Article; Study country; Year of Publication [Reference no.]

Type of study

Sample size

(No. of neonates)

Main Findings

Conclusion

Al-Matary et al.; Saudi Arabia; 2021 [17]

Retrospective Cohort Study

204

・ Mean gestational age at delivery was 39 weeks (IQR 35 - 40).

・ The majority of neonates had normal laboratory results.

・ 43% of neonates admitted to NICU.

・ 7% of neonates required mechanical ventilation.

・ None of neonatal COVID-19 infections was detected.

・ 4 neonatal deaths were reported.

There was no evidence of vertical transmission of COVID-19 infection.

Angelidou et al.; USA; 2021 [18]

Retrospective Cohort Study

255

・ 225 (88.2%) neonates were tested for COVID-19 infection and 2.2% were tested positive.

・ High maternal social vulnerability increased the likelihood of neonatal COVID-19 test positivity (adjusted odds ratio, 4.95; 95% CI, 1.53 - 16.01; p = 0.008).

・ Adverse neonatal outcomes were observed among preterm deliveries due to worsening maternal COVID-19 symptoms.

・ 1 positive result of COVID-19 testing was reported from the follow-up data of 151 newborns.

Maternal biological and social factors affect the perinatal outcomes of COVID-19 infections.

Gabriel et al.; Spain; 2020 [19]

Retrospective Cohort Study

248

・ Maternal admission for COVID-19 infection increased the risk of premature delivery (p = 0.006).

・ 115 (46.3%) neonates were admitted to the neonatal unit with 87 admissions due to organizational difficulties.

・ None of neonatal COVID-19 infections nor neonatal deaths was detected.

・ Exclusive breastfeeding rate at discharge and 1-month was 41.7% and 40.4% respectively.

Vertical transmission of COVID-19 was not detected during delivery and up to the newborns’ first month of life. Exclusive breastfeeding was less frequent than expected.

Gupta et al.; India; 2021 [20]

Retrospective Cohort Study

108

・ Mothers with positive RT-PCR test results for COVID-19 were associated with statistically significant higher rates of prematurity, lower mean birth weight, lower Apgar score and increased prevalence of foetal distress when compared to pregnant women with negative test results.

・ None of neonatal COVID-19 infections was detected.

COVID-19 infection can lead to adverse maternal and perinatal outcomes. Mother-to-child vertical transmission of COVID-19 infection may be possible.

Hcini et al.; France; 2020 [21]

Prospective Cohort Study

127

・ Infected mothers were associated with higher rates of intrauterine foetal demise as compared to controls (5.1% vs. 1.1%, RR 4.7 [95% CI: 1.4 - 45.9).

・ None of neonatal COVID-19 infections was detected at birth (0/108).

・ Among 29 neonates who were tested again between 25 to 42 hours of life, 4 had positive test results for COVID-19 and remained asymptomatic.

Infected pregnant women were at higher risk of intrauterine foetal demise than those uninfected mothers.

Khoury et al.; USA; 2020 [22]

Prospective Cohort Study

245

・ 2.5% of neonates had positive test results for COVID-19 infection immediately after birth.

・ Maternal COVID-19 severity was linked to BMI 30 or higher (p = 0.001).

・ Cesarean delivery was done for 52.4% of women with severe and 91.7% with critical COVID-19.

Disease severity was associated with obesity and higher cesarean birth rates.

Malik et al.; India; 2021 [23]

Database Analysis

524

・ 6.3% of the neonates to mothers with COVID-19 were tested positive for SARS-CoV-2.

・ Infected neonates had a 4.09 [95% CI 1.28 - 13.00] fold higher risk to develop sepsis as compared to the non-infected newborns (p = 0.031).

・ Infected neonates were significantly more likely to experience poor feeding as compared to the non-infected newborns (p = 0.017).

・ A total of 13 neonatal deaths was reported with 3 deaths from the COVID-19 infected group.

There is an increased risk of adverse neonatal outcomes, including sepsis and death for the newborns infected with COVID-19 as compared to the non-infected.

Maraschini et al.; Italy; 2020 [24]

Prospective Cohort Study

149

・ 6% of neonates had positive test results for COVID-19 infection at birth.

・ Neonatal mortality was not reported.

Clinical features and outcomes of COVID-19 in pregnant women had similar clinical features and outcomes of COVID-19 as the general population

Norman et al.; Sweden; 2021 [25]

Prospective Cohort Study

2323

・ Maternal SARS-CoV-2 test positivity was significantly associated with higher rates of neonatal care admission, neonatal morbidities such as respiratory distress syndrome, any neonatal respiratory disorder, and hyperbilirubinemia.

・ 0.9% of the newborns to mothers with COVID-19 were tested positive for SARS-CoV-2 in the neonatal period, of those 9 had diagnoses with unclear relation to COVID-19.

Pregnant women with COVID-19 infection had a significant but slightly increased risk for some neonatal morbidities.

Oncel et al.; Turkey; 2021 [26]

Prospective Cohort Study

125

・ Cesarean delivery, prematurity, and low birthweight rates were 71.2%, 26.4%, and 12.8%, respectively.

・ Most newborns (86.4%) were admitted to the isolation rooms in NICU.

・ 3.3% of neonates had positive test results for COVID-19 infection at birth, including one sampling of deep tracheal aspirate from an intubated newborn.

・ A total of 3 neonates were detected for SARS-CoV-2 after negative test results on the first day of life.

Maternal COVID-19 infection was associated with maternal mortality, increased rates of cesarean delivery and preterm birth, suspected possibility of vertical transmission, and low breastfeeding rate.

Saccone et al.; Multinational; 2021 [27]

Retrospective Cohort Study

251

・ Neonatal ICU admission rate was 27.5%.

・ Five (2.0%) neonatal deaths were reported.

・ The overall perinatal mortality rate was 4.1%.

・ Only one (0.4%) infant, born to a mother with COVID-19 diagnosed during the third trimester, had positive RT-PCR test results for SARS-CoV-2.

There is negligible risk for vertical transmission of COVID-19.

Sánchez-Luna et al.; Spain; 2021 [28]

Prospective Cohort Study

503

・ The most frequently performed diagnostic test for neonatal COVID-19 infection was RT-PCR test at a median age of 3 hours after birth.

・ Almost one-half of neonates had skin-to-skin contact with mothers after delivery.

・ Delayed umbilical cord clamping was performed in 43% of newborns.

・ Rooming-in was allowed in 62.3% of asymptomatic neonates.

・ 76.5% of neonates received maternal milk, with 204 of them exclusively breastfed.

There is no role of mothers-newborn separation. Delayed cord clamping, skin-to-skin contact and breastfeeding were allowed in the majority of newborns to COVID-19 infected mothers.

Singh et al.; India; 2021 [29]

Retrospective Cohort Study

121

・ The mean birth weight was reported as 2.59 kg.

・ Forty (33.05%) newborns were admitted to NICU.

・ Two neonates (1.65%) were detected for SARS-CoV-2 infection within the first day of life.

COVID-19 in pregnancy is associated with increased rates of prematurity and NICU admission. Perinatal mortality remains uncommon. The incidence of neonatal SARS-CoV-2 infection is low and most cases were asymptomatic, yet suggesting the possibility of vertical transmission.