Severe Ocular Risks Likely Low in Newborns Exposed to COVID-19 During Gestation

Some exposed newborns with negative PCR assays presented with fundus abnormalities.

Certain viruses, such as cytomegalovirus and Zika virus, are linked to ocular manifestations in newborns due to vertical transmission.

A new study, however, has suggested low risk between maternal exposure to coronavirus disease (COVID-19) and moderate-to-severe manifestations.

Led by Olívia Pereira Kiappe, MD, MSc, Federal University of Sao Paulo, Escola Paulista de Medicina, São Paulo, Brazil, the investigative team conducted a case series that enrolled newborns from April-November 2020.

They sought to determine ocular outcomes in newborns exposed to COVID-19 prior to birth.

Vertical Transmission and Ocular Risk

Kiappe and team determined COVID-19 positivity in both mothers and newborns using results from real-time reverse transcriptase–polymerase chain reaction assays (PCR) alongside oronasopharyngeal swab samples. Positive IgM serology was also considered a diagnostic test for mothers.

As such, a total of 165 COVID-19-exposed newborns were included in the study. The ages during ophthalmic examination ranged from 1 – 18 days.

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

“Maternal COVID-19 diagnosis varied between first and 40th gestational weeks,” noted the investigators.

They observed that 6 newborns had positive PCR results: 1 tested positive within 18 days of birth, and 5 tested positive in the 1st day of life (thereby 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).

Nevertheless, none of the COVID-19 infected infants presented with ocular abnormalities.

As for the newborns who were exposed but didn’t show a positive PCR assay, some presented with fundus abnormalities of unclear association.

Even more, 1 showed signs of retinal vascular tortuosity and venous engorgement according to ophthalmoscopy. Maternal infection for this patient occurred at 28 gestational weeks, and the investigators ruled out other possible comorbidities.

They also reported that 7 newborns presented with retinal hemorrhages, 2 had retinopathy of prematurity, and 1 had the aggressive posterior form and was thus treated with anti–vascular endothelial growth factor injection.

“The low rate of ocular abnormalities found in this study, likely within the range of anticipated findings in the absence of COVID-19, suggests that there is not a moderate or high increased risk of ocular abnormalities in newborns of mothers with COVID-19,” the investigators wrote.

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

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

The study, “Ocular Assessments of a Series of Newborns Gestationally Exposed to Maternal COVID-19 Infection," was published online in JAMA Opthalmology.