Outcome of Covid-19 Positive Newborns Presenting to a Tertiary Care Hospital

Of interest to note was case 7, first of a pair of twins admitted for meconium aspiration syndrome and late onset Pseudomonas aeruginosa sepsis. Baby had persistent thrombocytopenia despite two weeks of appropriate antibiotics treatment, and clearance of bacteria on repeat blood, cerebrospinal fluid, urine and endotracheal cultures. She developed ascites, cholestasis, elevated lactate dehydrogenase (13,700 U/L), deranged coagulation profile and elevated Interleukin-6 (13.58 pg/ mL). She required invasive mechanical ventilation, inotrope support, intravenous immunoglobulin and low molecular weight heparin. Upon retesting, baby continued to show SARS-CoV-2 positivity till day 21, and died on day 28. Multisystem inflammatory syndrome (MIS-C) was suspected in this case [1,2].

Fifteen neonates survived and were discharged home, and three died after 2-28 days of stay. Median (IQR) duration of hospital stay was 10 (9,16) days. Retesting was done as per protocol for 14 babies (remaining three became asymptomatic, and one died). Eight babies were negative on first retest, one on second retest (one succumbed before second) and four continued to be positive after third retest. Of the four babies who continued to test positive, three were critically sick and required ventilation and intensive care stay for more than 2 weeks.

Upon contact-tracing, 9 mothers and 1 caretaker (paternal aunt) were positive. Three of the positive mothers tested negative prior to delivery but tested positive on re-screen. Only one mother was symptomatic with fever. No contact was identifiable in 8 babies which may imply low viral load in the caregivers.

We, herein, highlight the clinico-demographic details and outcomes of SARS-CoV-2 positive neonates presenting to the outborn unit of a tertiary care pediatric hospital. All positive neonates in our study were symptomatic and respiratory symptoms were the most common. Fever was seen in one-sixth, unlike children and adults where fever is a predominant symptom [3-6]. Like older children, the overall prognosis of SARS-CoV-2 infection in neonates is better than adults [3-8], unless they have other co-morbidities e.g., total anomalous pulmonary various connection or polycystic kidney disease with renal failure seen in our series. Though systematic reviews attribute neonatal symptoms to COVID-19, most of our cases had symptoms which could be explained by neonatal illnesses [5].

A limitation of our study was that viral titers were not done. Neonates who remained PCR-positive for a long duration may imply a higher viral load. Although the frequency of SARS-CoV-2-positive neonates is extremely low, a significant proportion of the affected neonates requiring intensive care and mechanical ventilation suggests that the disease in neonates is more severe than older children [3-8], which correlates with our study as well.

Contributors: BS, SR, VD, SP, MB: conceived, designed the study, finalized the manuscript; BS,VD,SR: data collection, data analysis, writing manuscript; BS,VD,SR,SP: data collection, data analysis, managed the babies; BS,VD,SR,SP: Literature search, interpretation of data, writing manuscript.

Ethic clearance: IEC - Bai Jerbai Wadia Hospital for Children; No. IEC-BJWHC/88/2020 dated 26 August, 2020.

Funding: None; Competing interests: None stated.

8. Bernado G, Giordano M, Zollo G, et al. The clinical course of SARS-CoV-2 positive neonates. J Perinatol. 2020;40:1462-69.