Ocular Assessments of a Series of Newborns Gestationally Exposed to Maternal COVID-19 Infection

• Published in: JAMA ophthalmology Vol. 139; no. 7; p. 777
• Main Authors: Kiappe, Olívia Pereira, Santos da Cruz, Natasha Ferreira, Rosa, Paulo Alberto Cervi, Arrais, Luciana, Bueno de Moraes, Nilva Simeren
• Format: Journal Article
• Language: English
• Published: United States 01-07-2021
• Subjects: Brazil; COVID-19 - diagnosis; COVID-19 - transmission; COVID-19 - virology; COVID-19 Testing; Diagnostic Techniques, Ophthalmological; Eye - virology; Eye Infections, Viral - diagnosis; Eye Infections, Viral - transmission; Eye Infections, Viral - virology; Female; Gestational Age; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - virology; Prenatal Exposure Delayed Effects; Brazil
• ISSN: 2168-6173
• DOI: 10.1001/jamaophthalmol.2021.1088

Congenital viral infections leading to ocular abnormalities are frequent and devastating. As ophthalmological manifestations of COVID-19 in newborns are still unknown, it is important to clarify if SARS-CoV-2 could be associated with ocular abnormalities.
To determine whether exposure to SARS-CoV-2 is associated with outcomes in the eyes of newborns.
This case series enrolled newborns from April to November 2020 from 3 different maternity hospitals in São Paulo, Brazil. The diagnosis of COVID-19 in mothers and newborns was based on real-time reverse transcriptase-polymerase chain reaction assays with material obtained from oronasopharyngeal swab sample; positive IGM serology was also considered as a diagnostic test for mothers. Newborns were excluded if they had any evidence of another congenital infection. All infants underwent external ocular examination and binocular indirect ophthalmoscopy.
Serology test for COVID-19 and detection of SARS-CoV-2 from oronasopharyngeal specimen using a real-time reverse transcriptase-polymerase chain reaction assay on both mothers and newborns.
Screening for ophthalmologic manifestation in newborns after maternal COVID-19 infection.
A total of 165 newborns (age range at examination, 1 to 18 days) were evaluated. Of these, 123 (74.5%) were born at full term, and 42 (25.4%) were born preterm. Maternal gestational age at the time of COVID-19-positive test varied from first to 40th gestational weeks. Six newborns (3.6%) had positive polymerase chain reaction findings for SARS-CoV-2. One newborn tested positive within 18 days (horizontal transmission), and 5 newborns tested positive in the first day of life (possible vertical transmission). None had ocular abnormalities. Concerning exposed newborns with negative test results, 1 presented with venous engorgement and vascular tortuosity, 7 had intraretinal hemorrhages, and 2 were diagnosed as having retinopathy of prematurity.
In this uncontrolled case series of Brazilian newborns of mothers with COVID-19 infection, a low rate of COVID-19 infection was found among newborns, and none had ocular abnormalities. Additional controlled studies may be warranted to confirm these findings.