Neonatal outcome in COVID-19 pregnant women in District Hospital, Ballari

INTRODUCTION

MATERIALS AND METHODS

The hospital in which study is done is a teaching hospital and tertiary referral center for neonatal care. The annual delivery rate is approximately 5500, with nearly 1000 SNCU admissions per year. As per the recommendations, all the health-care staffs followed donning and doffing sequence of complete personal protective equipment which included goggles, cap, double layer gloves, N95 mask, shoe covers, and overall.

RESULTS

Among the 171 neonates born to 2019-nCoV-infected mothers, 62 neonates got admitted in SNCU for various indications. There were 34 males and 28 females; 19 were low birth weight (LBW), out of which 3 are very LBW 1000–1499 g, 1 was extremely LBW with 920 g of birth weight. There were 58 singleton and 02 twin deliveries. Out of 62 admissions, 60 got successfully discharged, 1 left against medical advice, and 1 expired due to severe meconium aspiration syndrome within 24 h of life in spite of ventilator support.

According to our study [Table 1], the incidence of positive neonatal COVID cases was 4%, out of which 42.8% symptomatic [Table 2]. Out of seven COVID-positive babies, three babies were symptomatic, two had refusal of feeds, and only one got admitted in SNCU [Table 3] with respiratory distress with hypernatremic dehydration, this baby was single, term, male, delivered by LSCS with breech presentation, baby cried immediately after birth, liquor was clear, Apgar at 1’- 7/10, at 5’- 9/10, birth weight was 3.570 kg.

On day 3^rd of life, the baby had symptoms of fever, weight loss >10% of birth weight. As per SNCU protocol, investigations sent and treatment started. Investigations were showing hypernatremia with serum sodium of 152.3 mmol/L, so diagnosed as hypernatremic dehydration with COVID-19 positive and treated for hypernatremia.

On the 4^th and 5^th day, the baby was asymptomatic and stable. On the 6^th day of life, the baby had tachypnea with subcostal retractions with desaturation 85% at room air, got improved on 4 lit/min of oxygen through hood. All acute-phase reactants were raised with normal blood counts. On the 7^thday, the baby got weaned off from oxygen and the baby was active and stable. On the 8^th day, the baby shifted to mother side, in step-down, and on the 11^th day of life, the baby was discharged.

All COVID-19-positive neonates remained asymptomatic as per the last follow-up telephonic call on day 14/day 29 of life. There were two deaths in the cohort; both were tested negative for COVID-19. One maternal death due to ARDS and the baby were asymptomatic and tested COVID-19 negative.

DISCUSSION

Our study was conducted as per SOP provided by NNF-K for testing and clinical protocol. This study describes seven COVID-19-positive neonates of the total 171 neonates tested with incidence of 4%. Only one of the COVID-19-positive neonates developed severe manifestations of the disease – respiratory distress syndrome with hypernatremic dehydration and was discharged subsequently. We followed the policy of rooming in with mother and direct breastfeeding with precautions in stable neonates born to COVID-19-positive mothers. A total of 96% of the roomed neonates tested negative for COVID-19. The positivity rate in neonates is variable in the previous studies. A study conducted in the Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India, showed positivity rate of 10.7%.^[15] In a multicentric study from Turkey,^[16] the rate has been described as 3.3%, whereas in a systematic review^[17] and two other studies,^[18,19] it is observed to be 2.7% (1/37) to 9.99% (3.3%) and 4.2% (3/72). In our study, we have good sample number of 171 babies delivered at our hospital. We have practiced rooming-in even for asymptomatic COVID-19-positive babies.

CONCLUSION

In COVID-19 pandemic, caring of babies and families was challenging for neonatal nurses and midwives. While babies have been infected, the naive of the neonatal immune system in relation to the inflammatory response would appear to be protective, with further responses achieved with the consumption of human milk. The World Health Organization had made clear recommendations about the benefits of breastfeeding, even if the mother and baby dyad were COVID-19 positive, if they remain well. The mother and baby had to be kept in same room and the mother was made able to participate in her baby’s care and develop her mothering role. Close cooperation between obstetric and pediatric departments was encouraged to deliver well-prepared resuscitation for neonates in the delivery room. In our study, transmission rate of 4% is seen. All symptomatic babies got cured and discharged successfully with average length of stay for 4 days. As 2019-nCoV was known to have pathogenic potential, to cause severe maternal or perinatal adverse outcomes, we recommended systematic screening of any suspected 2019-nCoV infection during pregnancy and extended intensive follow-up for confirmed mothers and their fetuses.