Severe ocular risk is likely to be low in neonates exposed to COVID-19 during pregnancy

Certain viruses, such as cytomegalovirus and Zika virus, have been associated with ocular manifestations in neonates due to vertical transmission.

New research, however, suggests little risk between maternal exposure to coronavirus disease (COVID-19) and moderate to severe manifestations.

Led by dr. Med. Olívia Pereira Kiappe, Federal University of Sao Paulo, Escola Paulista de Medicina, Sao Paulo, Brazil, the investigation team conducted a series of cases that enrolled newborns from April to November 2020.

They sought to determine the ocular outcome in neonates exposed to COVID-19 before birth.

Vertical transmission and ocular risk

Kiappe and team determined positivity for COVID-19 in both mothers and neonates using the results of reverse transcriptase-polymerase chain reaction (PCR) tests in reality, along with oronazopharyngeal swab samples. Positive IgM serology was also considered a diagnostic test for mothers.

As such, a total of 165 neonates exposed to COVID-19 were included in the study. Age during the ophthalmological examination ranged from 1 to 18 days.

Of this population, 123 were born at full term and 29 had low birth weight (<1500 g).

“The mother’s diagnosis of COVID-19 varied between the first and 40th week of gestation,” the investigators noted.

They observed that 6 infants had positive PCR results: 1 positive within 18 days of birth and 5 positive on the first day of life (thus making vertical transmission uncertain).

Infection occurred in the 3rd trimester in 4 or 5 newborns (31-38 gestational weeks) and in the 1st trimester in 1 newborn (8 gestational weeks).

However, none of the neonates infected with COVID-19 had eye abnormalities.

As for neonates who were exposed but did not show a positive PCR test, some had fundus abnormalities of unclear association.

Even more, 1 showed signs of retinal vascular tortuosity and venous inflation according to ophthalmoscopy. Maternal infection in this patient occurred in the 28th week of gestation, and the investigators ruled out other possible concomitant diseases.

They also reported that 7 infants with retinal hemorrhage, 2 had retinopathy of prematurity, and one had an aggressive posterior form and were therefore treated with an injection of antivascular endothelial growth factor.

“The low rate of ocular abnormalities identified in this study, probably within the range of expected findings in the absence of COVID-19, suggests that there is no moderate or high increased risk of ocular abnormalities in infants of mothers with COVID-19,” the investigators wrote.

They indicated, however, that more data, larger studies and standardized imaging are needed to make further suggestions on any type of risk for ocular manifestations.

“Although more data are needed, vertical transmission of SARS-CoV-2 appears to be possible and should be of concern, especially in a condition that could be asymptomatic, and which is so prevalent in the population and that could bring significant burden to patients and healthcare. system even at low rates of congenital infection, ”Kiappe and colleagues noted.

The study, “Ocular Estimates of a Range of Newborns Gestational Exposed to Maternal COVID-19 Infection,” was published online in JAMA ophthalmology.