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Do Neonates with COVID-19 Infection Get Severely Ill?

September 16, 2022

Although we continue to learn increasingly more about the myriad presentations of infection with SARS-CoV-2, there has not been much published about infection during the neonatal (up to 28 days of life) period.

This week, Pediatrics is early releasing an article by Joan Devin, PhD and colleagues from Children’s Health of Orange County (California) entitled, “Epidemiology of Neonatal COVID-19 in the United States” (10.1542/peds.2022-056297), which starts to fill this gap.

The authors reviewed electronic health record data from March 2020 through February 2021 on neonates (28 days or younger) who either had a positive laboratory-confirmed COVID-19 test or an ICD-10 diagnosis code for COVID-19.

Severe illness was defined as having at least two of the following three criteria:

  • Any of the following: fever (>37.5 degrees C), apnea, cough, tachypnea, respiratory distress, need for supplemental oxygen, vomiting or diarrhea
  • Any of the following: Low white blood cell count (<5x109/L), low lymphocyte count (<1x109/L), or elevated C-reative protein (>5 mg/L)
  • Abnormal chest xray or diagnosis of pneumonia

A total of 918 neonates had COVID-19 infection. The median age at the time of diagnosis was 14.5 days. Nearly two-thirds (63.5%) were asymptomatic, and the most common symptoms were tachypnea and fever.

Nearly 8% of the neonates with COVID-19 infection met the criteria for severe illness; these infants were more likely to have low birthweight, preterm delivery, and co-morbidities, including congenital (particularly cardiac) anomalies. 11% of those with severe illness required mechanical ventilation. One infant had symptoms suggestive of multisystem inflammatory syndrome in children (MIS-C); this infant was the only one in this sample who died.

Unfortunately, there is no information about the mode of transmission (for example, there are no data about COVID-19 status during pregnancy or among family members) or about COVID-19 vaccination during pregnancy. However, there is a lot of data about these neonates in this article that cannot be covered in this blog, and I urge you to link to it and learn more.

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