Maternal Coronavirus Disease 2019 Test Positivity and Neonatal Intensive Care Unit Outcomes for Infants Born Extremely Preterm.

OBJECTIVE: To describe the neonatal intensive care unit outcomes of infants born extremely preterm to mothers who test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. STUDY DESIGN: Prospective study (March 1, 2020-April 30, 2023) at 16 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers of inborn infants (birth weight 401-1000 g and/or gestational age <29 weeks) born to mothers tested for SARS-CoV-2 during pregnancy. Frequency of maternal SARS-CoV-2 detection, vertical transmission rate, and association of maternal SARS-CoV-2 positivity during pregnancy with infant outcomes were determined. RESULTS: During the 38-month study, 4548 extremely preterm infants were born to 4072 mothers tested for SARS-CoV-2 during pregnancy. Overall, 7% (297/4072) of mothers had a positive SARS-CoV-2 test; 1% (2/181) of tested infants were positive at age <72 hours. The majority of outcomes (eg, bronchopulmonary dysplasia and retinopathy of prematurity) did not differ between infants of test-positive vs test-negative mothers. Infants of test-positive mothers were more likely to be diagnosed with necrotizing enterocolitis (NEC) than those of test-negative mothers (14% vs 11%; P = .03). In adjusted analyses, infants born to test-positive mothers were more likely to develop NEC (risk ratio [RR] 1.40; 95% CI, 1.03-1.89; P = .03) or the combined outcome of death within 12 hours of age or NEC (RR 1.33; 95% CI, 1.09-1.62; P < .01) but not death within 12 hours of age (RR 1.22, 95% CI, 0.92-1.62; P = .16) or before discharge (RR 0.83, 95% CI, 0.55-1.26; P = .38). CONCLUSIONS: Among infants <29 weeks' gestation, vertical transmission of SARS-CoV-2 was infrequent. Maternal SARS-CoV-2 positivity was associated with NEC but not with other infant outcomes or mortality. TRIAL REGISTRATION: ClinicalTrials.gov ID. Generic Database: NCT00063063. https://clinicaltrials.gov/study/NCT00063063.

Duke Scholars

Author Charles Michael Cotten Pediatrics, Neonatology