In a recent study published within the Pediatrics journal, researchers assessed the epidemiology of neonatal coronavirus disease 2019 (COVID-19) infections.

Study: Epidemiology of Neonatal COVID-19 in the US. Image Credit: Iryna Inshyna/Shutterstock

Background

Neonatal populations have lower rates of COVID-19 infection than adult and pediatric populations, presumably due to innate protective mechanisms. While newborns with symptoms may require intensive care unit (ICU) admission, most patients have satisfactory spontaneous respiration with minimal COVID-19 symptoms. Although unusual, community-acquired COVID-19 in newborns is becoming more common as a consequence of highly transmissible emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants.

Concerning the study

In the current study, researchers explored the incidence, manifestation, and clinical outcomes of neonatal SARS-CoV-2 infections.

Retrospective neonatal data from the Cerner® Real-World Data were utilized in this cross-sectional study (CRWD). It consisted of clinical information, including demographics, interactions, illnesses, test results, and clinical events. Greater than 153 million people were included within the 2021 Q3 edition of CRWD, spanning all care settings and ages. Data related to newborns having a positive COVID-19 diagnosis between birth and 28 days after birth were extracted.

Data collection commenced with neonatal COVID-19 infections, which were used as a start line. Neonates who tested positive for SARS-CoV-2 infection and were younger than 28 days were included. SARS-CoV-2 testing and coding for neonates were conducted in accordance with each particular health system’s guidelines. The incidence of severe illness, regional distribution of infection, and the variety of treatment administered were considered primary outcomes of interest. The incidence of COVID-19 infection in newborns within the US, as recorded inside the CRWD, was the secondary end result.

Cases that matched at the very least two of the next criteria were considered to have severe illnesses: (1) Cases having any of the next symptoms including fever, apnea, cough, tachypnea, or respiratory, vomiting or diarrhea, need for oxygen support, distress or recession; (2) any combination of the next amongst low white blood cell (WBC) count, low lymphocyte count, or elevated a high level of c-reactive protein (CRP); and (3) a questionable chest x-ray.

Pneumonia diagnosis was employed as a stand-in for an abnormal chest x-ray. Moreover, comorbidities and demographic information were collected. Neonatal COVID-19 geographic distribution based on the patient’s zip code prefix together with the consumption of medicines including antivirals, antibiotics, corticosteroids, immunoglobulins, convalescent plasma (CCP), and inotropes/vasopressors was assessed.

Results

Between March 2020 and February 2021, 918 neonates were diagnosed with SARS-CoV-2 infection, including 77% who met the necessities for severe infection with COVID-19. The team noted that 3.40kg was the typical weight of the neonates at admission, with the median age at hospital admission ranging between 11 to 22 days for all newborns and from 15 to 22 days for those with severe COVID-19. For all newborns, the median time to diagnosis was 14.5 days, and for those with severe infection, the identical was 20 days. Within the severe infection cohort, there was a bigger percentage of newborns with low birth weight or early birth in comparison with the non-severe category.

Moreover, comorbidities were more probable in neonates diagnosed with severe COVID-19. Almost 46.5% of those with severe COVID-19 had at the very least one comorbidity, with congenital abnormalities accounting for 38% of all cases and cardiac irregularities reported in 17% of cases. Possible sepsis was noted in 24%, biliary obstruction in 28.2%, and transfusion-needed anemia in 7.0% of the neonates.

Roughly 7.4% of newborns with mild COVID-19 were premature, and their birth weight ranged from 500 to 2499 g. Congenital abnormalities were noted in 25.5% of all neonates. Notably, 63.5% of newborns initially presented to the hospital had no symptoms and no evidence of infection. Tachypnea and fever were essentially the most typical symptoms of infection, with 28.2% of infants experiencing severe COVID-19 infection having pneumonia. Moreover, higher CRP levels were more probable in those with severe COVID-19, together with fewer platelets and lower albumin levels.

Conclusion

The study findings showed that while neonatal COVID-19 rates were low, severe presentations and death were rare. Few infants required respiratory assistance or additional therapy, while most were asymptomatic. Interestingly, the timing of the diagnosis suggested a nosocomial or community-acquired infection. The researchers imagine it might be useful to look at how congenital disabilities affect COVID-19.