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. 2024 Apr 18;109(3):279-286.
doi: 10.1136/archdischild-2023-326167.

Characteristics and outcomes of neonates hospitalised with SARS-CoV-2 infection in the UK by variant: a prospective national cohort study

Chris Gale #  1 , Don Sharkey #  2 , Kathryn E Fitzpatrick  3 , Helen Mactier  4 , Alessandra Morelli  5 , Mariko Nakahara  5 , Madeleine Hurd  5 , Anna Placzek  5 , Marian Knight  5 , Shamez N Ladhani  6 , Elizabeth S Draper  7 , Cora Doherty  8 , Maria A Quigley  5 , Jennifer J Kurinczuk  5 ; Neonatal complications of COVID-19 Collaborative Group
Collaborators, Affiliations

Characteristics and outcomes of neonates hospitalised with SARS-CoV-2 infection in the UK by variant: a prospective national cohort study

Chris Gale et al. Arch Dis Child Fetal Neonatal Ed. .

Abstract

Objective: Neonatal infection with wildtype SARS-CoV-2 is rare and good outcomes predominate. We investigated neonatal outcomes using national population-level data to describe the impact of different SARS-CoV-2 variants.

Design: Prospective population-based cohort study.

Setting: Neonatal, paediatric and paediatric intensive care inpatient care settings in the UK.

Patients: Neonates (first 28 days after birth) with confirmed SARS-CoV-2 infection who received inpatient care, March 2020 to April 2022. Neonates were identified through active national surveillance with linkage to national SARS-CoV-2 testing data, routinely recorded neonatal data, paediatric intensive care data and obstetric and perinatal mortality surveillance data.

Outcomes: Presenting signs, clinical course, severe disease requiring respiratory support are presented by the dominant SARS-CoV-2 variant in circulation at the time.

Results: 344 neonates with SARS-CoV-2 infection received inpatient care; breakdown by dominant variant: 146 wildtype, 123 alpha, 57 delta and 18 omicron. Overall, 44.7% (153/342) neonates required respiratory support; short-term outcomes were good with 93.6% (322/344) of neonates discharged home. Eleven neonates died: seven unrelated to SARS-CoV-2 infection, four were attributed to neonatal SARS-CoV-2 infection (case fatality 4/344, 1.2% 95% CI 0.3% to 3.0%) of which three were born preterm due to maternal COVID-19. More neonates were born very preterm (23/54) and required invasive ventilation (27/57) when delta variant was predominant, and all four SARS-CoV-2-related deaths occurred in this period.

Conclusions: Inpatient care for neonates with SARS-CoV-2 was uncommon. Although rare, severe neonatal illness was more common during the delta variant period, potentially reflecting more severe maternal disease and associated preterm birth.

Trial registration number: ISRCTN60033461.

Keywords: COVID-19; epidemiology; neonatology.

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Conflict of interest statement

Competing interests: MK, MAQ, CG and JJK received grants from the UK NIHR Policy Research Programme in relation to the submitted work. KEF, AM, MH, AP, SNL, ESD, DS, CD and HM declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of case selection for study period 1 March 2020 to 1 April 2022. BPSU, British Paediatric Surveillance Unit; UKOSS, United Kingdom Obstetric Surveillance System.
Figure 2
Figure 2
Weekly confirmed neonatal SARS-CoV-2 infections by dominant circulating variant in the UK.
Figure 3
Figure 3
Maximum respiratory support requirements of hospitalised neonates with SARS-CoV-2 infection during the dominant circulating variant period (wildtype n=145, alpha n=122, delta n=57 and omicron n=18).
See this image and copyright information in PMC

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Supplementary concepts