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National active surveillance to understand and inform neonatal care in COVID-19
  1. Chris Gale1,
  2. Marian Knight2,
  3. Shamez Ladhani3,4,
  4. Elizabeth S Draper5,
  5. Don Sharkey6,
  6. Cora Doherty7,
  7. Helen Mactier8,
  8. Jennifer J Kurinczuk2
  9. On behalf of Members of Neonatal Complications of COVID-19 Surveillance Group
  1. 1 Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
  2. 2 NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  3. 3 Immunisation Department, Public Health England, London, UK
  4. 4 Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
  5. 5 Health Sciences, University of Leicester, Leicester, UK
  6. 6 Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK
  7. 7 Neonatology, University Hospital Wales, Cardiff, UK
  8. 8 Neonatology, Princess Royal Maternity, Glasgow, UK
  1. Correspondence to Dr Chris Gale, Neonatal Medicine, School of Public Health, Faculty of Medicine, Chelsea and Westminster campus, Imperial College London, London SW10 9NH, UK; christopher.gale{at}imperial.ac.uk

https://doi.org/10.1136/archdischild-2020-319372

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    The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and has spread rapidly. COVID-19 was declared a pandemic by the WHO on 12 March 2020. Robust, population-based data describing COVID-19 during pregnancy and the neonatal period are critical to understand and manage this global threat in these groups.

    There are three key ways that SARS-CoV-2 could affect neonates:

    1. Vertical transmission of SARS-CoV-2 from mother to infant, which may lead to neonatal COVID-19.

    2. Horizontal transmission of SARS-CoV-2 in the neonatal period, potentially leading to neonatal COVID-19; this may occur from family contacts or nosocomial transmission in healthcare settings, such as neonatal units.

    3. Indirect effects on the newborn following maternal COVID-19 that impact pregnancy or labour and birth, leading to complications, such as preterm birth. This will include situations where the neonate is affected by, but does not contract, SARS-CoV-2.

    The impact of COVID-19 on neonates, as well as the importance of these different potential mechanisms of exposure, remains unclear. Vertical transmission of SARS-CoV-2 has yet to be definitively established; neonatal infection with the virus has been detected in the first days after birth to mothers with COVID-191; however, this could represent early horizontal transmission. Support for vertical transmission comes from serological testing following maternal COVID-19, which found SARS-CoV-2 IgM in umbilical cord blood2; however, SARS-CoV-2 viral RNA was not detected in these newborns, and the validity of current serological tests remains to be established.3 Nevertheless, neonates can be symptomatic with COVID-19 regardless of the mechanism of transmission. Although initial data indicated that the disease was less severe in children,4 approximately 10% of neonates and infants with COVID-19 develop severe or critical disease, a higher proportion than that in …

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