Necrotizing enterocolitis in preterm infants born to mother with COVID-19

BACKGROUND: The previous studies have reported a significant correlation between COVID-19 in pregnant women with the incidence of pre-eclampsia and HELLP syndrome. Pre-eclampsia is known to be a risk factor for necrotizing enterocolitis (NEC) in preterm infants. AIM: This study aimed to investigate the incidence and associated factor of NEC in preterm infants born to mothers with COVID-19. METHODS: This observational study was conducted in neonatal intensive care unit at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Data collection was carried out from May 2020 to April 2021. All preterm infants born to mothers with positive COVID-19 were included as study participants. Infants were excluded if they had multiple congenital anomalies, spontaneous intestinal perforation was established during surgery, and their parents did not provide consent. Of the 49 preterm infants born to mother with COVID-19, one infant had multiple congenital anomalies and three infants did not get parental consent. No infants had spontaneous intestinal perforation. Therefore, a total of 45 preterm infants were analyzed in this study. Polymerase chain reaction (PCR) swab examination was performed within 48 h after birth. The diagnosis of COVID-19 was defined as positive if the SARS-CoV-2 virus could be detected on a nasal swab and throat swab through the reverse transcription-PCR examination. The diagnosis of NEC was established by clinical symptoms and confirmed by abdominal radiography. RESULTS: Out of 45 preterm infants included, 6 (13.3%) infants experienced NEC. Of the six preterm infants with NEC, there was one infant who survived. Factors that were significantly associated with the incidence of NEC included asphyxia (odds ratio [OR] = 10.000, 95% confidence interval [CI] = 1.056–94.677, p = 0.020) and intubated mother (OR = 19.000, 95% CI = 1.394–258.954, p = 0.005). Positive PCR results from the infants alone did not significantly increase the risk of NEC. The combination of positive PCR result with asphyxia and intubated mother was found to be significantly associated with the incidence of NEC (OR = 2.438, 95% CI = 1.673–3.551, p = 0.007). CONCLUSIONS: This study found that 13.3% of preterm infants born to mother with COVID-19 experienced NEC. Significant factors associated with the incidence of NEC in preterm infants born to mothers with COVID-19 included asphyxia and intubated mothers before delivery. A positive PCR result alone did not significantly increase the risk of NEC. Further research is needed to investigate other factors in NEC preterm infants born to COVID-19 mothers.