Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 152 No. 2122 (2022)

Neonates with SARS-CoV-2 infection: spectrum of disease from a prospective nationwide observational cohort study

  • Petra Zimmermann
  • Anita Uka
  • Michael Buettcher
  • Yves Fougère
  • Margherita Plebani
  • Christa Relly
  • Hanna Schmid
  • Nicole Ritz
DOI
https://doi.org/10.4414/SMW.2022.w30185
Cite this as:
Swiss Med Wkly. 2022;152:w30185
Published
27.05.2022

Summary

BACKGROUND: Coronavirus disease 2019 (COVID-19) can be more severe in infants than in older children. To date, only a few case series have reported data on neonates with COVID-19, including mostly asymptomatic neonates who were tested because of exposure to maternal SARS-CoV-2 infection. This study summarises nationwide epidemiological data, clinical characteristics, treatment and outcomes of neonates presenting with symptomatic SARS-CoV-2 infection.

METHODS: Data were prospectively collected through the Swiss Paediatric Surveillance Unit from hospitalised neonates with laboratory-confirmed SARS-CoV-2 infection (positive polymerase chain reaction on a respiratory sample) from 1 March 2020 to 31 September 2021. All 29 paediatric hospitals in Switzerland reported cases.

RESULTS: In total, 73 neonates were included; 7 (10%) were preterm. The median age at presentation was 17 days (interquartile range [IQR] 11–23); 40 (55%) were female. The majority of neonates (64, 88%) were admitted from home. Nine (12%) had a pre-existing medical condition. Overall, the most common symptom recorded was fever in 52 (71%), followed by rhinorrhoea or nasal congestion in 32 (44%) and respiratory distress in 19 (26%). Twenty (27%) neonates presented with fever without a source. Seven (10%) neonates were admitted to an intensive care unit (5 for respiratory failure and 2 for monitoring). One (1%) neonate required inotropic support. The median length of hospital stay in term neonates was 4 days (IQR 3–5). Two (3%) were treated with corticosteroids and 1 (1%) with remdesivir. In total, 60 (82%) neonates had contact with a known or suspected SARS-CoV-2 index case. All of the 71 neonates for whom data were available were discharged to their homes without symptoms.

CONCLUSION: In neonates, COVID-19 mainly presents with fever, and symptoms of upper and lower respiratory tract infection. The clinical course is mostly mild, requiring a short period of hospitalisation. COVID-19 needs to be added as a differential diagnosis in neonates who present with fever without a source. However, the presence of SARS-CoV-2 should not deter from the search for a serious bacterial infection. Further data from surveillance studies are needed to better understand COVID-19 in neonates, guide therapy and to evaluate whether the clinical spectrum is changing with new SARS-CoV-2 variants.

References

  1. Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI, et al.; ptbnet COVID-19 Study Group. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020 Sep;4(9):653–61. https://doi.org/10.1016/S2352-4642(20)30177-2
  2. Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J. 2020 May;39(5):355–68. https://doi.org/10.1097/INF.0000000000002660
  3. Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020 Sep;174(9):882–9. https://doi.org/10.1001/jamapediatrics.2020.1467
  4. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020 Jun;109(6):1088–95. https://doi.org/10.1111/apa.15270
  5. Zimmermann P, Curtis N. Why is COVID-19 less severe in children? A review of the proposed mechanisms underlying the age-related difference in severity of SARS-CoV-2 infections. Arch Dis Child. 2020 Dec;archdischild-2020-320338.
  6. Zimmermann P, Curtis N. COVID-19 in Children, Pregnancy and Neonates: A Review of Epidemiologic and Clinical Features. Pediatr Infect Dis J. 2020 Jun;39(6):469–77. https://doi.org/10.1097/INF.0000000000002700
  7. Uka A, Buettcher M, Bernhard-Stirnemann S, et al. Factors associated with hospital and intensive care admission in paediatric SARS-CoV-2 infection: a prospective nationwide observational cohort study. Eur J Pediatr. Forthcoming 2021.
  8. Ward JL, Harwood R, Smith C, et al. Risk factors for intensive care admission and death amongst children and young people admitted to hospital with COVID-19 and PIMS-TS in England during the first pandemic year. medRxiv 2021:2021.07.01.21259785. https://doi.org/10.1101/2021.07.01.21259785
  9. WHO. COVID-19 detailed surveillance data dashboard. (accessed 27 July 2021 at https://covid19.who.int)
  10. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jun;69(24):759–65. https://doi.org/10.15585/mmwr.mm6924e2
  11. Liguoro I, Pilotto C, Bonanni M, Ferrari ME, Pusiol A, Nocerino A, et al. SARS-COV-2 infection in children and newborns: a systematic review. Eur J Pediatr. 2020 Jul;179(7):1029–46. https://doi.org/10.1007/s00431-020-03684-7
  12. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020 Jun;145(6):e20200702. https://doi.org/10.1542/peds.2020-0702
  13. Parri N, Lenge M, Buonsenso D ; Coronavirus Infection in Pediatric Emergency Departments (CONFIDENCE) Research Group. Children with Covid-19 in Pediatric Emergency Departments in Italy. N Engl J Med. 2020 Jul;383(2):187–90. https://doi.org/10.1056/NEJMc2007617
  14. Tagarro A, Epalza C, Santos M, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr 2020.
  15. Liu W, Zhang Q, Chen J, Xiang R, Song H, Shu S, et al. Detection of Covid-19 in Children in Early January 2020 in Wuhan, China. N Engl J Med. 2020 Apr;382(14):1370–1. https://doi.org/10.1056/NEJMc2003717
  16. Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Skoff T ; CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr;69(14):422–6. https://doi.org/10.15585/mmwr.mm6914e4
  17. Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, et al.; PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol. 2021 Apr;57(4):573–81. https://doi.org/10.1002/uog.23619
  18. Bellos I, Pandita A, Panza R. Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:194–204. https://doi.org/10.1016/j.ejogrb.2020.11.038
  19. Alipour Z, Samadi P, Eskandari N, Ghaedrahmati M, Vahedian M, Khalajinia Z, et al. Relationship between coronavirus disease 2019 in pregnancy and maternal and fetal outcomes: retrospective analytical cohort study. Midwifery. 2021 Nov;102:103128. https://doi.org/10.1016/j.midw.2021.103128
  20. Al-Lawama M, Badran E, Ghanim N, Irsheid A, Qtaishat H, Al-Ammouri I, et al. Perinatal Transmission and Clinical Outcomes of Neonates Born to SARS-CoV-2-Positive Mothers. J Clin Med Res. 2021 Aug;13(8):420–4. https://doi.org/10.14740/jocmr4578
  21. Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound Obstet Gynecol. 2020 Jul;56(1):15–27. https://doi.org/10.1002/uog.22088
  22. Sánchez-Luna M, Fernández Colomer B, de Alba Romero C, Alarcón Allen A, Baña Souto A, Camba Longueira F, et al.; SENEO COVID-19 Registry Study Group. Neonates Born to Mothers With COVID-19: Data From the Spanish Society of Neonatology Registry. Pediatrics. 2021 Feb;147(2):147. https://doi.org/10.1542/peds.2020-015065
  23. Farghaly MA, Kupferman F, Castillo F, Kim RM. Characteristics of Newborns Born to SARS-CoV-2-Positive Mothers: A Retrospective Cohort Study. Am J Perinatol. 2020 Nov;37(13):1310–6. https://doi.org/10.1055/s-0040-1715862
  24. Shalish W, Lakshminrusimha S, Manzoni P, Keszler M, Sant’Anna GM. COVID-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach. Am J Perinatol. 2020 Jun;37(8):780–91. https://doi.org/10.1055/s-0040-1710522
  25. Barrero-Castillero A, Beam KS, Bernardini LB, Ramos EG, Davenport PE, Duncan AR, et al.; Harvard Neonatal-Perinatal Fellowship COVID-19 Working Group. COVID-19: neonatal-perinatal perspectives. J Perinatol. 2021 May;41(5):940–51. https://doi.org/10.1038/s41372-020-00874-x
  26. Angelidou A, Sullivan K, Melvin PR, Shui JE, Goldfarb IT, Bartolome R, et al. Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts. JAMA Netw Open. 2021 Apr;4(4):e217523. https://doi.org/10.1001/jamanetworkopen.2021.7523
  27. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T, et al.; for PregCOV-19 Living Systematic Review Consortium. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ. 2020 Sep;370:m3320. https://doi.org/10.1136/bmj.m3320
  28. Raschetti R, Vivanti AJ, Vauloup-Fellous C, Loi B, Benachi A, De Luca D. Synthesis and systematic review of reported neonatal SARS-CoV-2 infections. Nat Commun. 2020 Oct;11(1):5164. https://doi.org/10.1038/s41467-020-18982-9
  29. World Health Association. Definition and categorization of the timing of mother-to-child transmission of SARS-CoV-2. (accessed 22 Feburary 2021 at https://urldefense.com/v3/__https://www.who.int/publications/i/item/WHO-2019-nCoV-mother-to-child-transmission-2021.1__!!Dc8iu7o!hcW8vbYo89O-c-KELcz2o5Gd4aPcI74tcij7brMBoa7QaU7Kah76lBGCGUrtOhzSiKFmpg$)
  30. Paret M, Lalani K, Hedari C, Jaffer A, Narayanan N, Noor A, et al. SARS-CoV-2 Among Infants <90 Days of Age Admitted for Serious Bacterial Infection Evaluation. Pediatrics. 2021 Oct;148(4):148. https://doi.org/10.1542/peds.2020-044685
  31. Blázquez-Gamero D, Epalza C, Cadenas JA, Gero LC, Calvo C, Rodríguez-Molino P, et al. Fever without source as the first manifestation of SARS-CoV-2 infection in infants less than 90 days old. Eur J Pediatr. 2021 Jul;180(7):2099–106. https://doi.org/10.1007/s00431-021-03973-9
  32. Mithal LB, Machut KZ, Muller WJ, Kociolek LK. SARS-CoV-2 Infection in Infants Less than 90 Days Old. J Pediatr. 2020 Sep;224:150–2. https://doi.org/10.1016/j.jpeds.2020.06.047
  33. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al.; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 Infection in Children. N Engl J Med. 2020 Apr;382(17):1663–5. https://doi.org/10.1056/NEJMc2005073
  34. Bhuiyan MU, Stiboy E, Hassan MZ, Chan M, Islam MS, Haider N, et al. Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis. Vaccine. 2021 Jan;39(4):667–77. https://doi.org/10.1016/j.vaccine.2020.11.078

Most read articles by the same author(s)

<< < 1 2