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

• Published in: Nature communications Vol. 11; no. 1; pp. 5164 - 10
• Main Authors: Raschetti, Roberto, Vivanti, Alexandre J., Vauloup-Fellous, Christelle, Loi, Barbara, Benachi, Alexandra, De Luca, Daniele
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 15.10.2020; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308/174; 692/308/3187; Betacoronavirus - genetics; Betacoronavirus - immunology; Betacoronavirus - isolation & purification; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - pathology; Coronavirus Infections - transmission; COVID-19; Female; Humanities and Social Sciences; Humans; Infant, Newborn; Life Sciences; Lung - diagnostic imaging; Lung - pathology; Maternal Exposure - adverse effects; multidisciplinary; Pandemics; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - pathology; Pneumonia, Viral - transmission; SARS-CoV-2; Science; Science (multidisciplinary)
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-020-18982-9

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. There are a growing number of reports of neonatal SARS-CoV-2 infections. Here, De Luca and colleagues systematically analyse 176 published cases to better understand the route of transmission, as well as the clinical features and outcomes of neonatal COVID-19.