Neonates born to Covid-positive mothers are at risk of developing necrotizing enterocolitis (NEC), according to a recent study from Indonesia published in the Annals of Medicine and Surgery.¹ Preterm birth, lower birth weight, birth asphyxia and a positive RT PCR for SARS-CoV-2 were the factors that predisposed to NEC and also increased mortality.

Angelica et al conducted an observational study with the objective to examine factors associated with NEC in neonates born to Covid-positive mothers. For this they enrolled 125 neonates, with RT PCR-confirmed SARS-CoV-2 infection in mothers, who were hospitalized between May 2020 and March 2021. The neonates were also tested for the infection on the day of birth. Pre-eclampsia (16%) was the most common comorbidity in mothers followed by hypertension (4%) and obesity (2%).

Majority of the newborns were cesarean births (62%), were born full-term (70%) and had birth weight >2.5kg. According to the authors, this large number of cesarean deliveries was “to prevent transmission of coronavirus infection in the environment”. Seven (5.6%) were positive for Covid-19 and 25.6% had asphyxia at birth.

Five neonates developed necrotizing enterocolitis and only one of them survived. A positive RT PCR for SARS-CoV-2 was associated with high risk of necrotizing enterocolitis with odds ratio of 15.3. Neonates with birth asphyxia were at 13 times higher risk of NEC (OR 13.1). Newborns with birth weight <2.5kg (<5.5 lb) and gestational age <37 weeks were more likely to develop NEC. Out of the five neonates with NEC, two were positive for Covid-19, four had birth asphyxia, while four were cesarean births.

Mortality due to NEC was significantly higher in cesarean deliveries, neonates born at lower gestational age and those with asphyxia.

This study has identified factors that are associated with increased risk of NEC in newborns. Hence all pregnant women should be tested for SARS-CoV-2 and strict infection control measures should be in place at the time of delivery, aside from testing the newborns for Covid-19.

Reference

1. Angelika D, et al. Observational study on necrotizing enterocolitis in neonates born to SARS-CoV-2-positive mothers. Ann Med Surg (Lond). 2022 May 6;103711. doi: 10.1016/j.amsu.2022.103711.