The Public Health and Clinical Importance of Accurate Neonatal Testing for COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has infected large numbers of pregnant women, consequently highlighting the importance for newborns to be comprehensively evaluated for infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is much that remains to be learned about SARS-CoV-2 infection of the fetus and newborn, including delineating the mechanisms and cofactors for vertical and environmental transmission and the best methods for neonatal testing and diagnosis. In this issue of Pediatrics, Sánchez-Luna et al¹ present the results of their prospective analysis of neonates delivered to 497 pregnant women with COVID-19 in 79 hospitals throughout Spain. The data obtained from this national registry are of immense importance in adding to our understanding of the effects of maternal COVID-19 infection on neonatal outcomes, including potential vertical transmission of SARS-CoV-2. Sánchez-Luna et al found that 14 of 469 (3%) neonates tested by nasopharyngeal swabs at a median period of 3 hours after delivery were positive for SARS-CoV-2; this appears consistent with recent findings from a meta-analysis.² After a repeat test performed 24 to 48 hours later, however, 12 of these 14 neonates tested negative for the coronavirus, and all were asymptomatic. We must be cautious in trying to interpret these results.

Accurate neonatal testing for COVID-19 is not only a …

Address correspondence to David A. Schwartz, MD, MS Hyg, FCAP, 1950 Grace Arbor Court, Atlanta, GA 30329. E-mail: davidalanschwartz{at}gmail.com