Neonatal SARS-CoV-2 positivity and short-term outcomes

Background Neonatal SARS-CoV-2 positivity among newborns born to infected mothers appears to be uncommon, and factors associated with neonatal positivity and short-term outcomes remain incompletely understood. Objective This study aimed to compare short-term outcomes between SARS-CoV-2-positive and SARS-CoV-2-negative newborns born to mothers with COVID-19 during pregnancy. Methods In this matched case–control study, 263 pregnant women with COVID-19 were identified during the study period, and 218 newborns underwent RT-PCR testing for SARS-CoV-2 within the first 48 h of life. Among them, 23 newborns tested positive and were matched (1:2) with 46 newborns who tested negative according to clinically relevant maternal and neonatal characteristics, including the interval between maternal infection and delivery, maternal disease severity, gestational age, newborn sex, and birth weight appropriateness for gestational age. Results The mean gestational age and birth weight of the newborns were 38.2 ± 1.7 weeks and 2994.2 ± 464.5 g, respectively. Fifteen newborns (21.7%) experienced complications during hospitalization, most commonly hypotonia/hypoactivity (13.0%) and early respiratory distress (10.1%). Respiratory distress was associated with neonatal SARS-CoV-2 positivity (OR = 21.31; 95% CI 2.24–201.68; p = 0.008). In addition, maternal COVID-19 infection occurring closer to delivery was associated with an increased likelihood of neonatal SARS-CoV-2 positivity (OR = 1.007; 95% CI 1.001–1.014; p = 0.026). Conclusions SARS-CoV-2-positive newborns appeared to experience respiratory complications more frequently during hospitalization, while maternal infection closer to delivery was associated with neonatal positivity. Given the observational design and relatively small sample size, these findings should be interpreted with caution.