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Perinatal COVID-19: review of current evidence and practical approach towards prevention and management
Venkateshwarlu Vardhelli1, Aakash Pandita2, Anish Pillai3
1Fernandez Hospital, Hyderabad, Telangana, India.
Insights
Perinatal COVID-19 generally results in mild illness for neonates, with most cases being asymptomatic. Respiratory distress is the most common symptom, but outcomes are typically favorable, and precautions allow safe breastfeeding and skin-to-skin contact.
Area of Science:
- Neonatology
- Infectious Diseases
- Public Health
Background:
- Limited data exists on perinatal COVID-19 and neonatal outcomes.
- Existing literature primarily consists of case series and single-center experiences.
- Understanding clinical spectrum and management is crucial.
Purpose of the Study:
- To summarize the clinical spectrum of COVID-19 in neonates and mothers.
- To review prospective data on neonatal outcomes.
- To suggest a practical management approach for perinatal COVID-19 scenarios.
Main Methods:
- Comprehensive literature search of PubMed, Google Scholar, and Cochrane Database (Nov 2019 - June 2020).
- Inclusion of articles on perinatal COVID-19.
- Synthesis of data from 786 mothers and 793 neonates.
Main Results:
- 14% of neonates were born preterm; 5.5% tested positive for COVID-19.
- Respiratory distress was the most common symptom in neonates (7.6% required respiratory support).
- COVID-19 in neonates generally has favorable outcomes, with most being asymptomatic.
Conclusions:
- Neonatal COVID-19 is typically mild with favorable outcomes.
- Vertical transmission is a possible route of infection.
- Breastfeeding and skin-to-skin contact are safe with appropriate precautions.
Abstract:
The clinical spectrum of the perinatal COVID-19 and prospective data on neonatal outcomes remains largely unexplored. Most of the existing literature is in the form of case series or single-centre experience. In this review, we aim to summarize available literature on the clinical spectrum of COVID-19 in neonates and mothers and suggest a practical approach towards management of clinical scenarios. This review explores the clinical characteristics and outcomes of COVID-19 in neonates born to mothers who were detected with the virus during the pregnancy. We conducted a comprehensive search of PubMed, Google Scholar and Cochrane Database of Systematic Review between November 2019 and June 2020 and screened articles related to perinatal COVID-19. This review included 786 mothers, among which 64% (504) were delivered by caesarian section. There were 3 still births and 107 (14%) were delivered preterm. Out of 793 neonates born, 629 neonates (79%) were tested after birth. The commonest symptom in neonates was respiratory distress. Respiratory support was needed in 60 neonates (7.6%), with 14 babies needing mechanical ventilation (1.8%), 25 needing non-invasive ventilation and 21 needing nasal oxygen. Only 35 of the 629 tested neonates (5.5%) were positive for COVID-19. Of the 35 positive neonates, 14 (40%) were symptomatic. The COVID-19 seems to have favourable neonatal outcomes. Majority of neonates are asymptomatic. Respiratory distress is the most common manifestation. What is known: •COVID-19 affects all ages. •Neonatal disease is usually mild. What is new: •Vertical transmission is a possible route of infection in neonates. •Breast milk and skin-to-skin contact are safe in COVID-19-infected mothers if performed with appropriate use of precautions such as hand and breast hygiene and masking.
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