Data on COVID-19 infections in neonates are limited. We aimed to identify and describe the incidence, presentation, and clinical outcomes of neonatal COVID-19.

Over 1 million neonatal encounters at 109 US health systems, from March 2020 to February 2021, were extracted from the Cerner® Real World Database. COVID-19 diagnosis was assessed using SARS-CoV-2 laboratory tests and diagnosis codes. Neonates were defined as patients aged ≤28 days on hospital admission. Incidence of COVID-19 per 100,000 encounters was estimated.

COVID-19 was diagnosed in 918 (0.1%) neonates (or 91.1/100,000 encounters [95% CI 85.3 – 97.2]). Of these, 71 (7.7%) had severe infection (7/100,000 [95% CI 5.5 – 8.9]). Median time to diagnosis was 14.5 days from birth (interquartile ratio 3.1 – 24.2). Common signs of infection were tachypnea and fever. Those with severe infection were more likely to receive respiratory support (50.7% vs 5.2%, p <0.001). Severely ill neonates received analgesia (38%), antibiotics (33.8%), anticoagulants (32.4%), corticosteroids (26.8%), remdesivir (2.8%) and COVID-19 convalescent plasma (1.4%). A total of 93.6% neonates were discharged home, 1.1% were transferred to another hospital, and discharge disposition was unknown for 5.2%. One neonate (0.1%) with presentation suggestive of Multisystem Inflammatory Syndrome in Children died after 11 days of hospitalization.

Most neonates infected with SARS-CoV-2 were asymptomatic or developed mild illness without need for respiratory support. Some neonates had severe illness requiring treatment for COVID-19 with remdesivir and CCP. Thus, SARS-CoV-2 infection in neonates, though rare, may result in severe disease.

Published Date: Aug 2022

DOI: https://doi.org/10.1542/peds.2022-056297

Pediatrics: Epidemiology of Neonatal COVID-19 in the United States