Neonatal SARS-CoV-2 May Present With Hypoxemia Without Respiratory Distress

By Lisa Rappaport

July 01, 2020

(Reuters Health) - Neonatal SARS-CoV-2 infection may present in the first days of life with clinically significant hypoxemia in a newborn that doesn't have overt signs of respiratory distress or require oxygen therapy, one case report suggests.

"In mild disease, there may be non-specific signs such as poor feeding that alert the care-providers, before signs of respiratory distress are noted," said Dr. Shaili Amatya, an assistant professor in neonatal-perinatal medicine at Penn State Health Children's Hospital in Hershey, Pennsylvania, who wasn't involved in the study.

"The physiological mechanisms underlying the effects in infants versus older children are unknown," Dr. Amatya said by email. "The immature immune system of children may respond to SARS-CoV-2 differentially in various age groups."

The case, highlighted in Pediatrics, involved a full-term male newborn with an uncomplicated vaginal delivery with Apgar scores of 9 and 10 at 1 minute and 5 minutes, respectively. On the second day after delivery, the mother developed a fever and had a nasopharyngeal swab that was positive for SARS-CoV-2; the infant was subsequently swabbed, and also positive.

Mother and baby were transferred to an airborne isolation room. After 48 hours, the newborn developed poor sucking and perioral cyanosis without signs of respiratory distress. The baby's respiratory rate was 15 to 20 per minute, heart rate was 120 beats per minute, and blood pressure was normal.

Cardiac abnormalities were ruled out by echocardiogram, and PCR on the nasopharyngeal specimen ruled out other respiratory viruses.

The baby was moved to the NICU, where he was put on 30% inspired oxygen via high flow nasal cannula. Lung ultrasound at this point didn't show consistent abnormalities, and chest radiograph showed mild bilateral ground glass opacities. After 36 hours, no major abnormalities were found on CT scan.

Fifty hours after NICU admission, the infant improved enough to have respiratory support discontinued. He was fed maternal expressed milk via nasogastric tube for 48 hours, then was able to bottle feed.

At day 18, the baby was discharged. On days 15 and 21, his qualitative PCR for SARS-CoV-2 remained positive, the researchers note. This suggests that newborns could be a source of horizontal transmission, the study team concludes in Pediatrics.

The authors did not respond to a request for comments.

The case report does suggest that birth should take place in a health facility, where any suspected infections in mothers or newborns can be addressed, and that preventive measures to prevent infection in newborns are necessary at the health facility and at home after discharge, said Dr. Pablo Duran of the Latin American Center of Perinatology, Women and Reproductive Health in Montevideo, Uruguay.

"Newborns may show higher vulnerability, and this implies that especially when other conditions are present, they may have transient episodes of hypoxemia or other clinical conditions," Dr. Duran, who wasn't involved in the study, said by email. "The speed and adequacy of care and response provided are essential."

SOURCE: Pediatrics, online June 30, 2020.