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Experience of COVID-19 infections in neonates in tertiary care centre in north karnataka, India: A prospective cohort study.

Siddu Charki*, Gamini B S, Vijayakumar Biradar, Sangamesh Matapathi, M M Patil, S S Kalyanshettar, S V Patil

 Introduction: In neonates, COVID-19 pandemic is emerging as a new challenge to pediatricians. The risk of neonatal transmission from mother during the perinatal and postnatal period is less understood. Hence, we aimed to identify potential risk factors associated with transmission of neonates born to mothers positive for SARS-CoV-2 at time of delivery and to assess the outcome and thereby elucidate the best infection control clinical practices among mother neonate with COVID-19 infection. Methods: This prospective observational cohort study was conducted during May to October 2020; where all neonates born to mothers positive for SARS-CoV-2 at the time of delivery were enrolled. During the postnatal period, mother and neonate were kept in isolation ward together and initiated breastfeeding after ensuring adequate hand and respiratory hygiene except those requiring NICU admission. At 12-72 hours of life, neonate’s samples (nasopharyngeal swabs) for SARS-CoV-2 were collected for real-time PCR. Data regarding maternal and neonatal baseline characteristics and clinical presentation as well as infection control practices in the hospital was documented in structured proforma. Results: During the study period, 26 (3.6%) mothers tested positive for SARS-CoV-2 of 720 deliveries; Among 28 neonates delivered, 25 neonates were shifted with mother in the isolation ward whereas 3 premature neonate’s required NICU admission. Of the 28 neonates, 20 (71%) were born at term, the median gestational age was 37.6 weeks, 17 (61%) were female and 19 (68%) were born by caesarean section. 20 (71%) were breast fed whereas 8 (29%) of 28 neonates were formula fed. All neonates delivered to SARS-CoV-2 positive mothers tested negative for SARS-CoV-2 by rtPCR at 12-72 hours of life. Conclusion: Mother and primary care providers should be educated and trained about standard respiratory and hand hygiene practices to avoid perinatal and postnatal transmission. Breastfeeding and rooming-in in isolation ward are safe procedures when paired with effective and regular parental education of neonate infection protective strategies.