COVID-19 infection and associated death among hospitalized neonates: a national retrospective study

Abstract Background SARS-CoV-2 infection in infants and neonates is generally uncommon and tends to present with milder symptoms than in adults. While most infected neonates are asymptomatic, some may exhibit fever, poor feeding, nasal congestion, or respiratory distress. The overall prognosis is favorable, with most cases resolving without complications. This study evaluates COVID-19 infections among hospitalized neonates, with a specific focus on associated factors and clinical outcomes. Method This study analyzed data from the Iranian Maternal and Neonatal (IMaN) Network registry system, encompassing all hospitalized neonates across Iran from March 21, 2021, to March 20, 2022. Neonates with gestational ages under 28 weeks were excluded. Collected variables included demographic characteristics, gestational age, birth weight, maternal COVID-19 infection during pregnancy, congenital anomalies, comorbidities, clinical outcomes, and causes of mortality. The chi-square test was used for categorical variables. Multiple logistic regression models were utilized to independently identify factors associated with neonatal COVID-19 infection and death. Result During the study period, 225,082 neonates were included, of whom 10,175 were suspected of COVID-19 infection and tested via PCR; 1,328 (13.05%) were confirmed positive. A maternal history of COVID-19 infection in last two weeks of pregnancy was negatively associated with neonatal infection (OR = 0.73, P = 0.001). Among COVID-19 infected neonates 64 (4.82%) neonates died. COVID-19 infection was not associated with neonatal death. Moreover, very preterm birth (OR = 5.04, P < 0.001), congenital malformations (OR = 4.57, P < 0.001), and respiratory comorbidities (OR = 3.93, P < 0.001) were identified as significant factors associated with increased neonatal mortality among COVID-19 infected neonates. Conclusion In this study, COVID-19 infection was not associated with death. The presence of malformations and respiratory comorbidities was associated with an increased risk of death in these cases. Overall, the general course and outcomes of COVID-19 infection in neonates might be good. Clinical trial number Not applicable.