The incidence rate, distribution, characteristics and outcomes of neonatal COVID-19


In a recent study published in the Pediatrics journal, researchers assessed the epidemiology of neonatal coronavirus 2019 (COVID-19) infections.

Study: Epidemiology of neonatal COVID-19 in the United States. Image Credit: Iryna Inshyna/Shutterstock


Neonatal populations have lower COVID-19 infection rates than adult and pediatric populations, likely due to innate protective mechanisms. While newborns with symptoms may require intensive care unit (ICU) admission, most patients have satisfactory spontaneous breathing with minimal symptoms of COVID-19. Although rare, community-acquired COVID-19 in newborns is becoming more common due to emerging highly transmissible variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

About the study

In the present study, researchers explored the incidence, manifestation, and clinical outcomes of neonatal SARS-CoV-2 infections.

Retrospective neonatal data from Cerner® Real-World data was used in this cross-sectional study (CRWD). It consisted of clinical information, including demographics, interactions, diseases, test results, and clinical events. More than 153 million people were included in the third quarter 2021 edition of CRWD, spanning all care settings and ages. Data for newborns with a positive diagnosis of COVID-19 between birth and 28 days after birth were extracted.

Data collection began with neonatal COVID-19 infections, which served as the starting point. Newborns who tested positive for SARS-CoV-2 infection and aged less than 28 days were included. SARS-CoV-2 testing and coding for newborns was done according to the guidelines of each particular health system. Incidence of severe disease, regional distribution of infection, and type of treatment given were considered the primary outcomes of interest. The incidence of COVID-19 infection in neonates in the United States, as recorded in the CRWD, was the secondary outcome.

Cases that met at least two of the following criteria were considered to have severe disease: (1) Cases with any of the following symptoms, including fever, apnea, cough, tachypnea or difficulty breathing, vomiting or diarrhea, need oxygen, distress or recession; (2) any combination of the following among low white blood cell (WBC) count, low lymphocyte count, or high c-reactive protein (CRP) level; and (3) a questionable chest X-ray.

The diagnosis of pneumonia was used as a substitute for an abnormal chest X-ray. In addition, comorbidities and demographic information were collected. Neonatal geographic distribution of COVID-19 based on patient postal code prefix as well as medication consumption including antivirals, antibiotics, corticosteroids, immunoglobulins, convalescent plasma (CCP), and inotropes/vasopressors , were evaluated.


Between March 2020 and February 2021, 918 neonates were diagnosed with SARS-CoV-2 infection, including 77% who met the requirements for severe COVID-19 infection. The team noted that 3.40 kg was the average weight of newborns at admission, with the median age at hospital admission ranging from 11 to 22 days for all newborns and 15 to 22 days for those with severe COVID-19. For all neonates, the median time to diagnosis was 14.5 days, and for those with severe infection, it was 20 days. In the severe infections cohort, there was a higher percentage of newborns with low birth weight or early birth compared to the non-severe category.

Additionally, comorbidities were more likely in newborns diagnosed with severe COVID-19. Nearly 46.5% of people with severe COVID-19 had at least one comorbidity, with birth defects accounting for 38% of all cases and cardiac irregularities reported in 17% of cases. Possible sepsis was noted in 24% of neonates, biliary obstruction in 28.2%, and anemia requiring transfusion in 7.0% of neonates.

About 7.4% of newborns with mild COVID-19 were preterm, and their birth weights ranged from 500 to 2,499 g. Birth defects were noted in 25.5% of all neonates. Notably, 63.5% of newborns initially presented to the hospital had no symptoms and no signs of infection. Tachypnea and fever were the most typical symptoms of infection, with 28.2% of infants with severe COVID-19 infection having pneumonia. Additionally, higher CRP levels were more likely in people with severe COVID-19, along with fewer platelets and lower albumin levels.


Study results showed that while neonatal rates of COVID-19 were low, severe presentations and deaths were rare. Few infants required respiratory support or additional treatment, while most were asymptomatic. Interestingly, the timing of diagnosis suggested nosocomial or community-acquired infection. Researchers believe it would be beneficial to examine how congenital disabilities affect COVID-19.


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