COVID-19 diagnosed in 0.1 percent of neonates

Few neonates have severe acute respiratory syndrome coronavirus 2 infection, and most are asymptomatic or develop mild illness, according to a study published online Aug. 23 in Pediatrics.

Joan Devin, from Children's Health of Orange County in California, and colleagues described the incidence, presentation, and clinical outcomes of neonatal COVID-19. Data were included for more than 1 million neonatal encounters at 109 U.S. health systems from March 2020 to February 2021.

The researchers found that COVID-19 was diagnosed in 0.1 percent of neonates (91.1/100,000 encounters), of whom 7.7 percent had severe infection (7/100,000). There was a median of 14.5 days from birth to diagnosis. Tachypnea and fever were common signs of infection. The likelihood of receiving respiratory support was increased among those with severe infection (50.7 versus 5.2 percent). Severely ill neonates received analgesia, antibiotics, anticoagulants, corticosteroids, remdesivir, and COVID-19 convalescent plasma (38.0, 33.8, 32.4, 26.8, 2.8, and 1.4 percent, respectively). Overall, 93.6 and 1.1 percent of neonates were discharged home and transferred to another hospital, respectively; for 5.2 percent, discharge disposition was unknown. One neonate (0.1 percent) died after 11 days of hospitalization; presentation was suggestive of multisystem inflammatory syndrome in children.

"Neonatal COVID-19 rates are low, with severe presentation and death possible although rare," the authors write. "Most neonates were asymptomatic or developed mild illness, with few requiring respiratory support or adjunct medication."