Epidemiology and Clinical Features of COVID-19 among 4,015 Neonates in Iran: Results of the National Study from the Iranian Maternal and Neonatal Network.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on pregnant women and neonates in Iran. This retrospective study describes the national experience among neonates having suspected and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection following hospital admission to examine the epidemiology, demographic, and clinical features. STUDY DESIGN: All nationwide cases of suspected and confirmed neonatal SARS-CoV-2 infection were drawn from the Iranian Maternal and Neonatal Network (IMaN) between February 2020 and February 2021. IMaN registers demographic, maternal, and neonatal health data throughout Iran. Statistical analysis of demographic, epidemiological, and clinical data were performed. RESULTS: There were 4,015 liveborn neonates having suspected or confirmed SARS-CoV-2 infection that fulfilled the study inclusion criteria identified in the IMaN registry from 187 hospitals throughout Iran. There were 1,392 (34.6%) neonates that were preterm, including 304 (7.6%) less than 32 weeks' gestation. Among the 2,567 newborns admitted to the hospital immediately after birth, the most common clinical problems were respiratory distress (1,095 cases; 42.6%), sepsis-like syndrome (355; 13.8%), and cyanosis (300 cases; 11.6%). Of 683 neonates transferred from another hospital, the most frequent problems were respiratory distress (388; 56.8%), sepsis-like syndrome (152; 22.2%), and cyanosis (134; 19.6%). Among 765 neonates discharged home after birth and subsequently admitted to the hospital, sepsis-like syndrome (244 cases; 31.8%), fever (210; 27.4%), and respiratory distress (185; 24.1%) were most frequent. A total of 2,331 (58%) of neonates required respiratory care, with 2,044 surviving and 287 having a neonatal death. Approximately 55% of surviving neonates received respiratory support, compared with 97% of neonates who expired. Laboratory abnormalities included elevations of white blood cell count, creatine phosphokinase, liver enzymes, and C-reactive protein. CONCLUSION: This report adds the national experience of Iran to the list of reports from multiple countries describing their experience with COVID-19 in neonates, demonstrating that newborns are not exempt from COVID-19-morbidity and mortality. KEY POINTS: · Most common clinical problem was respiratory distress.. · Sepsis-like syndrome was also frequently present.. · A total of 58% of all neonates required respiratory care..

Spectrum of neonatal COVID-19 in Iran: 19 infants with SARS-CoV-2 perinatal infections with varying test results, clinical findings and outcomes.

BACKGROUND: There have been few cohorts of neonates with coronavirus disease-2019 (COVID-19) reported. As a result, there remains much to be learned about mechanisms of neonatal infection including potential vertical transmission, best methods of testing, and the spectrum of clinical findings. This communication describes the epidemiology, diagnostic test results and clinical findings of neonatal COVID-19 during the pandemic in Iran. MATERIALS AND METHODS: This is a retrospective cohort study of 19 neonates infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 10 hospitals throughout Iran. We analyzed obstetrical information, familial COVID-19 status, neonatal medical findings, perinatal complications, hospital readmissions, patterns of repeated testing, and clinical outcomes. RESULTS: Eleven neonates had family members infected. Five mothers were negative for COVID-19 and four neonates had no identifiable family source of infection. The neonatal mortality rate from COVID-19 was 10%. Seven newborns (37%) were discharged from the hospital as healthy but required readmission for symptoms of COVID-19. There were 2 multifetal gestations - one set each of twins and triplets, each with disparate testing and clinical outcomes. Premature delivery was common, occurring in 12 of 19 infants (63%). Initial testing for COVID-19 was negative in 4 of the 19 neonates (21%) who subsequently became positive. In 2 cases, neonates tested positive at 1 and 2 h after birth which was suspicious for vertical transmission of SARS-CoV-2. CONCLUSIONS: These cases have notable variation in the epidemiology, clinical features, results of testing and clinical outcomes among the infected newborns. Neonates initially testing negative for COVID-19 may require readmission due to infection. Two neonates were highly suspicious for intrauterine vertical transmission. Repeat testing of neonates who initially test negative for COVID-19 is recommended, without which 21% of neonatal infections would have been undiagnosed.

Confirming Vertical Fetal Infection With Coronavirus Disease 2019: Neonatal and Pathology Criteria for Early Onset and Transplacental Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Infected Pregnant Mothers.

Increasing numbers of pregnant women with coronavirus disease 2019 are being reported around the world. The majority of neonates delivered to pregnant women infected with severe acute respiratory syndrome coronavirus 2 have been negative for the virus, but a small number have tested positive for infection. It is important to determine whether vertical transmission of coronavirus disease 2019 occurs and the mechanisms for its development. Based on a number of clinical and laboratory findings, it has been suggested that transplacental transmission may be occurring, but a method to confirm this is necessary. This communication analyzes and evaluates the covariables that have been discussed as potential indicators of vertical and, specifically, intrauterine transmission, including the timing of onset of neonatal illness, neonatal viral test positivity, neonatal antibody testing for immunoglobulin (Ig) G and IgM, and viral analysis of swabs of whole specimens of placental tissue. None of these methods can provide confirmatory evidence that infection developed prior to labor and delivery, or that transplacental transmission occurred. This commentary proposes that diagnosis of early-onset neonatal coronavirus disease 2019 infection should be limited to neonates with positive reverse transcription polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 within the initial 72 hours of life. It also proposes that the occurrence of intrauterine transplacental severe acute respiratory syndrome coronavirus 2 among infected mother-infant dyads be based upon identification of severe acute respiratory syndrome coronavirus 2 in chorionic villus cells using immunohistochemistry or nucleic acid methods such as in situ hybridization. Evaluating placentas from neonates with coronavirus disease 2019 using these methods will be instrumental in determining the potential role and prevalence of transplacental transmission of the coronavirus.