Transmisión vertical y COVID-19: revisión del alcance

Revisión de alcance, conforme el Institute Joanna Briggs y PRISMA-ScR. Se realizó búsqueda en cinco bases de datos digitales de publicaciones sobre la temática infección por coronavirus y transmisión vertical. Datos extraídos, analizados y sintetizados descriptivamente por tres investigadores independientes.

Resultados:

La búsqueda rescató 76 publicaciones. Luego de etapas de selección, 15 artículos fueron analizados, todos en inglés; descriptivos, retrospectivos o estudios de caso. Para rastrear la infección se adoptaron la recolección de swab nasal en el neonato y el análisis de proteína C reactiva de la leche materna, sangre del cordón, líquido amniótico, placenta y secreción vaginal. Hubo un pequeño porcentaje de neonatos cuyos tests dieron positivo de COVID-19, aunque tales casos no fueron atribuidos a la transmisión vertical.

Conclusión:

La transmisión vertical no pudo ser comprobada. Protocolo de investigación registrado en Open Science Framework (https://osf.io/fawmv).

Descriptores:
Transmisión Vertical de Enfermedad Infecciosa; Infecciones por Coronavirus; Revisión; Recién Nacido; Enfermería Obstétrica

Country	Objectives	Study design/ participants	Methodological procedures and outcomes	Risk of bias (JBI)^* * Risk of bias calculated with Joanna Briggs Institute Appraisal Tools(14). ⁽¹⁴14 Melnyk BM, Fineout-Overholt E. Making the case for evidence-based practice. In: Melnyk BM, Fineout-Overholt E, (Eds.). Evidence-based practice in nursing and healthcare: a guide to best practice. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 3-24.⁾
Italy⁽¹⁷17 Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020. https://doi.org/10.1111/1471-0528.16278 https://doi.org/10.1111/1471-0528.16278... ⁾	Assess the type of delivery and immediate neonatal outcomes in women infected with COVID-19 before or up to 36 hours after delivery	Crosssectional study with retrospective data/n=42	Medical records of 42 binomials were reviewed. Three neonates had SARS-CoV-2 (COVID-19) infection. Two were on exclusive breastfeeding with mothers without a mask who were diagnosed with postpartum COVID-19; the other one was born via vaginal delivery and separated from the mother immediately after birth because the mother presented postpartum hemorrhage. In this case, the newborn presented diarrhea on the first and third days of life and respiratory symptoms. The infant was taken to the ICU and remained on MV for one day. The infant presented positive PCR only on the seventh day of life.	89%
China⁽¹⁸18 Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020;223(1):111.e1-111.e14. https://doi.org/10.1016/j.ajog.2020.04.014 https://doi.org/10.1016/j.ajog.2020.04.0... ⁾	Assess the clinical characteristics and results of pregnancies of women with pneumonia due to COVID-19 and the potential risk of VT.	Cross-sectional study with retrospective data (series of case studies)/n=116	Records of pregnant women with pneumonia due to COVID-19 from 25 hospitals were analyzed. Eight cases occurred before 24 gestational weeks and, of these, one resulted in spontaneous abortion (infection with fever at week 5). All cases had normal fetal morphology (on ultrasound). Of 10 cases between 24 and 33 weeks, 20% progressed to preterm labor, with one pregnancy at 28 weeks and another twin pregnancy at 31 weeks. Of 24 cases between 34 and 36 weeks, 79% progressed to preterm delivery and 27.3% to premature rupture of membranes. No VT was found in the PCR result of newborns.	50%
China⁽¹⁹19 Lu D, Sang L, Du S, Li T, Chang Y, Yang XA. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol. 2020:92:1660-4. https://doi.org/10.1002/jmv.25927 https://doi.org/10.1002/jmv.25927... ⁾	Assess the clinical characteristics of a pregnant woman with COVID-19 and the pregnancy outcomes.	Case study/n=1	Description of a case study of a pregnant woman, primigravida, 22 years old, 38 weeks of pregnancy. During labor, she did not present any identifiable symptoms of COVID-19. Fetal movements were present, vital parameters were normal, fetal morphology ultrasound with normal development. She had a history of contact with people with COVID-19 (husband and sister). She was maintained in isolation and oxygen therapy was administered in a catheter (2L/minute) due to the diagnosis of pneumonia. She had fever at day 2 after delivery, with improvement and discharge at day 25. No VT was found in the PCR result of the newborn.	100%
China⁽²⁰20 Peng Z, Wang J, Mo Y, Duan W, Xiang G, Yi M, et al. Unlikely SARS-CoV-2 vertical transmission from mother to child: a case report. J Infect Public Health. 2020;13(5):818-20. https://doi.org/10.1016/j.jiph.2020.04.004 https://doi.org/10.1016/j.jiph.2020.04.0... ⁾	Present and discuss the case of a newborn whose mother was diagnosed with COVID-19.	Case study/n=1	Description of the case study of a pregnant woman, primigravida, 25 years old. Infection acquired in the third trimester of pregnancy. No VT was found in the PCR result of the newborn.	87.5%
Peru⁽²¹21 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020;37(8):861-5. https://doi.org/10.1055/s-0040-1710050 https://doi.org/10.1055/s-0040-1710050... ⁾	Describe the case of a pregnant woman with COVID-19 infection whose newborn was positive for COVID-19.	Case study/n=1	Description of the case of a pregnant woman, third pregnancy, no prior abortion, 41 years old, 33 weeks of pregnancy, admitted with respiratory failure. She had a history of gestational diabetes, use of insulin and metformin, and obesity. Partner and two children with COVID-19 symptoms for 14 days. The infant was born via cesarean delivery with 2.970 g, Apgar 6 and 8 at day 1 and 5, respectively. The newborn had positive PCR, 16 and 48 hours postpartum. On the sixth day of life, the newborn developed cough and respiratory distress, which were resolved with nasal oxygen therapy (catheter).	87.5%
China⁽²²22 Yang P, Wang X, Liu P, Wei C, He B, Zheng J, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020;127:104356. https://doi.org/10.1016/j.jcv.2020.104.356 https://doi.org/10.1016/j.jcv.2020.104.3... ⁾	Report the clinical characteristics of newborns whose mothers were infected with SARS-CoV-2.	Case study/n=7	Description of seven case studies of mothers infected with SARS-CoV-2 during pregnancy, with 85.7% diagnosed one to six days before delivery. All infants were born via cesarean delivery and had an Apgar score over 8 in the fifth minute of life; 57.1% had between 36 and 37 gestational weeks. The neonates were taken to the ICU for respiratory isolation, and two required non-invasive ventilation with CPAP due to prematurity. All PCR tests were negative, and the newborns were discharged in good condition.	50%
China⁽²³23 Liu W, Wang J, Li W, Zhou Z, Liu S, Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med. 2020;13:1-6. https://doi.org/10.1007/s11684-020-0772-y https://doi.org/10.1007/s11684-020-0772-... ⁾	Assess the clinical characteristics of neonates whose mothers had SARS-CoV-2 infection.	Case study/n=19	Neonates had an average gestational age of 38 weeks; 94.7% of deliveries were via cesarean section, and all newborns were separated from their mothers immediately after delivery. No clinical and/or laboratory evidence of SARS-CoV-2 infection was found in the newborns. The newborns were separated from their mothers immediately after delivery to avoid contamination.	50%
China⁽²⁴24 Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcription study. PLoS ONE. 2020;15(4):e0230295. https://doi.org/10.1371/jounal.pone.023095 https://doi.org/10.1371/jounal.pone.0230... ⁾	Report the case of a convalescent pregnant woman diagnosed with COVID-19 infection 37 days before the delivery, in the third trimester of pregnancy.	Case study/n=1	A case study of a newborn whose mother was diagnosed with COVID-19 in the 33^rd week of pregnancy. PCR and immunoglobulin (IgM and IgG) tests of the newborn placenta were negative. Anatomopathological examination of the placenta was also negative for COVID-19.	75%
China⁽²⁵25 Zhang ZJ, Yu XJ, Fu T, Liu Y, Jiang Y, Yang BX, et al. Novel coronavirus infection in newborn babies under 28 days in China. Eur Respir J. 2020;55(6):2000697. https://doi.org/10.1183/13993003.00697-2020 https://doi.org/10.1183/13993003.00697-2... ⁾	Identify all newborns infected with COVID-19 and describe their clinical characteristics, treatment, results and potential transmission.	Case study/n=4	Four newborns were assessed, aged between 30 hours and 17 days of life, diagnosed with COVID-19, whose mothers had a confirmed diagnosis of COVID-19 (clinical, laboratory and imaging tests). Retrospective data from medical records were analyzed. Of the four newborns diagnosed with the infection, two had fever, one had dyspnea, one had cough and one was asymptomatic. The newborns received supportive treatment, not requiring intensive care or MV. The newborns were discharged between 16 and 30 days of hospitalization. It was not possible to rule out the risk of infection transmitted by health professionals during the hospitalization period.	50%
China⁽²⁶26 Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants born to mothers with a new coronavirus (COVID-19). Front Ped. 2020;8:104. https://doi.org/10.3389/fped.2020.00104 https://doi.org/10.3389/fped.2020.00104... ⁾	Describe the clinical case of four newborns of mothers diagnosed with COVID-19 infection.	Case study/n=4	Four cases of newborns were described; their mothers had COVID-19, so they were separated from their mothers immediately after delivery. Two had skin rashes of unknown etiology and one had facial ulceration, which disappeared spontaneously. One infant developed tachypnea and MV was required for three days, with discharge on the sixth day of life. Skin rash was considered a consequence of maternal inflammatory toxin. No VT was found in the PCR result of the newborns.	75%
Turkey ⁽²⁷27 Kalafat E, Yaprak E, Cinar G, Varli B, Ozisik S, Uzun C, et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol. 2020;55(6):835-7. https://doi.org/10.1002/uog.22034 https://doi.org/10.1002/uog.22034... ⁾	Report the case of positive findings from pulmonary ultrasound compatible with COVID-19 in a woman with a negative PCR result.	Case study/n=1	A case study a pregnant woman, 35 weeks pregnant, who had no fever, with cough, dyspnea and nausea, and negative result in the PCR test. She had a thalassemia trait, not anemic. Her condition was worse two days after the negative result in the PCR test. The pulmonary ultrasound test showed an increase in the thick lines of the lung (posterior basal segments). She refused a new exam. Two days later, dyspnea was worse, with reduced fetal movement and lower limb edema. CT and new oropharyngeal swab tests were performed. The patient's CT was consistent with viral infection, with positive swab test for SARS-CoV-2 infection. No VT was found in the PCR result of the newborn.	87.5%
China⁽²⁸28 Fan C, Lei C, Fang C, Li C, Wang M, Liu Y, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis. 2020;ciaa226. https://doi.org/10.1093/cid/ciaa226 https://doi.org/10.1093/cid/ciaa226... ⁾	Report two clinical cases of newborns whose mothers were infected with SARS-CoV-2 in the third trimester of pregnancy.	Case study/n=2	Case 1: second pregnancy, 34 years, 37 weeks, no comorbidities. The patient presented nasal congestion and abdominal rash, exposed to COVID-19. On the 11th day of infection, the infant was born with 3.400g, Apgar 9 and 10 on the 1st and 5th minutes of life, respectively, and was separated from the mother at birth. On the 3rd day of life, the newborn presented abdominal distension and lymphopenia. On the 4th day, chest CT indicated pneumonia, negative COVID-19 result in nasal swab PCR, and in the specimens of umbilical cord blood, placenta, amniotic fluid, vaginal secretion swab, and breast milk. The newborn presented good response with antibiotic therapy and was discharged at day 8 after birth. Case 2: primigravida, 29 years old, 36 weeks, no comorbidities. She presented chills, fever, nasal congestion, sore throat and minor vaginal bleeding, and was released after examination. Two days later, the husband received a positive result for COVID-19. On the third day of symptoms, she presented positive PCR for COVID-19 and suggestive CT imaging on the fifth day of symptoms. That same day, the infant was born with 2.980g, Apgar 9 and 10 in the first and fifth minutes of life, separated from the mother at birth. The newborn presented pneumonia and lymphopenia with good response to antibiotic therapy in two days. No VT was found in the PCR result of the newborns in both cases.	100%
China⁽²⁹29 Wang S, Guo L, Chen L, Liu W, Cao Y, Yang J, et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis. 2020;ciaa 225. https://doi.org/10.1093/cid/ciaa225 https://doi.org/10.1093/cid/ciaa225... ⁾	Report the case of a neonate with COVID-19 infection 36 hours after birth.	Case study/n=1	Second pregnancy, with previous abortion, 34 years old, no comorbidities, without home contacts, 15 confirmed cases of COVID-19 in the community where she lived. At 40 weeks, she had vaginal bleeding and abdominal pain. She presented fever (37.8ºC), chest CT suggestive of COVID-19, lymphopenia, neutrophilia and high PCR level. The mother had no contact with the newborn after birth. A PCR test was performed in the newborn after 36 hours of life, with a positive result. The newborn was asymptomatic, but with suggestive chest CT scan. PCR was negative on day 14, the newborn was discharged on day 15.	87.5%
China⁽³⁰30 Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019 n-Cov pneumonia. Transl Pediatr. 2020;9(1):51-60. https://doi.org/10.21037/tp.2020.02.06 https://doi.org/10.21037/tp.2020.02.06... ⁾	Describe the clinical characteristics of 10 neonates whose mothers had a diagnosis of pneumonia due to COVID-19.	Case study/n=10	Mean age of mothers: 30 years. Diagnosis: one to six days of symptoms. Four infants were born at term and six were premature; two were extremely underweight and one was large for its gestational age. Six had respiratory distress, four had gastrointestinal symptoms, two had fever, and one had high respiration rate. Seven had a chest CT suggestive of COVID-19. Apgar scores ranged from 7 to 10 in the first minute and from 8 to 10 in the fifth minute. No antiviral agent was administered to them. Five were discharged; four remained hospitalized in good condition and one died due to multiple organ failure (due to prematurity). No VT was found in the PCR result of the newborns.	100%
China⁽³¹31 Chen H, Guo J, Wang C, Lou F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226) 809-15. https://doi.org/10.1016/S0140-6736(20)30360-3 https://doi.org/10.1016/S0140-6736(20)30... ⁾	Assess the clinical characteristics of pregnant women with COVID-19 and potential VT.	Case study/n=9	All pregnant women had an infection in the third trimester. Maternal age ranged from 26 to 40 years; gestational age 36 to 39 weeks and 4 days. One patient had gestational hypertension and eight did not have comorbidities. All were stable at the time of delivery. Most common symptoms: fever, sore throat and myalgia. Two cases of fetal hypoxemia and two cases of premature rupture of membranes. Samples of amniotic fluid, umbilical cord, neonatal swab and milk sample were collected from six neonates with negative results in the PCR test.	87.5%

Variables	Reference/participants
Delivery	⁽¹⁷17 Ferrazzi E, Frigerio L, Savasi V, Vergani P, Prefumo F, Barresi S, et al. Vaginal delivery in SARS-CoV-2 infected pregnant women in Northern Italy: a retrospective analysis. BJOG. 2020. https://doi.org/10.1111/1471-0528.16278 https://doi.org/10.1111/1471-0528.16278... ⁾ (42)	⁽¹⁸18 Yan J, Guo J, Fan C, Juan J, Yu X, Li J, et al. Coronavirus disease 2019 (COVID-19) in pregnant women: a report based on 116 cases. Am J Obstet Gynecol. 2020;223(1):111.e1-111.e14. https://doi.org/10.1016/j.ajog.2020.04.014 https://doi.org/10.1016/j.ajog.2020.04.0... ⁾ (116)	⁽¹⁹19 Lu D, Sang L, Du S, Li T, Chang Y, Yang XA. Asymptomatic COVID-19 infection in late pregnancy indicated no vertical transmission. J Med Virol. 2020:92:1660-4. https://doi.org/10.1002/jmv.25927 https://doi.org/10.1002/jmv.25927... ⁾ (1)	⁽²⁰20 Peng Z, Wang J, Mo Y, Duan W, Xiang G, Yi M, et al. Unlikely SARS-CoV-2 vertical transmission from mother to child: a case report. J Infect Public Health. 2020;13(5):818-20. https://doi.org/10.1016/j.jiph.2020.04.004 https://doi.org/10.1016/j.jiph.2020.04.0... ⁾ (1)	⁽²¹21 Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol. 2020;37(8):861-5. https://doi.org/10.1055/s-0040-1710050 https://doi.org/10.1055/s-0040-1710050... ⁾ (1)	⁽²²22 Yang P, Wang X, Liu P, Wei C, He B, Zheng J, et al. Clinical characteristics and risk assessment of newborns born to mothers with COVID-19. J Clin Virol. 2020;127:104356. https://doi.org/10.1016/j.jcv.2020.104.356 https://doi.org/10.1016/j.jcv.2020.104.3... ⁾ (7)	⁽²³23 Liu W, Wang J, Li W, Zhou Z, Liu S, Rong Z. Clinical characteristics of 19 neonates born to mothers with COVID-19. Front Med. 2020;13:1-6. https://doi.org/10.1007/s11684-020-0772-y https://doi.org/10.1007/s11684-020-0772-... ⁾ (19)	⁽²⁴24 Li M, Chen L, Zhang J, Xiong C, Li X. The SARS-CoV-2 receptor ACE2 expression of maternal-fetal interface and fetal organs by single-cell transcription study. PLoS ONE. 2020;15(4):e0230295. https://doi.org/10.1371/jounal.pone.023095 https://doi.org/10.1371/jounal.pone.0230... ⁾ (1)	⁽²⁵25 Zhang ZJ, Yu XJ, Fu T, Liu Y, Jiang Y, Yang BX, et al. Novel coronavirus infection in newborn babies under 28 days in China. Eur Respir J. 2020;55(6):2000697. https://doi.org/10.1183/13993003.00697-2020 https://doi.org/10.1183/13993003.00697-2... ⁾ (4)	⁽²⁶26 Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants born to mothers with a new coronavirus (COVID-19). Front Ped. 2020;8:104. https://doi.org/10.3389/fped.2020.00104 https://doi.org/10.3389/fped.2020.00104... ⁾ (4)	⁽²⁷27 Kalafat E, Yaprak E, Cinar G, Varli B, Ozisik S, Uzun C, et al. Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19. Ultrasound Obstet Gynecol. 2020;55(6):835-7. https://doi.org/10.1002/uog.22034 https://doi.org/10.1002/uog.22034... ⁾ (1)	⁽²⁸28 Fan C, Lei C, Fang C, Li C, Wang M, Liu Y, et al. Perinatal transmission of COVID-19 associated SARS-CoV-2: should we worry? Clin Infect Dis. 2020;ciaa226. https://doi.org/10.1093/cid/ciaa226 https://doi.org/10.1093/cid/ciaa226... ⁾ (2)	⁽²⁹29 Wang S, Guo L, Chen L, Liu W, Cao Y, Yang J, et al. A case report of neonatal COVID-19 infection in China. Clin Infect Dis. 2020;ciaa 225. https://doi.org/10.1093/cid/ciaa225 https://doi.org/10.1093/cid/ciaa225... ⁾ (1)	⁽³⁰30 Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019 n-Cov pneumonia. Transl Pediatr. 2020;9(1):51-60. https://doi.org/10.21037/tp.2020.02.06 https://doi.org/10.21037/tp.2020.02.06... ⁾ (10)	⁽³¹31 Chen H, Guo J, Wang C, Lou F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226) 809-15. https://doi.org/10.1016/S0140-6736(20)30360-3 https://doi.org/10.1016/S0140-6736(20)30... ⁾ (9)
Vaginal	57.1	14.1	-	-	-	-	5.3	Yes	-	25	-	-	-	30	-
Cesarean	42.9	85.9	Yes	Yes	Yes	100	94.7	-	100	75	Yes	100	Yes	70	100
Clinical condition of pregnant women
Pneumonia at admission	45.2	77.8	Yes	Yes	Yes	85.7	100	Yes	-	100	Yes	100	Yes	100	100
Oxygen therapy	36.8	5.2	Yes	Yes	Yes	-	-	No	-	25	Yes	-	-	-	100
Intubation	-	1.7	No	No	Yes	-	-	No	-	-	Yes	-	-	-	No
Hospitalization in ICU	21.1	6.9	No	No	Yes	-	-	No	-	-	Yes	-	-	-	-
Maternal death	No	No	No	No	No	No	No	No	No	No	No	No	No	No	No
Symptoms
Fever	Yes	50.9	Yes	Yes	Yes	Yes	57.9	Yes	Yes	75	No	100	Yes	90	78
Cough	Yes	28.4	Yes	-	-	Yes	26.3	Yes	Yes	50	Yes	-	-	40	44
Fatigue	-	12.9	Yes	Yes	Yes	-	-	-	-	50	-	-	-	-	22
Dyspnea	Yes	7.8	Yes	Yes	Yes	-	26.3	-	-	50	Yes	-	-	-	11
Diarrhea	Yes	0.9	Yes	-	-	Yes	10.5	-	-	25	-	-	-	10	11
Diagnosis
Before delivery	23.8	37.9	No	Yes	No	85.7	68.4	Yes	75	-	Yes	100	-	50	88
At admission	64.3	-	Yes	No	Yes	No	10.5	-	-	-	-	-	Yes	20	-
Postpartum period	11.9	-	No	No	No	14.3	21.1	-	25	-	-	-	-	30	22
Positive result in PCR test	Yes	56.0	Yes	Yes	Yes	Yes	52.9	Yes	100	100	Yes	100	Yes	80	100
CT scan indicative of infection	-	96.3	Yes	Yes	Yes	85.7	100	Yes	100	100	Yes	100	Yes	100	100
Amniotic fluid	-	Yes-	-	Yes-	-	Yes-	Yes-	Yes-	-	-	-	Yes-	-	-	67(-)
Cord blood	-	Yes-	-	Yes-	-	Yes-	Yes-	-	-	-	Yes-	Yes-	Yes-	-	67(-)
Breast milk	-	Yes-	Yes-	Yes-	-	-	Yes-	Yes-	-	-	Yes-	Yes-	Yes-	-	67(-)
Placenta	-	-	-	Yes-	-	-	-	Yes-	-	-	Yes-	Yes-	Yes-	-	-
Vaginal swab	-	Yes-	-	Yes-	-	-	-	Yes-	-	-	-	Yes-	-	-	-
Treatment
Antiviral	-	54.3	Yes	Yes	Yes	-	31.6	Yes	-	-	Yes	100	Yes	50	67
Interferon	-	-	Yes	Yes	-	-	-	-	-	-	-	-	Yes	10	-
Corticoid	-	31.9	No	Yes	Yes	-	No	Yes	-	-	Yes	50	Yes	-	-
Antibiotic	-	94.0	No	Yes	Yes	-	-	-	-	-	Yes	100	Yes	-	100
Hydroxychloroquine	-	-	-	-	Yes	-	-	-	-	-	Yes	-	-	-	-
Neonate
COVID-19 infection	7.1	No	No	No	Yes	No	No	No	Yes	No	No	No	Yes	No	No
Breastfeeding	26.2	-	No	No	No	-	No	-	25	No	Yes	-	No	-	-
Oropharyngeal swab	Yes	86	Yes	Yes	Yes	Yes	Yes	Yes-	Yes+	75-	Yes-	Yes-	Yes+	Yes-	Yes-
Preterm birth	26.2	21.2	No	Yes	Yes	57.1	10.5	No	No	No	Yes	50	No	60	44
Neonatal death	0	0.9	No	No	No	No	No	No	No	No	No	No	No	10	No
Neonatal ICU	7.1	47.0	Yes	Yes	Yes	71.4	Yes	No	No	25	No	50	Yes	-	-

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[1] Corresponding author: Mariana Torreglosa Ruiz. E-mail: marianatorreglosa@hotmail.com