To date, there are relatively few cases of neonates with COVID-19 and there is limited knowledge of neonatal infection with severe acute respiratory syndrome with coronavirus 2 (SARS-CoV-2). However, recent studies suggest an increased risk of severe COVID-19 in infants compared to older children, based on data showing an increased rate of hospitalization among infants.
In the United States, between February and April 2020, infants under one year of age accounted for 62% of all hospitalizations in children associated with COVID-19, and infants under three months of age accounted for 18.8% of pediatric COVID-19. related hospitalizations between March and July 2020. However, clinicians may be more likely to accept newborns with COVID-19, so the hospitalization rate may not be appropriate for determining disease severity.
Evidence from previous studies indicates that there is a low incidence of COVID-19 in neonates and when the disease occurs, it is relatively mild, although cases of severe disease have been reported. For example, a French study found that 37% of all pediatric hospitals with COVID-19 had children under ninety days, but 97% of these babies did not have a serious illness.
Transmission of SARS-CoV-2 to newborns is rare, but it does occur and there are concerns for babies with an immature immune system. Because COVID-19 is so rare in newborns, there are no studies with appropriate comparison groups. A team of researchers from the Centers for Disease Control and Prevention (CDC) in this study used a large set of eHealth data in the United States to compare the severity of severe disease in newborns with and without a diagnosis of COVID-19 at birth.
This study was published in Journal of Perinatology.
Between March and December 2020, 701,777 registered births occurred in 609 hospitals in the United States, of which 49% were not white Spaniards, 46.5% used Medicaid, and 9.2% were premature. A total of 209 cases of COVID-19 were reported during hospitalizations at birth. The majority of infants with COVID-19 were born prematurely compared to infants without the disease. Of the newborns with COVID-19, 69.9% showed no signs of severe disease.
The risk of developing sepsis or requiring admission to the intensive care unit is increased in full-term / preterm infants with COVID-19 compared to those without COVID-19. However, 77.4% of newborns with COVID-19 showed no signs of severe disease. Early-born infants who tested positive for COVID-19 were at increased risk of needing invasive ventilation compared to those without the disease.
In infants of Spanish descent, infants positive for SARS-CoV-2 showed a higher risk of respiratory complications than infants in Spanish without the disease. There is an increased risk of intensive care in non-Hispanic infants of the ‘other / unknown’ race and an increased risk of sepsis in non-Hispanic white full-term / preterm infants with COVID-19 compared to those without COVID-19.
There is an increased risk of mechanical ventilation and respiratory complications in non-Hispanic blacks who are positive for SARS-CoV-2. Early-born Latin American babies with COVID-19 are at increased risk of respiratory complications, and the same is observed in infants of a “other / unknown” non-Hispanic race, as well as an increased risk of sepsis and the need for invasive ventilation. Of all neonates requiring admission to the intensive care unit, those with COVID-19 had to remain there for a significantly longer period than those without COVID-19.
From the data collected for this study, the incidence of COVID-19 in neonates between March and December 2020 appears to be rare. Therefore, the results of the study suggest that full-term / preterm infants who were positive for COVID-19 may not be at increased risk of respiratory complications or require mechanical ventilation, but may be at increased risk of sepsis. and admission to the intensive care unit.
Also, early preterm infants who have COVID-19 may not be at increased risk of intensive care and respiratory complications, but may be at increased risk of requiring invasive ventilation. Future studies may examine changes in the risk profile of neonates with COVID-19.