Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

Abstract

A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70 and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother–neonate separation from birth is associated with late SARS-CoV-2 infection [OR 4.94 (95% CI: 1.98–13.08), p=0.0002; adjusted OR 6.6 (95% CI: 2.6–16), p<0.0001], while breastfeeding is not [OR 0.35 (95% CI: 0.09–1.18), p=0.10; adjusted OR 2.2 (95% CI: 0.7–6.5), p=0.148]. Our findings add to the literature on neonatal SARS-CoV-2 infections.