OBJECTIVES Data on coronavirus disease 2019 (COVID-19) infections in neonates are limited. We aimed to identify and describe the incidence, presentation, and clinical outcomes of neonatal COVID-19. METHODS Over 1 million neonatal encounters at 109 United States health systems, from March 2020 to February 2021, were extracted from the Cerner Real World Database. COVID-19 diagnosis was assessed using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) laboratory tests and diagnosis codes. Incidence of COVID-19 per 100 000 encounters was estimated. RESULTS COVID-19 was diagnosed in 918 (0.1%) neonates (91.1 per 100 000 encounters [95% confidence interval 85.3-97.2]). Of these, 71 (7.7%) had severe infection (7 per 100 000 [95% confidence interval 5.5-8.9]). Median time to diagnosis was 14.5 days from birth (interquartile range 3.1-24.2). Common signs of infection were tachypnea and fever. Those with severe infection were more likely to receive respiratory support (50.7% vs 5.2%, P < .001). Severely ill neonates received analgesia (38%), antibiotics (33.8%), anticoagulants (32.4%), corticosteroids (26.8%), remdesivir (2.8%), and COVID-19 convalescent plasma (1.4%). A total of 93.6% neonates were discharged home after care, 1.1% were transferred to another hospital, and discharge disposition was unknown for 5.2%. One neonate (0.1%) with presentation suggestive of multisystem inflammatory syndrome in children died after 11 days of hospitalization. CONCLUSIONS Most neonates infected with SARS-CoV-2 were asymptomatic or developed mild illness without need for respiratory support. Some had severe illness requiring treatment of COVID-19 with remdesivir and COVID-19 convalescent plasma. SARS-CoV-2 infection in neonates, though rare, may result in severe disease.

中文翻译：

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美国新生儿 COVID-19 的流行病学。

目的 关于新生儿 2019 年冠状病毒病 (COVID-19) 感染的数据有限。我们旨在确定和描述新生儿 COVID-19 的发病率、表现和临床结果。方法 2020 年 3 月至 2021 年 2 月期间，美国 109 个卫生系统的超过 100 万次新生儿接触是从 Cerner 真实世界数据库中提取的。使用严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 实验室测试和诊断代码评估 COVID-19 诊断。估计了每 100 000 次接触中的 COVID-19 发病率。结果 918 名 (0.1%) 新生儿被诊断出 COVID-19（每 100 000 次就诊中有 91.1 名 [95% 置信区间 85.3-97.2]）。其中，71 人（7.7%）有严重感染（每 10 万人中有 7 人 [95% 置信区间 5.5-8.9]）。诊断的中位时间为出生后 14.5 天（四分位距 3.1-24.2）。常见的感染迹象是呼吸急促和发烧。重度感染者更有可能接受呼吸支持（50.7% vs 5.2%，P < .001）。重症新生儿接受镇痛剂（38%）、抗生素（33.8%）、抗凝剂（32.4%）、皮质类固醇（26.8%）、瑞德西韦（2.8%）和COVID-19恢复期血浆（1.4%）。共有 93.6% 的新生儿在护理后出院回家，1.1% 被转移到另一家医院，5.2% 的出院情况不明。一名表现提示儿童多系统炎症综合征的新生儿（0.1%）在住院 11 天后死亡。结论 大多数感染 SARS-CoV-2 的新生儿无症状或病情轻微，无需呼吸支持。有些人患有严重疾病，需要用瑞德西韦和 COVID-19 恢复期血浆治疗 COVID-19。新生儿感染 SARS-CoV-2 虽然罕见，但可能导致严重疾病。