Clinical Outcome of Neonates Born to SARS-CoV-2 Positive Mothers in India: A Systematic Review and Meta-Analysis

Abstract

During the SARS-CoV-2 pandemic, India accounted for 10-50% of cases reported across the world. Perinatal care from a developing country during this period has its own importance. This study was conducted to evaluate the health outcome of neonates born to SARS-CoV-2 positive mothers in India from the published literature by a systematic review and meta-analysis. Articles reporting neonates born from SARS-CoV-2 confirmed mothers in India, published in PubMed, Scopus®, and Embase® databases, were analyzed. After registration with the International Prospective Register of Systematic Reviews (PROSPERO), the study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcomes were the mode of delivery, perinatal asphyxia, preterm birth, breastfeeding, neonatal mortality, SARS-CoV-2 infectivity among neonates of SARS-CoV-2 mothers. The pooled rate was expressed with a 95% confidence interval. Heterogeneity and study level effect size were assessed using I² statistics and DerSimonian and Laird random effect method of meta-analysis. Data analysis was made by Stata 15.1 (StataCorp LLC, College Station, Texas, USA). Total 3,551 neonates born from 3,542 SARS-CoV-2 positive mothers were included from 14 studies (four prospective and 10 retrospective studies). The pooled rates of premature birth, Caesarean delivery, breastfeeding, and neonatal mortality were 18.89%, 55.89%, 67.79%, respectively, with 12.64/1000 live births. SARS-CoV-2 positivity rate was 5.28%; 11.76% were symptomatic, and five (1.7%) died from 281 SARS-CoV-2 positive neonates. There was an increase in the number of Caesarean delivery, premature birth, and lower mortality among neonates born to SARS-CoV-2 positive mothers compared to the Indian neonatal database. Around five percent of neonates delivered to SARS-CoV-2 positive mothers were infected, and the majority of them had good clinical outcomes.