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Review
. 2021 May;41(5):940-951.
doi: 10.1038/s41372-020-00874-x. Epub 2020 Dec 8.

COVID-19: neonatal-perinatal perspectives

Alejandra Barrero-Castillero  1   2 , Kristyn S Beam  1   2 , Laura B Bernardini  2 , Erika G Cordova Ramos  2   3 , Patricia E Davenport  2 , Anna R Duncan  2 , Yarden S Fraiman  2 , Lauren C Frazer  2 , Helen Healy  2 , Emily M Herzberg  2   4 , Madeline L Keyes  2 , Kristen T Leeman  5 , Kristin Leone  2 , Jonathan C Levin  6 , Matthew Lin  2 , Ravikiran M Raju  2 , Anne Sullivan  2 ; Harvard Neonatal-Perinatal Fellowship COVID-19 Working Group
Affiliations
Review

COVID-19: neonatal-perinatal perspectives

Alejandra Barrero-Castillero et al. J Perinatol. 2021 May.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic, resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused severe and widespread illness in adults, including pregnant women, while rarely infecting neonates. An incomplete understanding of disease pathogenesis and viral spread has resulted in evolving guidelines to reduce transmission from infected mothers to neonates. Fortunately, the risk of neonatal infection via perinatal/postnatal transmission is low when recommended precautions are followed. However, the psychosocial implications of these practices and racial/ethnic disparities highlighted by this pandemic must also be addressed when caring for mothers and their newborns. This review provides a comprehensive overview of neonatal-perinatal perspectives of COVID-19, ranging from the basic science of infection and recommendations for care of pregnant women and neonates to important psychosocial, ethical, and racial/ethnic topics emerging as a result of both the pandemic and the response of the healthcare community to the care of infected individuals.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. SARS-CoV-2 viral entry and replication in host.
The spike (S) glycoproteins of the SARS-CoV-2 virus bind to the ACE2 receptor on the host cell. (2) The TMPRSS2 protein cleaves the S proteins off the viral envelope, (3) allowing for viral entry either by endocytosis or fusion. (4) Single-stranded viral RNA is replicated by host machinery into a large polyprotein. (5) The polyprotein is then cleaved by a viral protease. (6) Viral protein and RNA is then packaged into a nucleocapsid. (7) New virions are assembled and (8) released to further infect the host [–15].
Fig. 2
Fig. 2. Summary of clinical guidelines for care of infants born to SARS-CoV-2-positive mothers, updated as of July 22nd, 2020.
We provide a summary of the clinical guidelines from the American Academy of Pediatrics (AAP), Centers for Disease Control (CDC), World Health Organization (WHO), and American Academy of Family Physicians (AAFP) for care of infants born to SARS-CoV-2-positive mothers, updated as of July 22nd, 2020.
Fig. 3
Fig. 3. National surveillance programs of newborns exposed to SARS-CoV-2 in the United States, as of July 31, 2020.
We provide a summary of national surveillance programs collecting data on newborns exposed to SARS-CoV-2 in the United States, as of July 2020.
Fig. 4
Fig. 4
Strategies for providing family-centered care for mothers and newborns during a pandemic [82, 85].
Fig. 5
Fig. 5. Existing knowledge gaps related to neonatal–perinatal perspectives of COVID-19.
Current knowledge gaps in the literature related to neonatal–perinatal perspectives of COVID-19.
See this image and copyright information in PMC

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