The Direct and Indirect Impact of SARS-CoV-2 Infections on Neonates: A Series of 26 Cases in Bangladesh

Abstract

Background: The impact of SARS-CoV-2 on neonates remains largely unknown in low- and middle-income countries (LMICs). We provide an epidemiologic and clinical report of SARS-CoV-2 infections in neonates hospitalized in Bangladesh.

Methods: Outborn neonates admitted to Dhaka Shishu Hospital, a tertiary-care referral hospital, between 29 March and 1 July were screened for SARS-CoV-2. We reviewed clinical data, including chest radiograph and laboratory reports, and conducted SARS-CoV-2 genome sequencing. Patients were followed-up for 27-75 days. A subset of caregivers was also tested.

Results: Of 83 neonates tested, 26 were positive (median age 8 days). Most neonates were admitted with diagnosis unrelated to SARS-CoV-2: 11 presented with serious non-communicable diseases, 7 with early-onset sepsis, 5 with late-onset sepsis and 2 with pneumonia. In 3 of 5 chest radiograph, infiltrates and ground-glass or patchy opacities were noted. Two neonates developed metabolic acidosis, one developed disseminated intravascular coagulation. Most SARS-CoV-2 positive neonates were referred to government-designated COVID-19 hospitals, leading to gaps in treatment. Twenty-three neonates could be followed-up: 12 were healthy, 8 died and 3 were still seeking medical care. Of 9 caregivers tested, 8 were positive.

Conclusions: SARS-CoV-2 may have serious adverse effects on children born in LMICs. The virus likely contributed directly to two deaths, but the remaining 6 neonates who died had serious comorbidities. Positive SARS-CoV-2 test results led to gaps in immediate clinical care for other morbidities, which likely contributed to adverse outcomes. This case series emphasizes the need to understand COVID-19 in neonates in LMICs and its indirect impacts.

FIGURE 1.

Age distribution and outcome of neonatal cases of SARS-CoV-2.

FIGURE 2.

Overview of the key events of the 26 SARS-CoV-2 neonatal infections. This includes dates of hospital admission and other key events for each case during the course of this surveillance study.

FIGURE 3.

Chest radiograph images of 5 neonates with SARS-CoV-2 infections. A: Chest radiograph of Ne07 showed patchy opacities in right lower lobe suggesting pneumonia. B: Chest radiograph of Ne08 looked normal. C: Chest radiograph of Ne09 showed bilateral ground-glass opacity indicative of SARS-CoV-2. D: Chest radiograph of Ne13 showed few patchy opacities in the right lower perihilar region indicating nonspecific inflammatory lesion in right lower zone. E: Chest radiograph of Ne23 looked normal.