COVID-19 in Neonates with Positive RT–PCR Test. Systematic Review

SARS-CoV-2 Infection Among Newborn Infants: A Scoping Review

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection of mothers may increase the risk of complications and adverse birth outcomes among newborn infants born more than 37 weeks' gestation.

PURPOSE

The aim of this scoping review is to identify the research gaps in the literature on SARS-CoV-2 positive newborn infants born at more than 37 weeks' gestation in United States (U.S.).

DATA SOURCES

A search for relevant articles was conducted using multiple resources including three databases CINAHL, Ovid MEDLINE, and Web of Science. This scoping review included case reports, case series, cohort, and retrospective studies focusing on newborn infants born more than 37 weeks of gestation with SARS-CoV-2 infection.

STUDY SELECTION

A total of 4262 citations were screened, and 12 articles met the eligibility criteria.

DATA EXTRACTION

Two authors independently screened the articles using a multi-step approach.

RESULTS

This review identified the gaps in literature on newborn infants up to one month of age. Few studies have focused on SARS-CoV-2 positive newborn infants born more than 37 gestational weeks. This review demonstrates a higher prevalence of community-acquired SARS-CoV-2 infections among infants following discharge.

IMPLICATIONS OF PRACTICE AND RESEARCH

Few U.S. based studies have focused on newborn infants born more than 37 weeks' gestation with SARS-CoV-2 infection. Future follow-up studies are essential on these infants especially during the first 30 days of life. Discharge teaching on SARS-CoV-2 infection is vital in reducing community transmission, admissions, and emergency department visits.

Differences in clinical characteristics of early-onset and late-onset severe acute respiratory syndrome coronavirus 2 infections in neonates

Differences in clinical characteristics of early-onset and late-onset severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in neonates remain unclear. This study aimed to determine whether there are differences in the main clinical, radiological, and laboratory features of early-onset and late-onset SARS-CoV-2 infections in neonates. This single-center, prospective cohort study enrolled neonates with SARS-CoV-2 infection from December 7, 2022, to January 3, 2023, and evaluated their clinical characteristics during hospitalization. All neonates (N = 58) infected with SARS-CoV-2 within 28 days of birth who were admitted to the neonatal intensive care unit of Taizhou Hospital were included. These neonates were classified into the early-onset (diagnosed within 7 days of birth) and late-onset (diagnosed more than 7 days after birth) groups. The symptoms, treatment, and prognosis of SARS-CoV-2 infection were the main study outcomes. The incidence of hospitalization attributable to SARS-CoV-2 infection was 10.6% (58 of 546 neonates) in Linhai. Sixteen (28%) of the 58 SARS-CoV-2 infections were early-onset cases, and 42 (72%) were late-onset cases. The common symptoms among the late-onset group were fever (p < 0.001) and cough (p < 0.001). Neonates with late-onset SARS-CoV-2 infection (p < 0.001) were significantly more likely to develop pneumonia.  Conclusion: The clinical symptoms and rates of pneumonia caused by SARS-CoV-2 infection in neonates differed between the early-onset and late-onset groups. Different clinical management is necessary for neonates with early-onset and late-onset SARS-CoV-2 infections. What is Known: • Neonates are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). • Differences in clinical characteristics of early-onset and late-onset SARS-CoV-2 infections in neonates remain unclear. What is New: • Fever and cough were the most common symptoms among neonates with late-onset infection. • Neonates with late-onset SARS-CoV-2 infection were more likely to develop pneumonia.

Possibility of intrauterine transmission from mother to fetus/newborn: Systematic review and meta-analysis of diagnostic methods to detect SARS-CoV-2 infection

Several studies have reported vertical transmission of SARS-CoV-2; however, information regarding intrauterine transmission based on diagnostic methods to detect SARS-CoV-2 infection is scarce. A systematic review and meta-analysis was conducted to identify and explore the studies that attempt to ascertain the possibility of intrauterine transmission of SARS-CoV-2 infection according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. The results demonstrate that SARS-CoV-2 can be transmitted intrauterine, as detected by clinical manifestations (1.00, 95 % CI: 1.00 - 1.00, 0.51, 95 % CI: 0.22 - 0.80), imaging (0.50, 95 % CI: 0.24 - 0.76, 0.03, 95 % CI: 0.00 - 0.17), molecular (1. 00, 95 % CI: 1.00 - 1.00, 0.92, 95 % CI: 0.77 - 1.00), immunological (0.32, 95 % CI: 0.10 - 0.57, 0.34, 95 % CI: 0.11 - 0.61), and histological approaches (0.79, 95 % CI: 0.52 - 0.98) in maternal and fetal/neonatal specimens, respectively. The possibility of intrauterine transmission of SARS-CoV-2 from mother to fetus/newborn was 41 % (95 % CI 0.37 - 0.45). We might confirm/verify the intrauterine transmission of SARS-CoCV-2 from mother to fetus/newborn.

Newborn Hospitalizations Before and During COVID-19 Pandemic in Poland: A Comparative Study Based on a National Hospital Registry

Objectives: There are limited data on the impact of the COVID-19 outbreak in Poland on newborn health. The aim of the study is to show recent information on hospitalizations of newborns in Poland in the pre-pandemic and COVID-19 pandemic era. Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized in 2017-2021. Results: The data on which the study was based consisted of a substantial number of 104,450 hospitalization records. Annual hospitalization rate was estimated to be 50.3-51.9 per 1,000 in 2017-2019, 56 per 1,000 in 2020 and it rose to 77.7 per 1,000 in 2021. In comparison to the pre-pandemic period, in the COVID-19 era, we observed significantly more hospitalization cases of newborns affected by maternal renal and urinary tract diseases (p < 0.001), syndrome of infant of mother with gestational diabetes (p < 0.001), maternal complications of pregnancy (p < 0.001). In the COVID-19 era, the prevalence of COVID-19 among newborns was 4.5 cases per 1,000 newborn hospitalizations. Conclusion: The COVID-19 pandemic outbreak could significantly contribute to qualitative and quantitative changes in hospitalizations among newborns.

Hybrid Diagnostic Model for Improved COVID-19 Detection in Lung Radiographs Using Deep and Traditional Features

A recently discovered coronavirus (COVID-19) poses a major danger to human life and health across the planet. The most important step in managing and combating COVID-19 is to accurately screen and diagnose affected people. The imaging technology of lung X-ray is a useful imaging identification/detection approach among them. The help of such computer-aided machines and diagnoses to examine lung X-ray images of COVID-19 instances can give supplemental assessment ideas to specialists, easing their workload to some level. The novel concept of this study is a hybridized approach merging pertinent manual features with deep spatial features for the classification of COVID-19. Further, we employed traditional transfer learning techniques in this investigation, utilizing four different pre-trained CNN-based deep learning models, with the Inception model showing a reasonably accurate result and a diagnosis accuracy of 82.17%. We provide a successful diagnostic approach that blends deep characteristics with machine learning classification to further increase clinical performance. It employs a complete diagnostic model. Two datasets were used to test the suggested approach, and it did quite well on several of them. On 1102 lung X-ray scans, the model was originally evaluated. The results of the experiments indicate that the suggested SVM model has a diagnostic accuracy of 95.57%. When compared to the Xception model's baseline, the diagnostic accuracy had risen by 17.58 percent. The sensitivity, specificity, and AUC of the proposed models were 95.37 percent, 95.39%, and 95.77%, respectively. To show the adaptability of our approach, we also verified our proposed model on other datasets. Finally, we arrived at results that were conclusive. When compared to research of a comparable kind, our suggested CNN model has a greater accuracy of classification and diagnostic effectiveness.

A multicentre study on the clinical characteristics of newborns infected with coronavirus disease 2019 during the omicron wave

Objective

To investigate the clinical characteristics and outcomes of newborns infected with coronavirus disease 2019 (COVID-19) during the Omicron wave.

Methods

From December 1, 2022, to January 4, 2023, clinical data were collected from neonates with COVID-19 who were admitted to 10 hospitals in Foshan City, China. Their epidemiological histories, clinical manifestations and outcomes were analysed. The neonates were divided into symptomatic and asymptomatic groups. The t test or χ2 test was used for comparisons between groups.

Results

A total of 286 children were diagnosed, including 166 males, 120 females, 273 full-term infants and 13 premature infants. They were 5.5 (0-30) days old on average when they were admitted to the hospital. These children had contact with patients who tested positive for COVID-19 and were infected through horizontal transmission. This study included 33 asymptomatic and 253 symptomatic patients, among whom 143 were diagnosed with upper respiratory tract infections and 110 were diagnosed with pneumonia. There were no severe or critical patients. Fever (220 patients) was the most common clinical manifestation, with a duration of 1.1 (1-6) days. The next most common clinical manifestations were cough with nasal congestion or runny nose (4 patients), cough (34 patients), poor appetite (7 patients), shortness of breath (15 patients), and poor general status (1 patient). There were no significant abnormalities in routine blood tests among the neonates infected with COVID-19 except for mononucleosis. However, compared with the asymptomatic group, in the symptomatic group, the leukocyte and neutrophil granulocyte counts were significantly decreased, and the monocyte count was significantly increased. C-reactive protein (CRP) levels were significantly increased (≥10 mg/L) in 9 patients. Myocardial enzyme, liver function, kidney function and other tests showed no obvious abnormalities.

Conclusions

In this study, neonates infected with the Omicron variant were asymptomatic or had mild disease. Symptomatic patients had lower leucocyte and neutrophil levels than asymptomatic patients.

[Clinical characteristics of neonates infected with the Omicron variant of SARS-CoV-2: a multicenter cross-sectional survey]

OBJECTIVES

To investigate the clinical characteristics of neonates infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

A cross-sectional survey was conducted on 542 hospitalized neonates with confirmed coronavirus disease 2019 (COVID-19) in 27 hospitals in Shenzhen from December 7, 2022, to January 12, 2023 (during the Omicron variant epidemic period). The neonates were divided into two groups: asymptomatic infection and symptomatic infection. The clinical characteristics, results of laboratory examination, chest X-ray findings, and outcome were compared between the two groups.

RESULTS

Among the 542 neonates, there were 285 males and 257 females. Among them, 515 (95.0%) were full-term infants, and 27 (5.0%) were preterm infants. The asymptomatic infection group had 60 cases, and the symptomatic infection group had 482 cases. Among them, 336 cases (69.7%) were mild, 125 cases (25.9%) were moderate, 15 cases (3.1%) were severe, and 6 cases (1.2%) were critical. Fever was the most common symptom (434 cases, 90.0%), followed by cough and/or spitting (183 cases, 38.0%), nasal congestion and/or runny nose (131 cases, 27.2%), shortness of breath (36 cases, 7.5%), and feeding intolerance (30 cases, 6.2%). Among the 325 cases who underwent chest X-ray examination, 136 cases (41.8%) had patchy or consolidative shadows in the lungs, 2 cases (0.6%) had pneumothorax, 2 cases (0.6%) had decreased lung transparency, and 185 cases (57.0%) showed no abnormality. Among the 396 cases (73.1%) who received treatment, 341 cases (86.1%) received symptomatic treatment, 137 cases (34.6%) received antibiotic treatment, 4 cases (1.0%) received immunoglobulin treatment, and 23 cases (5.8%) received respiratory support treatment. All 542 neonates were discharged from the hospital after their clinical symptoms were relieved, and the median hospital stay was 5 days. The white blood cell count, neutrophil count, hemoglobin, and procalcitonin were lower in the symptomatic infection group than those in the asymptomatic infection group (P<0.05), while the platelet count and blood glucose levels were higher in the symptomatic infection group than those in the asymptomatic infection group (P<0.05). The proportions of neonates with decreased neutrophil count, increased platelet count, and decreased hemoglobin concentration were higher in the symptomatic infection group than those in the asymptomatic group (P<0.05).

CONCLUSIONS

Most neonates with COVID-19 caused by the Omicron variant of SARS-CoV-2 are mild, with fever as the predominant symptom. Symptomatic neonates with COVID-19 are often accompanied by decreased neutrophil count, increased platelet count, and decreased hemoglobin level. Symptomatic treatment is the main treatment, and the prognosis is good.

Mother-to-child transmission of SARS-CoV-2 infection in high-income countries: a systematic review and meta-analysis of prospective observational studies

Mother-to-child transmission of SARS-CoV-2 has been reported since the onset of the COVID-19 pandemic. We conducted a study to summarize evidence on the risk of mother-to-child transmission in the first 30 days after birth in high-income countries and to evaluate the association between preventive measures and the risk of infection for the neonate. A systematic review and meta-analysis were undertaken following PRISMA guidelines. The National Library of Medicine, Web of Science, and Excerpta Medica databases were screened on February 26, 2022. All prospective observational studies addressing the frequency of infection in infants born to mothers SARS-CoV-2 positive were included. Twenty-six studies were included, reporting data of 2653 mothers with SARS-CoV-2 and 2677 neonates. The proportion meta-analysis pointed out an overall estimate of SARS-CoV-2 infection among infants of 2.3% (95% CI: 1.4-3.2%). Data from studies with (1.4%, 95% CI: 0.8-2) and without (1.3%, 95% CI: 0.0-2.7%) rooming-in provided similar risk of infection. Adopting at least two prevention measures during rooming-in resulted in a rate of mother-to-child infection of 1.0% (95%CI: 0.3-1.7%). The results of this study show a low rate of perinatal infection, support the rooming-in and confirm the effectiveness of preventive measures in reducing the risk of mother-to-child viral transmission.

[Clinical features of 23 neonates infected with Omicron variant of severe acute respiratory syndrome coronavirus 2]

OBJECTIVES

To summarize the clinical features of neonates infected with Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

The medical data of 23 neonates with Omicron variant of SARS-CoV-2 infection admitted to the City North Campus of Urumqi First People's Hospital from October to December 2022 were retrospectively reviewed.

RESULTS

All 23 infants had a history of exposure to confirmed caregivers with SARS-CoV-2 infection after birth, and none of them was vertically transmitted. Clinical classification: 5 cases of asymptomatic infection, 18 cases of mild infection, and no cases of moderate, severe, or critically ill. The first symptoms were fever in 13 cases, cough in 3 cases, nasal congestion in 1 case, and diarrhea in 1 case. Blood white blood cell counts decreased in 2 cases, and C-reactive protein increased in 1 case. Seven infants underwent chest X-ray examination due to cough or shortness of breath, and one of which showed focal exudative changes, while the rest showed no abnormal changes. All infants were discharged after symptomatic treatment and the median hospital stay was 6 days. The duration of nucleic acid positivity of SARS-CoV-2 was negatively correlated with N gene Ct values and ORF1ab gene Ct values (rs=-0.719 and -0.699, respectively; P<0.05). One month after discharge, all infants had no symptoms or signs of nucleic acid re-positivity.

CONCLUSIONS

The clinical manifestations are usually mild or asymptomatic in neonates infected with SARS-CoV-2 Omicron variant. The lower the Ct values of the N and ORF1ab genes of SARS-CoV-2, the longer the duration of nucleic acid positivity. Neonates infected with SARS-CoV-2 Omicron variant can have a good prognosis after symptomatic treatment.

Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate

The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.

Electrochemical paper-based antigen sensing platform using plant-derived monoclonal antibody for detecting SARS-CoV-2

The current approaches of diagnostic platforms for detecting SARS-CoV-2 infections mostly relied on adapting the existing technology. In this work, a simple and low-cost electrochemical sensing platform for detecting SAR-CoV-2 antigen was established. The proposed sensor combined the innovative disposable paper-based immunosensor and cost-effective plant-based anti-SARS-CoV-2 monoclonal antibody CR3022, expressed in Nicotiana benthamiana. The cellulose nanocrystal was modified on screen-printed graphene electrode to provide the abundant COOH functional groups on electrode surface, leading to the high ability for antibody immobilization. The quantification of the presence receptor binding domain (RBD) spike protein of SARS-CoV-2 was performed using differential pulse voltammetry by monitoring the changing current of [Fe(CN)₆]^3-/4- redox solution. The current change of [Fe(CN)₆]^3-/4- before and after the presence of target RBD could be clearly distinguished, providing a linear relationship with RBD concentration in the range from 0.1 pg/mL to 500 ng/mL with the minimum limit of detection of 2.0 fg/mL. The proposed platform was successfully applied to detect RBD in nasopharyngeal swab samples with satisfactory results. Furthermore, the paper-based immunosensor was extended to quantify the RBD level in spiked saliva samples, demonstrating the broadly applicability of this system. This electrochemical paper-based immunosensor has the potential to be employed as a point-of-care testing for COVID-19 diagnosis.

First Neonates with Vertical Transmission of SARS-CoV-2 Infection in Late Pregnancy in West Part of Romania: Case Series

The Coronavirus disease 2019 (COVID-19) pandemic has exposed the vulnerable neonatal population to unknown risks. Given that herd immunity is has not been reached, the entire population is susceptible to Severe Acute Respiratory Syndrome Coronavirus 2 Virus(SARS-CoV-2) infection. The arising concern about the vertical transmission of neonatal complications caused by the novel coronavirus is a continuous challenge for managing newborns, considering the rare cases and unclear guidelines. Therefore, a retrospective study was conducted in a tertiary unit from Timisoara, Romania. Of the 283 newborns born during the study period, only 3 neonates were diagnosed with SARS-CoV-2 infection in the first 24 h of life (DOL-0). The present study plans to identify the findings, including clinical features, laboratory characteristics, and outcomes of newborns with vertical transmission of SARS-CoV-2. All infected neonates were confirmed with COVID-19 by Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) from nasal aspirates and were isolated in the neonatology department. They were the first and the only neonate infected at birth from the West part of Romania. The clinical findings were unremarkable except for one neonate who developed mild respiratory distress syndrome. Elevated IgG-specific anti-SARS-CoV-2 serum levels were found in one newborn. Swab samples in DOL-0 strengthened the awareness of vertical transmission, although peripartum SARS-CoV-2 infection does not seem responsible for severe symptoms. We conclude that vertical transmission is rare in late pregnancy. Even if the studied newborns showed mild forms of COVID-19, it is essential to note that newborns represent a particular category of patients. More studies are needed to complete the observations of this study.

Extracorporeal membrane oxygenation in the care of a preterm infant with COVID-19 infection: Case report

Coronavirus disease 2019 (COVID-19) was first reported to the World Health Organization (WHO) in December 2019 and has since unleashed a global pandemic, with over 518 million cases as of May 10, 2022. Neonates represent a very small proportion of those patients. Among reported cases of neonates with symptomatic COVID-19 infection, the rates of hospitalization remain low. Most reported cases in infants and neonates are community acquired with mild symptoms, most commonly fever, rhinorrhea and cough. Very few require intensive care or invasive support for acute infection. We present a case of a 2-month-old former 26-week gestation infant with a birthweight of 915 grams and diagnoses of mild bronchopulmonary dysplasia and a small ventricular septal defect who developed acute respiratory decompensation due to COVID-19 infection. He required veno-arterial extracorporeal membrane oxygenation support for 23 days. Complications included liver and renal dysfunction and a head ultrasound notable for lentriculostriate vasculopathy, extra-axial space enlargement and patchy periventricular echogenicity. The patient was successfully decannulated to conventional mechanical ventilation with subsequent extubation to non-invasive respiratory support. He was discharged home at 6 months of age with supplemental oxygen via nasal cannula and gastrostomy tube feedings. He continues to receive outpatient developmental follow-up. To our knowledge, this is the first case report of a preterm infant during their initial hospitalization to survive ECMO for COVID-19.