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1206 Figure 1Weekly number of neonates admitted who have confirmed SARS-CoV-2 by date of diagnosis, UK, 1st March 2020 to 7th November 2021[Figure omitted. See PDF] 1206 Table 1Maternal and neonatal mortality in association with SARS-CoV-2 infection, UK 01/03/2020-31/10/2021ConclusionUsing population level surveillance data we describe neonatal complications directly and indirectly attributable to SARS-CoV-2 infection during the first three pandemic waves. This study demonstrates the low risk to neonates despite the emergence of new variants. Continued surveillance will allow the impacts of new variants on the neonatal population to be characterised.ReferencesGale C, Quigley MA, Placzek A, et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. Lancet Child Adolesc Heal 2021;5:113–21.Vousden N, Ramakrishnan R, Bunch K, et al. Impact of SARS-CoV-2 variant on the severity of maternal infection and perinatal outcomes: Data from the UK Obstetric Surveillance System national cohort. Medrvix 2021. doi:10.1101/2021.07.22.21261000.Knight M, Kurinczuk JJ, Tuffnell D, Brocklehurst P. The UK Obstetric Surveillance System for raredisorders of pregnancy. BJOG An Int J Obstet Gynaecol 2005;112:263–5.
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Objectives Identify the association between maternal SARS-CoV-2 infection in pregnancy and individual neonatal morbidities and outcomes, particularly longer-term outcomes such as neurodevelopment. Setting Case-control and cohort studies from any location published after 1st January 2020, including pre-print articles. Participants Neonates born to pregnant women diagnosed with a SARS-CoV-2 infection at any stage during pregnancy, including asymptomatic women. Primary and secondary outcome measures Neonatal mortality and morbidity, including preterm birth, Caesarean delivery, small for gestational age, admission to neonatal intensive care unit, level of respiratory support required, diagnosis of culture-positive sepsis, evidence of brain injury, necrotising enterocolitis, visual or hearing impairment, neurodevelopmental outcomes, and feeding method. These outcomes were selected according to a Core Outcome Set developed between health professionals, researchers and parents. Results The search returned 3234 papers, from which 204 were included with a total of 45,646 infants born to mothers with SARS-CoV-2 infection during pregnancy across 36 countries. We found limited evidence of an increased risk of some neonatal morbidities, including respiratory disease. There was minimal evidence from low-income settings (1 study) and for neonatal outcomes following first trimester infection (17 studies). Neonatal mortality was very rare. Preterm birth, neonatal unit admission and small for gestational age status were more common in infants born following maternal SARS-CoV-2 infection in pregnancy in most larger studies. Conclusions There is limited data on neonatal morbidity and mortality following maternal SARS-CoV-2 infection in pregnancy, particularly from low-income countries and following early pregnancy infections. Large, representative studies addressing these outcomes are needed to better understand the consequences for babies born to women with SARS-CoV-2 in pregnancy. Trial registration PROSPERO ID: CRD42021249818 Strengths and limitations Inclusion of studies of both asymptomatic and symptomatic SARS-CoV-2 infections at any point in pregnancy to maximise generalisability of findings Focus on neonatal outcomes, as opposed to purely obstetric outcomes, to accurately quantify neonatal morbidity Study is limited by available data; important data gap in low-income settings