As the coronavirus disease 2019 (COVID-19) pandemic continues, its impact on newborns remains uncertain. Early reports from China suggested that although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could be associated with adverse pregnancy outcomes, newborns did not appear to show clinical signs of infection and had negative viral testing results.1,2 More recent reports suggest that, although low, risk of neonatal infection does exist. A recent (as we write this commentary) review identified 27 publications describing 217 newborns born to mothers with COVID-19, of which 21 publications describing 187 newborns were from China.3 Of the 217 newborns, 7 (3%) had evidence of SARS-CoV-2 infection: 3 had positive serum levels of immunoglobulin G and immunoglobulin M antibodies with negative polymerase chain reaction (PCR) test results, and 4 had positive PCR test results. Beyond the immediate postnatal period, in several case studies, authors report positive SARS-CoV-2 test results in symptomatic newborns in the first month of life, and new reports are published frequently.3–7 The mechanism of neonatal infection is unclear. Vertical transmission during pregnancy is not thought to be likely; SARS-CoV-2 test results on placenta, umbilical cord, amniotic fluid, vaginal secretions, and breast milk samples have uniformly been negative.8 More likely is postnatal infection through horizontal transmission.
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