Epidemiologic and clinical characteristics of neonates with late-onset COVID-19: 1-year data of Turkish Neonatal Society

Ilke Mungan Akin, Mehmet Kenan Kanburoglu, Cuneyt Tayman, Mehmet Yekta Oncel, Timucin Imdadoglu, Mustafa Dilek, Akan Yaman, Fatma Narter, Ilkay Er, Hasan Kahveci, Omer Erdeve, Esin Koc, Neo-Covid Study Group, Eren Yildiz, Nuriye Aslı Melekoglu, Emel Okulu, Handan Hakyemez Toptan, Ozge Surmeli, Emrah Can, Fatma Hilal Yilmaz, Hilal Ozkan, Ibrahim Caner, Serdar Cömert, Saime Sundus Uygun, Sinem Akbay, Asli Memisoglu, Ayse Anik, Baran Cengiz Arcagok, Belma Saygili Karagol, Mehmet Ates, Muhammet Bulut, Mustafa Ali Akin, Nihat Demir, Ramazan Ozdemir, Sema Arayici, Sebnem Kader, Adil Umut Zubarioglu, Ahmet Oktem, Ali Bulbul, Berna Hekimoglu, Emel Ataoglu, Demet Orhan Baser, Emine Esin Yalinbas, Ebru Yalin Imamoglu, Ferda Ozlu, Leyla Bilgin, Melike Kefeli, Meltem Koyuncu Arslan, Selahattin Akar, Handan Bezirganoglu, Senol Bozdag, Resat Gurpinar, Nukhet Aladag Ciftdemir, Ozmert Ma Ozdemir, Ilke Mungan Akin, Mehmet Kenan Kanburoglu, Cuneyt Tayman, Mehmet Yekta Oncel, Timucin Imdadoglu, Mustafa Dilek, Akan Yaman, Fatma Narter, Ilkay Er, Hasan Kahveci, Omer Erdeve, Esin Koc, Neo-Covid Study Group, Eren Yildiz, Nuriye Aslı Melekoglu, Emel Okulu, Handan Hakyemez Toptan, Ozge Surmeli, Emrah Can, Fatma Hilal Yilmaz, Hilal Ozkan, Ibrahim Caner, Serdar Cömert, Saime Sundus Uygun, Sinem Akbay, Asli Memisoglu, Ayse Anik, Baran Cengiz Arcagok, Belma Saygili Karagol, Mehmet Ates, Muhammet Bulut, Mustafa Ali Akin, Nihat Demir, Ramazan Ozdemir, Sema Arayici, Sebnem Kader, Adil Umut Zubarioglu, Ahmet Oktem, Ali Bulbul, Berna Hekimoglu, Emel Ataoglu, Demet Orhan Baser, Emine Esin Yalinbas, Ebru Yalin Imamoglu, Ferda Ozlu, Leyla Bilgin, Melike Kefeli, Meltem Koyuncu Arslan, Selahattin Akar, Handan Bezirganoglu, Senol Bozdag, Resat Gurpinar, Nukhet Aladag Ciftdemir, Ozmert Ma Ozdemir

Abstract

The literature on neonates with SARS-CoV-2 is mainly concerned with perinatal cases, and scanty data are available about environmentally infected neonates. To fill knowledge gaps on the course and prognosis of neonatal cases, we analyzed 1-year data from the Turkish Neonatal Society in this prospective cohort study of neonates with postnatal transmission. Data from 44 neonatal intensive care units (NICUs), of neonates with positive RT-PCR results at days 5-28 of life, were extracted from the online registry system and analyzed. Of 176 cases, most were term infants with normal birth weight. Fever was the most common symptom (64.2%), followed by feeding intolerance (25.6%), and cough (21.6%). The median length of hospitalization was 9 days, with approximately one quarter of infants receiving some type of ventilatory support. Myocarditis (5.7%) was the most common complication during follow-up. Among the clinical findings, cough (odds ratio [OR]: 9.52, 95% confidence interval [CI]: 4.17-21.71), tachypnea (OR: 26.5, 95% CI: 9.59-73.19), and chest retractions (OR: 27.5, 95% CI: 5.96-126.96) were associated with more severe clinical disease. Also, there were significant differences in the C-reactive protein level, prothrombin time (PT), partial thromboplastin time, international normalized ratio, and days in the NICU (p = 0.002, p = 0.012, p = 0.034, p = 0.008, and p < 0.001, respectively) between patients with mild-moderate and severe-critical presentations. A PT above 14 s was a significant predictor of severe/critical cases, with a sensitivity of 64% and specificity of 73%.

Conclusions: Our data showed that late-onset COVID-19 infection in neonates who need hospitalization can be severe, showing associations with high rates of ventilatory support and myocarditis. Cough, tachypnea, and retractions on admission suggest a severe disease course.

Trial registration: ClinicalTrials.gov identifier: NCT04401540.

What is known: • Neonatal cases of COVID-19 infection are mainly reported as perinatal COVID-19 cases. • Neonates with perinatal transmission have a mild course and favorable prognosis.

What is new: • Among symptomatic neonates with late-onset COVID-19 infection, fever was the most common symptom, and almost one quarter of hospitalized cases needed some type of respiratory support. Myocarditis was the most common complication. • The presence of cough, tachypnea, retractions, and a PT above 14 s were associated with an increased risk of severe COVID-19.

Keywords: COVID-19; Newborn; Postnatal; SARS-CoV-2.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Figures

Fig. 1
Fig. 1
Distribution of late-onset neonatal COVID-19 cases during one year period

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