Ocular Abnormalities Not Likely in Newborns of SARS-CoV-2-infected Mothers

By Linda Carroll

April 09, 2021

(Reuters Health) - Unlike pathogens such as Cytomegalovirus and Zika, SARS-CoV-2 is not likely to cause ocular problems in newborns whose mothers were infected with the virus during pregnancy, a new case series suggests.

In an analysis of data from 165 infants born in Sao Paulo, Brazil, researchers found that just six newborns had positive PCR findings for SARS-CoV-2, and none of the six displayed ocular abnormalities, according to the report published in JAMA Ophthalmology.

"Vertical transmission is a serious complication of viral diseases occurring during pregnancy and often may lead to ocular manifestations," said the study's lead author, Dr. Olivia Kiappe, a retina and vitreous fellow and researcher at the Federal University of Sao Paulo. "Cytomegalovirus and Zika virus are examples of viral infections that can have devastating consequences to the eye of the newborn," she said in an email.

"This study suggests that there is not a moderate or high increased risk of ocular abnormalities in newborns of mothers with COVID-19," Dr. Kiappe said. "Although more data are needed, vertical transmission of SARS-CoV-2 seems possible and should be a concern. Considering the noninvasive nature of the ophthalmological examination, ocular manifestations should be further investigated."

To investigate the possibility that SARS-CoV-2 transmitted in utero by pregnant women could cause eye problems, Dr. Kiappe and her colleagues enrolled 165 newborns whose mothers had been diagnosed with SARS-CoV-2 infections. The babies were born at three maternity hospitals in Sao Paulo between April and November of 2020.

Of the 165 infants, 123 (74.5%) were born full-term, while 42 (25.4%) were born preterm. Six of the newborns had positive PCR tests of oronasopharyngeal swab samples for SARS-CoV-2. One infant tested positive within 18 days, suggesting possible horizontal transmission, the authors note, while the other five tested positive on the first day of life, suggesting vertical transmission. None of these newborns had ocular abnormalities.

Among the newborns who tested negative, one presented with venous engorgement and vascular tortuosity, while seven had intraretinal hemorrhages and two were diagnosed as having retinopathy of prematurity.

It will be important to do long-term follow-up on these babies because they were examined so early in life, said Dr. Christopher Golden am associate professor of pediatrics at the Johns Hopkins University School of Medicine, in Baltimore.

"The developing eye is at risk any time there is an infection involved, especially when the infection occurs when the mom is still pregnant," Dr. Golden said. "Infections can alter the way the nervous tissue in the eye develops."

As for the findings in children who tested negative for the virus, "they could be the result of C-section delivery or just premature delivery," Dr. Golden said.

The new report is looking at "something that is really worth studying being that some of the systemic findings in COVID-19 are heavily involving vasculature and clotting and since the eye is one of the most heavily vascularized organs," said Dr. Erin Walsh, the co-director of pediatric ophthalmology and strabismus services at Mount Sinai in New York City. "There has been a study showing some issues in the retinas of adults with COVID-19. So, I definitely think it's worth looking for."

One issue of with the current study is "a lack of any sort of real discussion on what normal birth patterns of the retina are," Dr. Walsh said. Moreover, "there was no comment on other systemic issues such as cardiovascular health (that might have explained the findings in the infants who did not test positive for COVID-19)."

After the experience with Zika, it makes sense to look for possible eye issues relating to COVID-19, Dr. Walsh said. "With all the multisystemic inflammation that's been occurring in kids, I would bet, down the road, when rigorous studies are done, researchers might actually find some subtle or not so subtle vascular findings in the retina."

SOURCE: https://bit.ly/3d0O8dS JAMA Ophthalmology, online April 8, 2021.

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