Necrotising enterocolitis in infants with in‐utero SARS-CoV-2 exposure in Tshwane, South Africa

Abstract

Background. Literature suggests an association between in-utero SARS-CoV-2 exposure and necrotising enterocolitis (NEC). Objective. To determine whether admitted infants exposed to SARS-CoV-2 in utero had a higher NEC incidence than unexposed infants; and to describe the overall incidence of NEC during the COVID-19 pandemic to explore potential associations. Methods. The evaluation period included 1-year pre-COVID-19 (April 2019 - March 2020) and a 2-year COVID-19 period (April 2020 - March 2022). An electronic database was used to identify infants and to collect routine data. Additional databases were used to identify mothers with COVID-19 and SARS-CoV-2-exposed neonates. Results. All infants exposed to SARS-CoV-2 in utero tested negative for COVID-19 before admission, indicating no vertical transmissions. Among 32 SARS-CoV-2-exposed infants, one developed NEC (incidence 3.1%), compared with 2.5% in unexposed infants (p=0.834). NEC incidence was similar across periods (1.8% v. 2.5%; p=0.147). The median day of life of NEC diagnosis was 12 days for both periods. The sex distribution of infants with NEC was similar during both periods. Conclusion. While this study did not demonstrate a statistically significant increase in NEC incidence during the COVID-19 pandemic, a potential association cannot be excluded, owing to the potential pathophysiological mechanisms that support this hypothesis.