Covid-19 and the increase in premature births

Complicated pregnancies since Covid-19 more often they hesitate in a premature birth which can seriously endanger the baby’s life and generate all the complications typical of prematurity. The data of the Covid-19 Register of the Italian Society of Neonatology (SIN), as already noted in 2020, confirm a increase in premature births gives infected women pari all’11,2%, compared to the prematurity rate of non-infected women of 6.9%.

A non-pregnant 30-year-old who contracts the virus has a low chance of being hospitalized in intensive care, but if she’s pregnant, the risk goes up three times. Furthermore, the SARS-CoV-2 virus can be transmitted, albeit rarely, from mother to fetus and sometimes cause severe neonatal Covid-19 cases.”, Says President Sin Fabio Mosca. “For women who are pregnant or who want to have a child, we recommend that they get vaccinated, to protect themselves and their little one”.

On the occasion of the XXVII National Congress, in Rome from 6 to 9 October 2021, the Sin presents the updated data of the Covid-19 Register and reiterates the importance of the anti-Covid vaccination in pregnancy, to protect the mother and the unborn child.

The Register and the data

As of 30 June 2021, 3147 records were entered relating to as many newborns meeting the criteria for inclusion in the Register, of which 3091 were hospitalized at birth and 56 relating to newborns returned to the hospital for infection diagnosed after hospitalization of birth. Most of the cards were inserted by the Northern Centers, hardest hit by the pandemic and, in particular, by the Lombardy Region (37.1% of the cards inserted), followed by Emilia-Romagna (11.4% of the cards inserted) and Piedmont. (9.5% of the cards inserted). Overall, the Birth Points of the North have entered 70% of the cards, while those of both the Center and the South have both entered 15% of the cards.

84.5% of newborns (2611/3091) were born to women with infection at delivery, the remaining 15.5% (480/3091) to women with previous infection during pregnancy. In 85% of cases, the infection in pregnancy passed without symptoms; when present, the symptoms were mild to medium, requiring invasive ventilatory assistance (with tracheal intubation) in 12 cases and non-invasive ventilatory assistance (with nasal cannulae) in 11 cases. If we consider the population of those born to mothers infected at the time of delivery, most of them, 65.3%, came to light with vaginal birth, 18.7% with elective caesarean section and only 16% with caesarean section performed. in urgency for sometimes maternal reasons, often related to SARS-CoV-2 infection, sometimes fetal. In 88.8% of cases, newborns were born at term of pregnancy, i.e. with a gestational age ≥ 37 weeks. Therefore, the percentage of premature births, equal to 11.2%, is higher than that reported in the literature before the pandemic event, as reported by several studies, in even higher percentages, in women with Covid-19. In 10.9% of cases, these were newborns with a low birth weight, that is, with a weight of less than 2500 g. More than half of the births of mothers positive at childbirth or in the immediate post-partum period, 64.6%, were isolated with the mother (rooming-in), 20.6% were isolated in the ICU, 7.8% were isolated at the nursery school, 1.8% were isolated with their mother and subsequently separated and 5.2% were transferred to another center. 74.5% of the infants were fed exclusively with breast milk (64.1% at the breast and 10.4% with expressed breast milk).

Almost all (98.7%) of newborns born to mothers with infection at delivery were subjected to nasopharyngeal swab at birth: 1.6% of them tested positive for the swab performed within 48 hours of life, the remaining 2.6% only to a second swab performed later during hospitalization of the birth. Intrauterine transmission of the infection is likely to have occurred in positive infants within 48 hours of life, while horizontal transmission from mother to infant cannot be excluded in others, probably partly caused by unscrupulous adherence to precautionary measures. for transmission through droplet (surgical mask, careful hand washing, distancing the baby’s cradle from the mother’s bed in case of joint isolation, i.e. in the case of rooming-in). In most cases, in accordance with what is reported on average in the literature, the infection in newborns was asymptomatic (in 77.9% of cases) or paucisymptomatic. Poor adherence to precautionary measures was also likely the cause of the acquisition of infection by 2.2% of infants who were negative at discharge and positivized during follow-up.

Even the newborns returned to the hospital for home-acquired SARS-CoV-2 infection, despite being all symptomatic (prevalent symptoms: fever in 44.8% of cases and feeding difficulties in 24.1% of cases), presented a serious symptomatology mild or medium, requiring invasive ventilatory support in two cases and non-invasive ventilatory support in two other cases. None of them died from the infection and the hospital stay was relatively short (median 5 days, maximum duration 9 days).

We have created the Covid-19 Registry in order not to waste the wealth of knowledge gained by Neonatologists during the SARS-CoV-2 pandemic”Concludes President Mosca. “These updated data, relating to assistance to those born to Covid-positive mothers diagnosed at any time during pregnancy and to newborns with acquired infection within the first month of life, represent a valuable tool for operators in the sector, but also for institutions. both from a scientific, clinical and social point of view. Thanks to the acquired knowledge we have been able to guarantee the mother-newborn dyad, even during the health emergency, safety and quality in care, supporting Zero Separation and favoring rooming-in and the start of breastfeeding.”.