Table 2

Characteristics of included studies reporting COVID-19 cases in neonates

Study, country, settingSample sizeAge of symptom onsetGestations of neonate at deliveryDiagnosis present in the mother and methodDelivery details/method/
Apgar/
rescucitation		PPE procedures undertaken at deliveryMethod of COVID-19 diagnosis and timingSymptoms and complicationsTherapyLength of follow-up/final outcome
Alzamora et al,29 Peru, secondary hospital1Day 0Unclear, presumed 34 weeks.Nasopharyngeal swab RT-PCR assay positive.The neonate weighed 2970 g, with Apgar scores of 6 and 8 at 1 and 5 min, respectively.He was immediately separated from his mother and was not exposed to family members.Nasopharyngeal swab of neonate for SARS-CoV-2 RT-PCR, obtained 16 hours after delivery.Neonate was electively intubated at birth.Baby required 12 hours, then continuous positive airway pressure and was weaned successfully.On the sixth day of life, the newborn had mild respiratory difficulty and sporadic cough requiring supplemental oxygen with nasal cannula.
Kamali Aghdam et al,30 Iran, children’s hospital115 daysTerm.CS, no diagnostic tests in mother.Not stated in detail.Not reported.Pharyngeal swab RT-PCR assay positive.Fever, no cough, mild subcostal recession.Oxygen and fluids, vancomycin and amikacin given.Discharged well on day 6 after admission.
Chacón-Aguilar et al,31 Spain, secondary hospital126 daysNot reported.Symptomatic family members, no further details.Unremarkable history, nil else noted.Not reported.A nasopharyngeal swab sample was tested for SARS-CoV-2 on admission.Swinging fever, cranial ultrasound and EEG were normal.Empirical antibiotics.Day 6 discharge, neurologically normal and follow-up appointment booked.
Piersigilli et al,32 Belgium1From birth26 weeks+4 days’ gestation.Diagnosed on day 6 with chest symptoms and by RT-PCR from nasopharyngeal swab.CS section due to maternal HELLP syndrome, Apgars 5/8/8 at 1 min/5 min/10 min.None reported.Day 7 when mother’s results returned by RT-CPR.Normal preterm course, chest radiograph showed no parenchymal infiltrates.Initial non-invasive positive pressure ventilation and surfactant, pneumothorax at 12 hours.Swab negative at 14 days, still in neonatal unit receiving care.
Wang et al,33 China, secondary hospital117 days38 weeks 6 days.Mother and father positive for nucleic acid testing.Normal delivery, no resuscitation.Not reported.Day 20 negative nasopharyngeal swab for RT-PCR, positive on day 23.Day 17 vomiting and loose stools, day 18 fever, day 20 cough.No active management described.Day 29 RT-PCR swabs negative and child discharged on day, discharged 14 days after admission, well.
Wang et al,34 Wuhan, China, secondary hospital1N/A, as asymptomaticTerm.Pharyngeal swab positive.Emergency CS, Apgar 8 at 1 minut, 9 at 5 minute.The mother had been wearing an N95 mask throughout the operation, and the baby had no contact with the mother after birth.The result of pharyngeal swab for SARS-CoV-2 was positive at 36 hours after birth. All products of delivery negative.Asymptomatic.No treatment needed.Day 17 swabs negative, discharged on day 18.
Yu et al,35 China, tertiary hospital1 (6 negative infants reported)Day 139 weeks 6 days.Pharyngeal swab RT-PCR positive on admission.Elective CS due to maternal diagnosis.Maternal swab RT-PCR.Swab positive for RT-PCR.No fever/cough, with mild shortness of breath symptoms.
Chest X-ray revealed mild pulmonary infection.		Standard neonatal care.Discharged after 2 weeks, well.
Zeng et al,36 China, tertiary hospital33 babies analysed, 3 positive

  1. Day 2

  2. Day 1

  3. Day 1

  1. 40 weeks.

  2. 40+4 weeks.

  3. 31+2 weeks.

All mothers had confirmed COVID-19 pneumonia by nasopharyngeal swabs (RT-PCR).All three were elective CS due to maternal COVID-19 pneumonia.Not described in the communication.Nasopharyngeal and anal swabs sent for SARS-CoV-2 RT-PCR in all three babies; all were positive on day 2 and day 4, and negative by days 6–7.

  1. Lethargy + fever with pneumonia on X-ray; resolved by 6 days.

  2. Same as one above.

  3. Neonatal RDS and Enterobacter bacteraemia; resolved with antibiotics.

Standard neonatal care and antibiotics; for the preterm baby, treatment as indicated for RDS.Final devolution not described in the article, but stated as favourable outcomes in all three babies.

  • CS, caesarean section; EEG, electroencephalogram; HELLP, hemolysis, elevated liver enzymes, and a low platelet count syndrome; N/A, not applicable; PPE, personal protective equipment; RDS, respiratory distress syndrome; RT-PCR, reverse transcription PCR; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.