The newborn period (the first 28 days of life) introduces a unique vulnerability to infectious agents, and the virus that causes COVID-19 is no exception. Newborns can contract the SARS-CoV-2 virus, though their clinical presentation often differs significantly from that seen in adults. While many infants experience only mild or asymptomatic illness, the risk of hospitalization for babies under one year old is higher compared to older children. Understanding how the virus affects this youngest age group helps parents and caregivers focus on appropriate protective measures.
Modes of Transmission for Newborns
A newborn can acquire the SARS-CoV-2 virus through two primary pathways: vertical transmission during the perinatal period or postnatal transmission after birth. Vertical transmission occurs when the virus passes from the mother to the baby across the placenta (in utero) or during the birth process (intrapartum). This route is generally considered uncommon, with documented mother-to-child transmission rates around the time of birth being low.
The most frequent source of infection is postnatal exposure, which occurs after delivery through close contact with an infected individual. This typically involves family members, caregivers, or hospital staff who are shedding the virus. Since the virus spreads mainly through respiratory droplets, close-range interactions like holding, feeding, and comforting the baby create ample opportunity for transmission.
The physical intimacy required for essential newborn care means that an unknowingly infectious parent or caregiver can easily expose the baby. Even when a mother has the infection, the benefits of practices like skin-to-skin contact and breastfeeding often outweigh the low risk of viral transmission if appropriate infection control measures are followed. Postnatal infection is the more common scenario.
Recognizing Symptoms in Infants
The symptoms of COVID-19 in infants can be subtle and non-specific, often resembling other common viral illnesses, making identification challenging without testing. Rather than the pronounced cough or shortness of breath seen in adults, a newborn may present with general signs of distress. These can include a persistent low-grade fever, increased irritability, or excessive sleepiness (lethargy).
Gastrointestinal symptoms like poor feeding, vomiting, or diarrhea are frequently observed. Respiratory distress may manifest as rapid breathing (tachypnea) or noticeable difficulty in breathing. Parents should watch closely for any changes in their normal behavior, feeding patterns, or breathing, as a baby cannot communicate discomfort.
Parents should contact a pediatrician immediately if their baby shows any concerning signs. Seek emergency medical attention if the infant exhibits red-flag symptoms such as an inability to wake up, a blue-tinge around the lips or face (indicating low oxygen levels), or severely labored breathing. These signs require immediate evaluation and care.
Clinical Outcomes and Severity
For the majority of newborns and infants, the clinical course is generally mild, with many cases being asymptomatic. When symptoms occur, they usually resolve quickly, often within a few days. Infants under six months of age are placed in a higher-risk category for severe disease outcomes compared to older children.
Infants under one year of age have shown higher rates of hospitalization than older pediatric groups. A small percentage of infected infants (often less than two percent) may require transfer to an intensive care unit for respiratory support. The need for specialized care is associated with complications like respiratory failure.
The likelihood of severe illness increases significantly if the newborn has underlying health conditions, such as prematurity, congenital heart abnormalities, or chronic lung issues. These conditions compromise the baby’s ability to fight off the infection and recover. A rare but serious complication linked to the virus is Multisystem Inflammatory Syndrome in Children (MIS-C). MIS-C causes inflammation across various organs and typically appears several weeks after the initial infection.
Strategies for Protecting Your Newborn
Limiting the newborn’s exposure involves controlling the environment and the people who interact with the baby. Caregivers should practice strict hand hygiene, washing hands thoroughly with soap and water before every feeding, diaper change, or close contact. Using an alcohol-based hand sanitizer (at least 60% alcohol) is an alternative when soap and water are unavailable.
If a caregiver or close family member is sick or recently exposed, they should wear a well-fitting face mask when within six feet of the newborn. Whenever possible, a healthy, unexposed caregiver should take over primary care duties until the sick individual is no longer contagious.
A primary strategy for protecting the newborn (who is too young for the vaccine) is for the mother to receive the COVID-19 vaccine during pregnancy. Maternal vaccination prompts the production of antibodies that transfer to the baby through the placenta, offering protection in the first months of life. Limiting visitors in the neonatal period, especially those who are unvaccinated or ill, further reduces the risk of postnatal transmission.