Maternal COVID-19 Infection Associated with Fetal Systemic Inflammatory Complications in COVID-19 Negative Neonates: A Case Series

Objective: To examine fetal and neonatal inflammatory and neurologic complications associated with maternal COVID-19 infection. Study design: Case series using a convenience sample of neonates cared for in a large referral-based Children’s Hospital NICU between September 2021 and May 2022. Results: We identified 7 neonates with exposure to maternal SARS-CoV-2 and a presentation consistent with inflammatory complications. All had some degree of neurologic injury with neuroimaging findings including restricted diffusion indicating injury in the white matter, cortex, deep gray structures and splenium of the corpus callosum as well as intracranial hemorrhage. In addition, many infants had cytopenias and abnormal coagulation studies. Placental pathology, when available, revealed inflammation, clot with calcifications, and hematomas with associated infarcts. Conclusion: Neonates born to mothers with SARS-CoV-2, even when negative for the virus themselves, may have complications consistent with a systemic inflammatory syndrome. Placental pathology as well as neurologic imaging in infants with neurologic findings may help to support this diagnosis.