Download PDF
Am J Perinatol 2024; 41(12): 1625-1633
DOI: 10.1055/a-2253-5665
Review Article

Optimal Delivery Management for the Prevention of Early Neonatal SARS-CoV-2 Infection: Systematic Review and Meta-analysis

Christina S. Chan‡   *
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
,
Juin Yee Kong‡   *
2   Department of Neonatology, Kandang Kerbau Women's and Children's Hospital, Singapore
,
Rehena Sultana
3   Department of Quantitative Medicine, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
,
Vatsala Mundra
4   School of Medicine, University of Texas, Southwestern Medical Center, Dallas, Texas
,
Kikelomo L. Babata
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
,
Kelly Mazzarella
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
,
Emily H. Adhikari
5   Department of Obstetrics and Gynecology, University of Texas, Southwestern Medical Center, Dallas, Texas
,
Kee Thai Yeo
2   Department of Neonatology, Kandang Kerbau Women's and Children's Hospital, Singapore
,
Jean-Michel Hascoët
6   Department of Pediatrics, Division of Neonatology, Lorraine University, DevAH, CHRU-Nancy, France
,
Luc P. Brion
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, Texas
› Author Affiliations Funding L.P.B. has received funding from the National Institutes of Health, from the Gerber Foundation, and from the Children's Medical Center Foundation in Dallas, TX for unrelated research.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Delivery management interventions (DMIs) were recommended to prevent delivery-associated transmission of maternal SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) to infants without evidence of effect on early neonatal SARS-CoV-2 infection (ENI) and neonatal death <28 days of life (ND). This systematic review describes different DMI combinations and the frequency of ENI and ND.

Study Design Individual patient data were collected from articles published from January 1, 2020 to December 31, 2021 from Cochrane review databases, Medline, and Google Scholar. Article inclusion criteria were: documented maternal SARS-CoV-2 polymerase chain reaction (PCR)-positive status 10 days before delivery or symptomatic at delivery with a positive test within 48 hours, known delivery method, and known infant SARS-CoV-2 PCR result. Primary outcomes were ENI (positive PCR at 12 hours to 10 days) and ND. All characteristics were pooled using the DerSimonian–Laird inverse variance method. Primary outcome analyses were performed using logit transformation and random effect. Pooled results were expressed as percentages (95% confidence intervals). Continuity correction was applied for all pooled results if any included study has 0 event.

Results A total of 11,075 publications were screened. 117 publications representing 244 infants and 230 mothers were included. All publications were case reports. ENI and ND were reported in 23.4% (18.2–29.18) and 2.1% (0.67–4.72) of cases, respectively. Among cases with available information, DMIs were reported for physical environment (85–100%), delivery-specific interventions (47–100%), and infant care practices (80–100%). No significant comparisons could be performed between different DMI combinations due to small sample size.

Conclusion The evidence supporting any DMI in SARS-CoV-2-infected mothers to prevent ENI or ND is extremely limited. Limitations of this meta-analysis include high risk of bias, small sample size, and large confidence intervals. This identifies the need for multinational database generation and specific studies designed to provide evidence of DMI guidelines best suited to prevent transmission from mother to neonate.

Key Points

  • In this review we analyzed 2 years of maternal SARS-CoV-2 published cases.

  • We assessed association of delivery management interventions with infant SARS-CoV-2 infection.

  • We found no evidence supporting any DMI for that purpose.

Keywords

COVID-19 - SARS-CoV-2 - neonates - pregnancy - delivery management

Data Availability Statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


* Authors contributed equally.


Supplementary Material



Publication History

Received: 25 May 2023

Accepted: 22 January 2024

Accepted Manuscript online:
24 January 2024

Article published online:
19 February 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223): 497-506
    CrossrefPubMedGoogle Scholar
  • 2 WHO. Pneumonia of unknown cause – China. Geneva: World Health Organization; . January 5, 2020
    Google Scholar
  • 3 Qadri F, Mariona F. Pregnancy affected by SARS-CoV-2 infection: a flash report from Michigan. J Matern Fetal Neonatal Med 2022; 35 (09) 1805-1807
    CrossrefPubMedGoogle Scholar
  • 4 Smith ER, Oakley E, Grandner GW. et al; Perinatal COVID PMA Study Collaborators, Perinatal COVID PMA Study Collaborators. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. BMJ Glob Health 2023; 8 (01) e009495
    CrossrefPubMedGoogle Scholar
  • 5 Ning C, Wang H, Wu J, Chen Q, Pei H, Gao H. The COVID-19 vaccination and vaccine inequity worldwide: an empirical study based on global data. Int J Environ Res Public Health 2022; 19 (09) 5267
    CrossrefPubMedGoogle Scholar
  • 6 Bhattacharya O, Siddiquea BN, Shetty A, Afroz A, Billah B. COVID-19 vaccine hesitancy among pregnant women: a systematic review and meta-analysis. BMJ Open 2022; 12 (08) e061477
    CrossrefPubMedGoogle Scholar
  • 7 Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies. Acta Obstet Gynecol Scand 2020; 99 (07) 823-829
    CrossrefPubMedGoogle Scholar
  • 8 Khoury JE, Atkinson L, Bennett T, Jack SM, Gonzalez A. COVID-19 and mental health during pregnancy: the importance of cognitive appraisal and social support. J Affect Disord 2021; 282: 1161-1169
    CrossrefPubMedGoogle Scholar
  • 9 Khoury JE, Atkinson L, Bennett T, Jack SM, Gonzalez A. Coping strategies mediate the associations between COVID-19 experiences and mental health outcomes in pregnancy. Arch Women Ment Health 2021; 24 (06) 1007-1017
    CrossrefPubMedGoogle Scholar
  • 10 Lavizzari A, Klingenberg C, Profit J. et al. International comparison of guidelines for managing neonates at the early phase of the SARS-CoV-2 pandemic. Pediatr Res 2021; 89 (04) 940-951
    CrossrefPubMedGoogle Scholar
  • 11 Zeng L, Xia S, Yuan W. et al. Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China. JAMA Pediatr 2020; 174 (07) 722-725
    CrossrefPubMedGoogle Scholar
  • 12 Chandrasekharan P, Vento M, Trevisanuto D. et al. Neonatal resuscitation and postresuscitation care of infants born to mothers with suspected or confirmed SARS-CoV-2 infection. Am J Perinatol 2020; 37 (08) 813-824
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Hudak ML, Flannery DD, Barnette K. et al; AMERICAN ACADEMY OF PEDIATRICS NPC-19 REGISTRY INVESTIGATORS. Maternal and newborn hospital outcomes of perinatal SARS-CoV-2 infection: a national registry. Pediatrics 2023; 151 (02) e2022059595
    CrossrefPubMedGoogle Scholar
  • 14 Angelidou A, Sullivan K, Melvin PR. et al. Association of maternal perinatal SARS-CoV-2 infection with neonatal outcomes during the COVID-19 pandemic in Massachusetts. JAMA Netw Open 2021; 4 (04) e217523
    CrossrefPubMedGoogle Scholar
  • 15 National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic. Centers for Disease Control and Prevention; . Accessed January 30, 2024 at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
    Google Scholar
  • 16 National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Considerations for inpatient obstetric healthcare settings. Centers for Disease Control and Prevention; . Accessed January 30, 2024 at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html
    Google Scholar
  • 17 Lin C, Chu SM, Hsu JF. et al. Delivery management of suspected or confirmed COVID-19 positive mothers. Pediatr Neonatol 2021; 62 (05) 476-482
    CrossrefPubMedGoogle Scholar
  • 18 Sunuwar N, Jaishi PP, Twayana AR, Neupane PK, Neupane SK. A retrospective study of COVID during pregnancy and the outcome of vaginal delivery. Ann Med Surg (Lond) 2022; 84: 104880
    PubMedGoogle Scholar
  • 19 Villar J, Soto Conti CP, Gunier RB. et al; INTERCOVID-2022 International Consortium. Pregnancy outcomes and vaccine effectiveness during the period of omicron as the variant of concern, INTERCOVID-2022: a multinational, observational study. Lancet 2023; 401 (10375): 447-457
    CrossrefPubMedGoogle Scholar
  • 20 Kurtser MA. Coronavirus infection COVID-19 and pregnancy. Herald Russ Acad Sci 2022; 92 (04) 445-451
    CrossrefPubMedGoogle Scholar
  • 21 Wang W, Xu Y, Gao R. et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 2020; 323 (18) 1843-1844
    PubMedGoogle Scholar
  • 22 Hoffmann M, Kleine-Weber H, Schroeder S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020; 181 (02) 271-280.e8
    CrossrefPubMedGoogle Scholar
  • 23 Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcriptome study. PLoS One 2020; 15 (04) e0230295
    CrossrefPubMedGoogle Scholar
  • 24 Pringle KG, Tadros MA, Callister RJ, Lumbers ER. The expression and localization of the human placental prorenin/renin-angiotensin system throughout pregnancy: roles in trophoblast invasion and angiogenesis?. Placenta 2011; 32 (12) 956-962
    CrossrefPubMedGoogle Scholar
  • 25 Valdés G, Neves LA, Anton L. et al. Distribution of angiotensin-(1-7) and ACE2 in human placentas of normal and pathological pregnancies. Placenta 2006; 27 (2–3): 200-207
    CrossrefPubMedGoogle Scholar
  • 26 Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46 (04) 586-590
    CrossrefPubMedGoogle Scholar
  • 27 Xiao AT, Tong YX, Zhang S. Profile of RT-PCR for SARS-CoV-2: a preliminary study from 56 COVID-19 patients. Clin Infect Dis 2020; 71 (16) 2249-2251
    CrossrefPubMedGoogle Scholar
  • 28 Zamaniyan M, Ebadi A, Aghajanpoor Mir S, Rahmani Z, Haghshenas M, Azizi S. Preterm delivery in pregnant woman with critical COVID-19 pneumonia and vertical transmission. Prenat Diagn 2020; 40 (13) 1759-1761
    CrossrefPubMedGoogle Scholar
  • 29 Baud D, Greub G, Favre G. et al. Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection. JAMA 2020; 323 (21) 2198-2200
    CrossrefPubMedGoogle Scholar
  • 30 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020; 37 (08) 861-865
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Chen H, Guo J, Wang C. et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020; 395 (10226): 809-815
    CrossrefPubMedGoogle Scholar
  • 32 Dong L, Tian J, He S. et al. Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn. JAMA 2020; 323 (18) 1846-1848
    PubMedGoogle Scholar
  • 33 Zeng H, Xu C, Fan J. et al. Antibodies in infants born to mothers with COVID-19 pneumonia. JAMA 2020; 323 (18) 1848-1849
    PubMedGoogle Scholar
  • 34 Palatnik A, McIntosh JJ. Protecting labor and delivery personnel from COVID-19 during the second stage of labor. Am J Perinatol 2020; 37 (08) 854-856
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Mick P, Murphy R. Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review. J Otolaryngol Head Neck Surg 2020; 49 (01) 29
    CrossrefPubMedGoogle Scholar