No Ocular Abnormalities in Newborns Exposed to COVID-19 In Utero

A low rate of coronavirus disease 2019 (COVID-19) infection was found in newborns of mothers infected with COVID-19, and no newborns were born with ocular abnormalities. This is according to research results published in JAMA Ophthalmology. 

To date, there have been no studies about ophthalmological findings in newborns due to vertical transmission of SARS-CoV-2 infection. Researchers conducted an uncontrolled case series study following newborns with maternal COVID-19 infections between April and November 2020 in São Paulo, Brazil. 

The cohort included 165 newborns with maternal COVID-19-positive test results, ranging between 1 and 18 years of age at ophthalmologic examination. Among these newborns, 74.5% were born at full term (25.4% preterm); 1-minute Apgar score was >7 in 6.6% of newborns. Mean weight at birth was 2921(±702) g (range, 745-4335 g). 

The date of maternal COVID-19 diagnosis varied between first and fortieth gestational week. 

Positive PCR results were found in 6 newborns; 1 tested positive within 18 days, and 5 tested positive on their first day of life, representing potential vertical transmission. No newborns presented with ocular abnormalities. In 4 of 5 newborns, COVID-19 infection occurred in the third trimester (age, 31 to 38 gestational weeks). 

Although ophthalmological findings were normal in all newborns, some infants with negative PCR results did present with abnormalities in the fundus that may or may not have been attributable to congenital disease. Of the newborns who were exposed, 1 presented with retinal vascular tortuosity and venous engorgement. Seven presented with retinal hemorrhages and 2 presented with retinopathy of prematurity — one of which was the aggressive posterior form requiring anti-vascular endothelial growth factor (VEGF) injection therapy. 

In addition to ocular findings, 5.4% of newborns presented with respiratory distress syndrome and 1 newborn presented with tonic-clonic seizures; following brain imaging, they were diagnosed with COVID-19 encephalitis. 

Study limitations include a lack of control group due to the design of the study, an inability to generalize study findings outside of the cohort, and a lack of standardized imaging. 

“The low rate of ocular abnormalities found in this study, likely within the range of anticipated findings in the absence of COVID-19, suggests that there is not a moderate or high increased risk of ocular abnormalities in newborns of mothers with COVID-19,” the research explains. “Additional controlled and larger-sized studies with standardized imaging…and standardization of ophthalmologists would be needed to rule out a low increased risk.” 

“Considering the noninvasive nature of fundus examination, retinal changes should be further investigated in prospective studies to understand their possible applications in the diagnosis and management of COVID-19,” according to investigators. 

Reference

Kiappe OP, da Cruz NFS, Rosa PAC, Arrias L, de Moraes NSB. Ocular assessments of a series of newborns gestationally exposed to maternal COVID-19 infection.JAMA Ophthalmol. Published online April 7, 2021. doi:10.1001/jamaophthalmol.2021.1088