Abstract
Background: Babies differ from older children with regard to their exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, data describing the effect of SARS-CoV-2 in this group are scarce, and guidance is variable. We aimed to describe the incidence, characteristics, transmission, and outcomes of SARS-CoV-2 infection in neonates who received inpatient hospital care in the UK.
Methods: We carried out a prospective UK population-based cohort study of babies with confirmed SARS-CoV-2 infection in the first 28 days of life who received inpatient care between March 1 and April 30, 2020. Infected babies were identified through active national surveillance via the British Paediatric Surveillance Unit, with linkage to national testing, paediatric intensive care audit, and obstetric surveillance data. Outcomes included incidence (per 10 000 livebirths) of confirmed SARS-CoV-2 infection and severe disease, proportions of babies with suspected vertically and nosocomially acquired infection, and clinical outcomes.
Findings: We identified 66 babies with confirmed SARS-CoV-2 infection (incidence 5·6 [95% CI 4·3–7·1] per 10 000 livebirths), of whom 28 (42%) had severe neonatal SARS-CoV-2 infection (incidence 2·4 [1·6–3·4] per 10 000 livebirths). 16 (24%) of these babies were born preterm. 36 (55%) babies were from white ethnic groups (SARS-CoV-2 infection incidence 4·6 [3·2–6·4] per 10 000 livebirths), 14 (21%) were from Asian ethnic groups (15·2 [8·3–25·5] per 10 000 livebirths), eight (12%) were from Black ethnic groups (18·0 [7·8–35·5] per 10 000 livebirths), and seven (11%) were from mixed or other ethnic groups (5·6 [2·2–11·5] per 10 000 livebirths). 17 (26%) babies with confirmed infection were born to mothers with known perinatal SARS-CoV-2 infection, two (3%) were considered to have possible vertically acquired infection (SARS-CoV-2-positive sample within 12 h of birth where the mother was also positive). Eight (12%) babies had suspected nosocomially acquired infection. As of July 28, 2020, 58 (88%) babies had been discharged home, seven (11%) were still admitted, and one (2%) had died of a cause unrelated to SARS-CoV-2 infection.
Interpretation: Neonatal SARS-CoV-2 infection is uncommon in babies admitted to hospital. Infection with neonatal admission following birth to a mother with perinatal SARS-CoV-2 infection was unlikely, and possible vertical transmission rare, supporting international guidance to avoid separation of mother and baby. The high proportion of babies from Black, Asian, or minority ethnic groups requires investigation.
Funding: UK National Institute for Health Research Policy Research Programme.
Original language | English |
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Pages (from-to) | 113-121 |
Number of pages | 9 |
Journal | The Lancet Child and Adolescent Health |
Volume | 5 |
Issue number | 2 |
Early online date | 9 Nov 2020 |
DOIs | |
Publication status | Published - Feb 2021 |
Bibliographical note
Funding Information: This research is funded by the UK NIHR Policy Research Programme, conducted through the Policy Research Unit in Maternal and Neonatal Health and Care (PR-PRU-1217-21202). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. We acknowledge the assistance of Jacob Avis and Richard Lynn at the BPSU, the BPSU reporting clinicians, the NIHR Clinical Research Networks, and other people without whose support this research would not have been possible in such a timely manner. Full details of all collaborators and acknowledgments can be found in appendix 2 (pp 2–4 ).MK, MAQ, and JJK received grants from the UK NIHR Policy Research Programme in relation to the submitted work. AP, SL, ESD, DS, CD, HM, and CG declare no competing interests.
Open Access: This is an Open Access article under the CC BY 4.0 license.
Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd.
Citation: Chris Gale, Maria A Quigley, Anna Placzek, Marian Knight, Shamez Ladhani, Elizabeth S Draper, Don Sharkey, Cora Doherty, Helen Mactier, Jennifer J Kurinczuk, Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance, The Lancet Child & Adolescent Health, Volume 5, Issue 2, 2021, Pages 113-121, ISSN 2352-4642.
DOI: https://doi.org/10.1016/S2352-4642(20)30342-4.