# Persistent SARS-CoV-2 Positive Tests in Neonates: Clinical Outcomes, Transmission Pathways, and Immune Vulnerability—Case Series

## TL;DR

Newborns with ongoing SARS-CoV-2 infections face serious health risks, including infections and poor growth, especially if born prematurely or with low birth weight.

## Contribution

This case series identifies persistent SARS-CoV-2 positivity in neonates as a significant clinical risk with specific complications and immune vulnerability.

## Key findings

- Neonates with persistent SARS-CoV-2 positivity had high rates of sepsis, superinfections, inadequate weight gain, and mortality.
- Persistent viral detection was linked to prolonged inflammation and increased susceptibility to secondary infections.

## Abstract

What are the main findings?
Neonates with persistent SARS-CoV-2 positivity showed high rates of adverse outcomes, including sepsis, superinfections, inadequate weight gain, and mortality, particularly among preterm and low-birth-weight infants.Persistent viral detection during hospitalization was associated with prolonged inflammatory states and increased susceptibility to secondary bacterial and fungal infections.

Neonates with persistent SARS-CoV-2 positivity showed high rates of adverse outcomes, including sepsis, superinfections, inadequate weight gain, and mortality, particularly among preterm and low-birth-weight infants.

Persistent viral detection during hospitalization was associated with prolonged inflammatory states and increased susceptibility to secondary bacterial and fungal infections.

What are the implications of the main findings?
Persistent SARS-CoV-2 positivity represents a significant clinical risk in neonates, underscoring the need for close monitoring, early identification of inflammation, and prevention of superinfections.

Persistent SARS-CoV-2 positivity represents a significant clinical risk in neonates, underscoring the need for close monitoring, early identification of inflammation, and prevention of superinfections.

Background: In 2020, the World Health Organization declared a Public Health Emergency of International Concern due to the global outbreak of SARS-CoV-2. Recognized as a severe and highly contagious disease, it affected both the adult and pediatric population. However, due to the early timing of the pandemic, limited research was conducted in the perinatal field, leaving many questions regarding the true impact of maternal transmission to fetuses and its consequences during the neonatal period. Methods: In this case series, we reviewed data from ten newborns delivered in the Instituto Nacional de Perinatología (INPer) in Mexico City (tertiary referral institute), all from high-risk pregnancies, between November 2020 and January 2021, all of whom tested positive for SARS-CoV-2 at various points during their hospital stay. Results: Despite showing correct extrauterine adaptation after birth, several of them developed complications such as sepsis, superinfections, inadequate weight gain, and, in some cases, death. Conclusions: These results highlight the urgent need for targeted neonatal care protocols and further research to better understand the impact of persistent viral positivity and immune vulnerability in this population.