Neonatal Outcomes in Infants Born to Mothers Recovered from COVID-19 During Pregnancy: A Single-Center Experience in Türkiye’s Level IV NICU

Neonatal Outcomes After In Utero COVID-19 Exposure

Abstract

Objective: The impact of in utero exposure to maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on neonatal health, particularly in the absence of active infection at delivery, remains incompletely understood. This study evaluated early neonatal outcomes and short-term follow-up among infants exposed to maternal Coronavirus Disease-2019 (COVID-19) during pregnancy, compared with unexposed neonates.
Methods: This retrospective observational cohort study was conducted at Gazi University Faculty of Medicine Hospital, a tertiary university hospital with a Level IV NICU, between March 2020 and August 2021. Neonates who tested polymerase chain reaction (PCR)-negative at delivery and were born to mothers with PCR-confirmed SARS-CoV-2 infection during pregnancy were classified as exposed, while neonates born to mothers without a history of COVID-19 during pregnancy served as controls. Neonatal outcomes during hospitalization and at one-month follow-up were assessed.
Results: A total of 196 neonates were included, of whom 112 were exposed in utero to maternal COVID-19. Neonatal intensive care unit (NICU) admission was more frequent among exposed infants [28.4% vs. 11.9%; relative risk (RR): 2.38, 95% confidence interval (CI): 1.25-4.54; p = 0.007]. In exposed neonates, hyperbilirubinemia requiring phototherapy occurred more frequently (38.8% vs. 22.2%; RR: 1.75, 95% CI: 1.08-2.85; p = 0.017), and the onset of jaundice occurred earlier [median (interquartile range) 3 (2-3) vs. 5.5 (3-8) days; p = 0.006]. Direct Coombs testing (performed in a clinically selected subset) showed similar overall positivity rates, but high-grade positivity (≥2+) occurred exclusively among exposed infants (p = 0.004). In trimester-specific analyses, second-trimester maternal infection was associated with a higher rate of neonatal endotracheal intubation than with first- or third-trimester exposure (10.0% vs. 0%; p = 0.034). No group differences were observed in early postnatal complications or rehospitalizations at one month.
CONCLUSION: Resolved maternal SARS-CoV-2 infection during pregnancy was not associated with major adverse neonatal outcomes, but it was linked to more frequent NICU admissions, earlier onset of clinical jaundice, a higher incidence of hyperbilirubinemia requiring treatment, and distinct patterns of severity on the direct Coombs test, potentially consistent with altered immune or hematologic processes. A trimester-specific association with endotracheal intubation was observed and should be interpreted cautiously.