Neonatal SARS-CoV-2 infections: systematic review, synthesis and meta-analysis of reported cases

Abstract It is unclear if COVID-19 affects neonates. Some cases of neonatal SARS-CoV-2 infections have been reported but not systematically analysed. We aim to clarify the main transmission route, clinical features and outcomes of neonatal SARS-CoV-2 infections and we performed an individual patient data meta-analysis, following PRISMA guidelines, of neonates infected by SARS-CoV-2 (demonstrated by: at least one positive nasopharyngeal swab and/or the presence of specific IgM). We analysed 117 infected neonates. 68% and 32% of infections were due to environmental and vertical transmission, respectively. Approximately 55% of infected neonates developed clinically evident COVID-19. Commonest clinical features were fever (50%), gastrointestinal (43.7%), respiratory (42.2%) and neurological manifestations (20.3%). Lung imaging was abnormal in 59.4%. The lack of mother-neonate separation from birth was associated with the incidence of late SARS-CoV-2 infection (OR 5.1 (95% CI: 1.6-18); p=0.003), while breastfeeding was not (OR 0.49 (95% CI: 0.12-1.94); p=0.35).