Synthesis and systematic review of reported neonatal SARS-CoV-2 infections

A number of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections have been reported in neonates. Here, we aim to clarify the transmission route, clinical features and outcomes of these infections. We present a meta-analysis of 176 published cases of neonatal SARS-CoV-2 infections that were defined by at least one positive nasopharyngeal swab and/or the presence of specific IgM. We report that 70% and 30% of infections are due to environmental and vertical transmission, respectively. Our analysis shows that 55% of infected neonates developed COVID-19; the most common symptoms were fever (44%), gastrointestinal (36%), respiratory (52%) and neurological manifestations (18%), and lung imaging was abnormal in 64% of cases. A lack of mother-neonate separation from birth is associated with late SARS-CoV-2 infection (OR 4.94 (95% CI: 1.98-13.08), p=0.0002; adjusted OR 6.6 (95% CI: 2.6-16), p<0.0001), while breastfeeding is not (OR 0.35 (95% CI: 0.09-1.18), p=0.10; adjusted OR 2.2 (95% CI: 0.7-6.5), p=0.148). Our findings add to the literature on neonatal SARS-CoV-2 infections.