate separation from birth was associated with the incidence of late SARS-CoV-2 infection (OR 6·3 (95% CI: 1·5-31); p=0·005), while breastfeeding was not (OR 0·4 (95% CI: 0·07-2·2); p=0·30).
INTERPRETATION: Neonatal SARS-CoV-2 can be transmitted both environmentally and vertically. Neonatal COVID-19 is often characterized by febrile status and favourable outcome. Mother-neonate rooming-in is associated with a higher incidence of late SARS-CoV-2 infections.
FUNDING STATEMENT: The work has no funding.
DECLARATION OF INTERESTS: Authors have no conflict of interest to disclose.
Keywords: neonate, SARS-CoV-2, COVID-19, vertical transmission, rooming-in, breastfeeding
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