Journal article
Maternal COVID-19 Test Positivity and Outcomes of Extremely Preterm Infants in the Neonatal Intensive Care Unit
The Journal of pediatrics, Vol.288, 114840
01/2026
DOI: 10.1016/j.jpeds.2025.114840
PMCID: PMC12668701
PMID: 41016465
Abstract
To describe the neonatal intensive care unit outcomes of infants born extremely preterm to mothers who test positive for SARS-CoV-2 during pregnancy.
Prospective study (3/1/2020-4/30/2023) at 16 NICHD Neonatal Research Network centers of inborn infants (birth weight 401-1000 grams and/or gestational age <29 weeks) born to mothers tested for SARS-CoV-2 during pregnancy. Frequency of maternal SARS-CoV-2 detection, vertical transmission rate, and association of maternal SARS-CoV-2 positivity during pregnancy with infant outcomes were determined.
During the 38-month study, 4548 extremely preterm infants were born to 4072 mothers tested for SARS-CoV-2 during pregnancy. Overall, 7% (297/4072) of mothers had a positive SARS-CoV-2 test; 1% (2/181) of tested infants were positive at age <72 hours. The majority of outcomes (eg, bronchopulmonary dysplasia, retinopathy of prematurity) did not differ between infants of test-positive vs test-negative mothers. Infants of test-positive mothers were more likely to be diagnosed with necrotizing enterocolitis (NEC) than those of test-negative mothers (14% vs 11%; p=0.03). In adjusted analyses, infants born to test-positive mothers were more likely to develop NEC (risk ratio 1.40; 95% CI 1.03 -1.89; p=0.03) or the combined outcome of death within 12 hours of age or NEC (risk ratio 1.33; 95% CI, 1.09-1.62; p<0.01) but not death within 12 hours of age (risk ratio 1.22, 95% CI 0.92-1.62; p=0.16) or before discharge (risk ratio 0.83, 95% CI 0.55-1.26; p=0.38).
Among infants <29 weeks' gestation, vertical transmission of SARS-CoV-2 was infrequent. Maternal SARS-CoV-2 positivity was associated with NEC but not with other infant outcomes or mortality.
Details
- Title: Subtitle
- Maternal COVID-19 Test Positivity and Outcomes of Extremely Preterm Infants in the Neonatal Intensive Care Unit
- Creators
- Emily A Messick - The Ohio State UniversityShampa Saha - RTI InternationalJonathan L Slaughter - Nationwide Children's HospitalMatthew J Kielt - The Ohio State UniversityKristen L Benninger - Nationwide Children's HospitalEdward F Bell - University of IowaBarbara J Stoll - Emory UniversityKaren M Puopolo - University of PennsylvaniaSagori Mukhopadhyay - Children's Hospital of PhiladelphiaDustin D Flannery - Children's Hospital of PhiladelphiaMyra H Wyckoff - The University of Texas Southwestern Medical CenterC Michael Cotten - Duke UniversityRavi M Patel - Emory UniversityAbbot R Laptook - Brown UniversityCathy Grisby - Cincinnati Children's Hospital Medical CenterAbhik Das - RTI InternationalMichele C Walsh - National Institute of Child HealthPablo J Sánchez - The Ohio State UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.288, 114840
- DOI
- 10.1016/j.jpeds.2025.114840
- PMID
- 41016465
- PMCID
- PMC12668701
- NLM abbreviation
- J Pediatr
- ISSN
- 1097-6833
- eISSN
- 1097-6833
- Publisher
- Elsevier
- Grant note
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development: UG1 HD27904, UG1 HD21364, UG1 HD68284, UG1 HD27853, UG1 HD40492, UG1 HD27851, UG1 HD27856, UG1 HD68278, UG1 HD36790, UG1 HD27880, UG1 HD34216, UG1 HD68270, UG1 HD53109, UG1 HD53089, UG1 HD68244, UG1 HD68263, UG1 HD40689, UG1 HD21385, UG1 HD87226, UG1 HD87229 National Center for Advancing Translational SciencesNational Institute of Child HealthNational Institutes of HealthEunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)NRN Steering Committee Chair: Richard A. Polin, MD, Division of Neonatology, College of Physicians and Surgeons, Columbia University: 2011-2023 Alpert Medical School of Brown University: U10 HD27904 Case Western Reserve University, Rainbow Babies & Children's Hos-pital: U10 HD21364 Deanne
The National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (UG1 HD27904, UG1 HD21364, UG1 HD68284, UG1 HD27853, UG1 HD40492, UG1 HD27851, UG1 HD27856, UG1 HD68278, UG1 HD36790, UG1 HD27880, UG1 HD34216, UG1 HD68270, UG1 HD53109, UG1 HD53089, UG1 HD68244, UG1 HD68263, UG1 HD40689, UG1 HD21385, UG1 HD87226, UG1 HD87229) , and the National Center for Advancing Translational Sciences (UL1 TR105, UL1 TR1425, UL1 TR1117, UL1 TR454, UL1 TR1108, UL1 TR1085, UL1 TR442, UL1 TR1449, and UL1 TR42) provided grant support for the Neonatal Research Network. Although the National Institute of Child Health and Human Develop-ment staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the re-sponsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The National Institutes of Health, the Eunice Kennedy Shriver Na-tional Institute of Child Health and Human Development (NICHD) , and the National Center for Advancing Translational Sciences pro-vided grant support for the Neonatal Research Network's Generic Database Study. Although NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the US Government. Participating NRN sites collected data and transmitted it to RTI International, the data coor-dinating center (DCC) for the network, which stored, managed, and analyzed the data for this study. On behalf of the NRN, RTI Interna-tional had full access to all of the data in the study and, with the NRN Center Principal Investigators, takes responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study. NRN Steering Committee Chair: Richard A. Polin, MD, Division of Neona-tology, College of Physicians and Surgeons, Columbia University (2011-2023) . Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (U10 HD27904) - Martin Keszler, MD; Angelita M. Hensman, PhD, RNC-NIC; Elisa Vieira, RN, BSN; Emilee Little, RN, BSN; Kimberly H. Porras, BS; Lucille St. Pierre, BS. Case Western Reserve University, Rainbow Babies & Children's Hos-pital (U10 HD21364) - Anna Maria Hibbs, MD, MSCE; Deanne
- Language
- English
- Electronic publication date
- 09/26/2025
- Date published
- 01/2026
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984966711702771
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