What's the Risk for Babies Born to Mothers With Coronavirus?

March 31, 2020

Babies at risk for coronavirus due to maternal COVID-19 pneumonia showed favorable outcomes.

In a small cohort of pregnant, coronavirus-positive women in Wuhan, China, 9% of babies presented with early-onset coronavirus, according to a research letter published in JAMA Pediatrics.

Investigators from Wuhan, China studied 33 babies born to mothers with coronavirus in order to determine any early-onset infection in newborns. As the number of infections of coronavirus around the world increases, the number of pregnant women and children with coronavirus is also on the rise, the study authors wrote. Before this study only 19 babies born to coronavirus-affected mothers had been investigated in other studies according to the investigators.

Wuhan was the original epicenter of the viral global outbreak. The investigators recruited the babies born to affected mothers from the Wuhan Children’s Hospital between January and February 2020. They collected information such as demographic, epidemiologic, and clinical feature data from the medical records system. Additionally, coronavirus testing via PCR tests were conducted via nasopharyngeal and anal swab sampling.

The group of 33 babies born to mothers with coronavirus included 3 babies with coronavirus themselves, the investigators learned. The most common symptom was shortness of breath, found in 4 of the 33 babies, though radiographic findings were nonspecific, the study authors said. There were no reported deaths.

The study authors went on to describe each of the 3 babies’ conditions: The first baby was born after 40 weeks gestation via C-section. The decision to use a C-section was made because of meconium-stained amniotic fluid and confirmed maternal COVID-19 pneumonia, the study authors wrote. On the baby’s second day of life, the child displayed lethargy and fever though unremarkable physical examination results. The baby was moved to the intensive care unit, where a chest radiographic image showed pneumonia. Other lab tests were normal except procalcitonin, the study authors added. The baby underwent nasopharyngeal and anal swab tests for coronavirus and was positive on days 2 and 4 of life but negative on day 6.

The second baby was born after 40 weeks’ and 4 days’ gestation, also via C-section because of maternal COVID-19 pneumonia, the study authors said. The child, a male, showed lethargy, vomiting, and fever, though there were unremarkable physical examination results. Lab tests showed leukocytosis, lymphocytopenia, and an elevated creatine kinase-MB fraction, according to the investigators, and a chest radiographic image additionally showed pneumonia. Just like the first baby, nasopharyngeal and anal swabs were positive for coronavirus on days 2 and 4 of life, but negative on day 6.

The third baby was born after 31 weeks’ and 2 days’ gestation through a C-section because of both fetal distress and confirmed maternal COVID-19 pneumonia, the study authors reported, adding that resuscitation was required. After 1, 5, and 10 minutes from birth, the infant’s Apgar scores were 3, 4, and 10, respectively, the study authors said. A chest radiographic image showed neonatal respiratory distress syndrome and pneumonia, but both resolved by day 14 of life. The baby was treated with noninvasive ventilation and caffeine, the study authors reported. Antibiotics were used to treat the infant for suspected sepsis, with an Enterobacter blood culture that was positive, leukocytosis, thrombocytopenia, and coagulopathy. Nasopharyngeal and anal swabs for coronavirus were positive in the infant on days 2 and 4 of life but were negative at day 7, the study authors said.

“Because strict infection control and prevention procedures were implemented during the delivery, it is likely that the sources of SARS-CoV-2 in the neonates’ upper respiratory tracts or anuses were maternal in origin,” the study authors wrote. “Although 2 recent studies1,2 have shown that there were no clinical findings or investigations suggestive of COVID-19 in neonates born to affected mothers, and all samples, including amniotic fluid, cord blood, and breast milk, were negative for SARS-CoV-2, the vertical maternal-fetal transmission cannot be ruled out in the current cohort. Therefore, it is crucial to screen pregnant women and implement strict infection control measures, quarantine of infected mothers, and close monitoring of neonates at risk of COVID-19.”