Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance.
Characteristics and outcomes of neonatal SARS-CoV-2 infection in the UK: a prospective national cohort study using active surveillance.
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DOI：
10.1016/s2352-4642(20)30342-4
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发表时间：
2021-03
期刊：
影响因子：
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通讯作者：
Kurinczuk JJ
中科院分区：
文献类型：
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作者：
Gale C;Quigley MA;Placzek A;Knight M;Ladhani S;Draper ES;Sharkey D;Doherty C;Mactier H;Kurinczuk JJ
婴儿与年龄较大的儿童在接触严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)方面有所不同。然而，描述SARS-CoV-2在这一群体中影响的数据很少，指导意见也是可变的。我们的目标是描述在英国接受住院护理的新生儿中SARS-CoV-2感染的发生率、特征、传播和结局。我们对2020年3月1日至4月30日期间接受住院护理的出生后28天内确诊为SARS-CoV-2感染的婴儿进行了一项基于英国人群的前瞻性队列研究。通过英国儿科监测股进行积极的国家监测，并与国家检测、儿科重症监护审计和产科监测数据相联系，确定了受感染的婴儿。结果包括确诊的 冠状病毒2型感染和严重疾病的发生率(每10,000个活产儿中)、疑似垂直和医院获得性感染的婴儿比例以及临床结果。确诊新生儿SARS-CoV2感染66例(发病率5·6[95%CI 4·3-7·1]/1万 )，其中重度新生儿SARS-CoV2感染28例(42%)，发病率2·4[1·6-3·4]/10 000。其中16例(24%)为早产。36例(55%)来自白人(发病率为4·6[3·2~6·4]/万 活产)，14例(21%)来自亚裔(15·2[8·3~25·5]例/万 活产)，8例(12%)黑人(18·0[7·8~35·5]例/10 万活产)，7例(11%)混血儿或其他族裔(5·6[2·2~11·5]例/10 万活产)。确诊感染的婴儿中有17名(26%)出生于已知的围产期SARS-CoV-2感染的母亲，2名(3%)被认为可能有垂直获得性感染(出生后12小时内SARS-CoV-2阳性的样本中母亲也呈阳性)。8名婴儿(12%)怀疑为院内获得性感染。截至2020年7月28日，58名(88%)婴儿已出院，7名(11%)仍在住院，1名(2%)死于与SARS-CoV-2感染无关的原因。新生儿SARS-CoV-2感染在住院婴儿中并不常见。患有围产期SARS-CoV-2感染的母亲在出生后新生儿入院感染的可能性不大，可能的垂直传播也很少见，这支持了避免母婴分离的国际指导。黑人、亚洲人或少数族裔婴儿的比例很高，需要进行调查。英国国家卫生研究所政策研究计划。
Babies differ from older children with regard to their exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, data describing the effect of SARS-CoV-2 in this group are scarce, and guidance is variable. We aimed to describe the incidence, characteristics, transmission, and outcomes of SARS-CoV-2 infection in neonates who received inpatient hospital care in the UK. We carried out a prospective UK population-based cohort study of babies with confirmed SARS-CoV-2 infection in the first 28 days of life who received inpatient care between March 1 and April 30, 2020. Infected babies were identified through active national surveillance via the British Paediatric Surveillance Unit, with linkage to national testing, paediatric intensive care audit, and obstetric surveillance data. Outcomes included incidence (per 10 000 livebirths) of confirmed SARS-CoV-2 infection and severe disease, proportions of babies with suspected vertically and nosocomially acquired infection, and clinical outcomes. We identified 66 babies with confirmed SARS-CoV-2 infection (incidence 5·6 [95% CI 4·3–7·1] per 10 000 livebirths), of whom 28 (42%) had severe neonatal SARS-CoV-2 infection (incidence 2·4 [1·6–3·4] per 10 000 livebirths). 16 (24%) of these babies were born preterm. 36 (55%) babies were from white ethnic groups (SARS-CoV-2 infection incidence 4·6 [3·2–6·4] per 10 000 livebirths), 14 (21%) were from Asian ethnic groups (15·2 [8·3–25·5] per 10 000 livebirths), eight (12%) were from Black ethnic groups (18·0 [7·8–35·5] per 10 000 livebirths), and seven (11%) were from mixed or other ethnic groups (5·6 [2·2–11·5] per 10 000 livebirths). 17 (26%) babies with confirmed infection were born to mothers with known perinatal SARS-CoV-2 infection, two (3%) were considered to have possible vertically acquired infection (SARS-CoV-2-positive sample within 12 h of birth where the mother was also positive). Eight (12%) babies had suspected nosocomially acquired infection. As of July 28, 2020, 58 (88%) babies had been discharged home, seven (11%) were still admitted, and one (2%) had died of a cause unrelated to SARS-CoV-2 infection. Neonatal SARS-CoV-2 infection is uncommon in babies admitted to hospital. Infection with neonatal admission following birth to a mother with perinatal SARS-CoV-2 infection was unlikely, and possible vertical transmission rare, supporting international guidance to avoid separation of mother and baby. The high proportion of babies from Black, Asian, or minority ethnic groups requires investigation. UK National Institute for Health Research Policy Research Programme.