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Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance.
Lancet Child Adolesc Health. 2021 02; 5(2):113-121.LC

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.

Authors+Show Affiliations

Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK. Electronic address: christopher.gale@imperial.ac.uk.NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.Public Health England, London, UK; St George's University of London, London, UK.Department of Health Sciences, Centre for Medicine, University of Leicester, Leicester, UK.Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.University Hospital of Wales, Cardiff, UK.Princess Royal Maternity and the University of Glasgow, Glasgow, UK.NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33181124

Citation

Gale, Chris, et al. "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, vol. 5, no. 2, 2021, pp. 113-121.
Gale C, Quigley MA, Placzek A, et al. Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. Lancet Child Adolesc Health. 2021;5(2):113-121.
Gale, C., Quigley, M. A., Placzek, A., Knight, M., Ladhani, S., Draper, E. S., Sharkey, D., Doherty, C., Mactier, H., & Kurinczuk, J. J. (2021). 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, 5(2), 113-121. https://doi.org/10.1016/S2352-4642(20)30342-4
Gale C, et al. Characteristics and Outcomes of Neonatal SARS-CoV-2 Infection in the UK: a Prospective National Cohort Study Using Active Surveillance. Lancet Child Adolesc Health. 2021;5(2):113-121. PubMed PMID: 33181124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance. AU - Gale,Chris, AU - Quigley,Maria A, AU - Placzek,Anna, AU - Knight,Marian, AU - Ladhani,Shamez, AU - Draper,Elizabeth S, AU - Sharkey,Don, AU - Doherty,Cora, AU - Mactier,Helen, AU - Kurinczuk,Jennifer J, Y1 - 2020/11/09/ PY - 2020/08/20/received PY - 2020/10/09/revised PY - 2020/10/13/accepted PY - 2020/11/13/pubmed PY - 2021/2/2/medline PY - 2020/11/12/entrez SP - 113 EP - 121 JF - The Lancet. Child & adolescent health JO - Lancet Child Adolesc Health VL - 5 IS - 2 N2 - 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. SN - 2352-4650 UR - https://www.unboundmedicine.com/medline/citation/33181124/Characteristics_and_outcomes_of_neonatal_SARS_CoV_2_infection_in_the_UK:_a_prospective_national_cohort_study_using_active_surveillance_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-4642(20)30342-4 DB - PRIME DP - Unbound Medicine ER -