What are the ophthalmological manifestations in newborns after maternal COVID-19 infection?
In this case series, 165 newborns exposed to SARS-CoV-2 went through ophthalmological evaluation. One exposed newborn presented with retinal vascular tortuosity and venous engorgement seen on ophthalmoscopy, 7 newborns showed intraretinal hemorrhages, and 2 newborns had retinopathy of prematurity.
These findings likely rule out a moderate or high increased risk of ocular involvement in newborns of mothers with SARS-CoV-2 infection regardless of gestational age.
Congenital viral infections leading to ocular abnormalities are frequent and devastating. As ophthalmological manifestations of COVID-19 in newborns are still unknown, it is important to clarify if SARS-CoV-2 could be associated with ocular abnormalities.
To determine whether exposure to SARS-CoV-2 is associated with outcomes in the eyes of newborns.
Design, Setting, and Participants
This case series enrolled newborns from April to November 2020 from 3 different maternity hospitals in São Paulo, Brazil. The diagnosis of COVID-19 in mothers and newborns was based on real-time reverse transcriptase–polymerase chain reaction assays with material obtained from oronasopharyngeal swab sample; positive IGM serology was also considered as a diagnostic test for mothers. Newborns were excluded if they had any evidence of another congenital infection. All infants underwent external ocular examination and binocular indirect ophthalmoscopy.
Serology test for COVID-19 and detection of SARS-CoV-2 from oronasopharyngeal specimen using a real-time reverse transcriptase–polymerase chain reaction assay on both mothers and newborns.
Main Outcomes and Measures
Screening for ophthalmologic manifestation in newborns after maternal COVID-19 infection.
A total of 165 newborns (age range at examination, 1 to 18 days) were evaluated. Of these, 123 (74.5%) were born at full term, and 42 (25.4%) were born preterm. Maternal gestational age at the time of COVID-19–positive test varied from first to 40th gestational weeks. Six newborns (3.6%) had positive polymerase chain reaction findings for SARS-CoV-2. One newborn tested positive within 18 days (horizontal transmission), and 5 newborns tested positive in the first day of life (possible vertical transmission). None had ocular abnormalities. Concerning exposed newborns with negative test results, 1 presented with venous engorgement and vascular tortuosity, 7 had intraretinal hemorrhages, and 2 were diagnosed as having retinopathy of prematurity.
Conclusions and Relevance
In this uncontrolled case series of Brazilian newborns of mothers with COVID-19 infection, a low rate of COVID-19 infection was found among newborns, and none had ocular abnormalities. Additional controlled studies may be warranted to confirm these findings.
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Corresponding Author: Olívia Pereira Kiappe, MD, MSc, Retina and Vitreous Sector, Department of Ophthalmology, Universidade Federal de São Paulo, Escola Paulista de Medicina, Rua Botucatu, 821, Vila Clementino, São Paulo, SP 04023-062, Brasil (firstname.lastname@example.org).
Accepted for Publication: March 5, 2021.
Published Online: April 7, 2021. doi:10.1001/jamaophthalmol.2021.1088
Author Contributions: Drs Kiappe and Rosa had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Kiappe.
Acquisition, analysis, or interpretation of data: Kiappe, Cruz, Rosa, Arrais.
Drafting of the manuscript: Kiappe, Cruz, Arrais.
Critical revision of the manuscript for important intellectual content: Kiappe, Rosa.
Statistical analysis: Cruz, Arrais.
Administrative, technical, or material support: Kiappe, Cruz, Rosa, Arrais.
Conflict of Interest Disclosures: None reported.
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