Increased Resuscitation Need Among Neonates Born To COVID-19
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The knowledge about the epidemiology, clinical characteristics, prevention, and treatment of SARS-CoV-2 infection is continually evolving. Limited evidence exists on the perinatal transmission and the management of SARS-CoV-2 infection among newborns, especially from the developing world.

In this prospective cohort study, data was collected from NNF COVID-19 registry which included 1711 neonates constituting 1589 intramural neonates and 122 extramural neonates. Out of 1589 intramural neonates, 259 were excluded as testing was not done , hence 1330 neonates were analysed in this group. All neonates were monitored for clinical symptoms for the first seven days after birth and for as long as the mother was admitted to the hospital.

The primary outcome measures were- the incidence of perinatal transmission; and the rates of SARS-CoV-2 virus positivity in the neonates in association with mode of delivery, type of feeding and care practices. The secondary outcomes were respiratory morbidities, the need for respiratory support, and mortality in these infants.

Major findings of the study are:

-Researchers found a significantly higher incidence of perinatal transmission than that reported in recent reviews as evidenced by 143(10.8%) neonates being positive in the present study.

-Amongst the intramural newborn infants, 106 (8%) were positive for SARS-CoV-2 within 72 hours and 21 (1.5%) beyond 72 hours of birth.

-The risk of transmission was not associated with mode of delivery or type of feeding.

-Premature delivery rate(20.7%) was high among COVID positive mothers which is similar to other studies.

-SARS-CoV-2 positive neonates were five times more likely to be symptomatic and twice more likely to need resuscitation. Also the need for NICU admission , surfactant therapy and inotropic support was higher among COVID infected neonates.

SARS-CoV2 infection may have a varied presentation in neonates but respiratory distress and sepsis like features were most reported in this study. Some of the variations in NICU admission rates may be due to local protocols for admission and isolation rather than due to the illness per se. Prematurity is an obvious confounder for higher respiratory and other morbidities in the SARS- CoV-2 positive group.

Authors conclude-"Breastfeeding and rooming-in seem to be safe but require compliance with additional precautions".

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