Newborns can and do get COVID-19, though the infection is uncommon and most affected babies recover without lasting harm. In an early review of 217 newborns born to mothers with confirmed SARS-CoV-2, about 3% showed evidence of infection, either through positive PCR tests or antibody results suggesting exposure in the womb.1Pediatrics. Caring for Newborns Born to Mothers With COVID-19: More Questions Than Answers The real picture, though, involves several layers: how the virus reaches a baby, what it does once it gets there, how the immature immune system responds, and what parents can do to reduce risk.
How a Newborn Gets Infected
There are two broad windows of exposure. The first is before or during birth, through what researchers call vertical transmission. The second is after delivery, through close contact with an infected caregiver. Vertical transmission has been one of the more debated questions in neonatal COVID research. Evidence now supports that it can happen, primarily through the placenta, though the overall rate appears low. One analysis of more than 1,300 births to infected mothers estimated the risk of vertical transmission at roughly 6%.2PubMed Central. COVID-19: the possibility, ways, mechanisms, and interruptions of mother-to-child transmission Other proposed routes include ascending vaginal infection and, theoretically, breast milk, though the placenta is considered the most likely pathway. Even several years into the pandemic, researchers have noted that controversy persists around the exact mechanisms.3PubMed Central. SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic
Postnatal infection is more straightforward. After birth, a baby can inhale respiratory droplets from a coughing mother, family member, or hospital worker. This is the same airborne route that spreads the virus between adults, and it is probably responsible for a larger share of neonatal infections than in-utero transmission. Practical steps like hand hygiene, masking while symptomatic, and limiting the number of close contacts around the baby are the main ways to interrupt this route.
What Symptoms Look Like in a Newborn
COVID symptoms in newborns overlap with other common neonatal illnesses, which makes diagnosis tricky without testing. A systematic review of confirmed neonatal cases found that respiratory difficulty was the most frequent sign, followed by fever. Gastrointestinal symptoms, including diarrhea, feeding intolerance, and abdominal distension, appeared in about half of affected newborns.4PubMed. Clinical characteristics of confirmed COVID-19 in newborns: a systematic review Some babies, however, test positive but show no symptoms at all.
The combination of breathing trouble and feeding problems is not unique to COVID; it also shows up in bacterial sepsis, respiratory syncytial virus (RSV) infection, and many other conditions that affect newborns. Fever in the first month of life always warrants medical attention regardless of whether COVID is suspected, because the list of possible causes includes several infections that need rapid treatment.
How Severe Can It Get?
Most newborns with COVID do not become critically ill, but they fare worse on average than newborns without the infection. A U.S. study covering births from March through December 2020 found that about 70% of newborns with COVID had no indicators of severe illness, compared with roughly 87% of those without COVID. Among late preterm and full-term babies, COVID was linked to a nearly fourfold higher risk of sepsis and a doubled risk of ICU admission. For very premature babies born before 34 weeks, the elevated risk showed up mainly as a greater need for invasive ventilation.5PubMed Central. Illness severity indicators in newborns by COVID-19 status in the United States, March–December 2020
These numbers deserve context. The vast majority of affected newborns still fall into the mild or asymptomatic category. Severe outcomes cluster in babies who are already medically vulnerable, whether due to prematurity, low birth weight, or other complications. Healthy, full-term babies with COVID tend to recover without intensive intervention.
A rarer but more alarming complication is neonatal multisystem inflammatory syndrome, sometimes called MIS-N, the newborn counterpart of the MIS-C seen in older children. Researchers have proposed that it arises when autoantibodies triggered by the mother’s SARS-CoV-2 infection cross the placenta and set off an inflammatory cascade in the baby, somewhat analogous to neonatal lupus.6PubMed Central. Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Prenatal Maternal SARS-CoV-2: A Case Series MIS-N remains rare, and the mechanism is still speculative, but it underscores why monitoring matters even after mild infections.
Why Most Newborns Handle the Virus Relatively Well
One of the consistent findings since early in the pandemic has been that young children, including newborns, generally fare better than adults. Part of the explanation lies in how the neonatal immune system is wired. Rather than mounting the aggressive inflammatory response that causes severe disease in adults, a newborn’s immune system leans toward tolerance. Certain immune-suppressive cells that are naturally abundant in early life may help dampen the runaway inflammation that characterizes severe COVID in older patients.7The Journal of Immunology. Neonatal and Children’s Immune System and COVID-19: Biased Immune Tolerance versus Resistance Strategy These cells gradually decline with age, which may be one reason the protective effect weakens as children grow.
Research published in The Lancet Child & Adolescent Health supports this picture, concluding that the neonatal immune system, despite being immature, handles SARS-CoV-2 effectively, with most infected newborns either asymptomatic or mildly ill.8PubMed Central. The ability of the neonatal immune response to handle SARS-CoV-2 infection This does not mean newborns are invulnerable. It means the default trajectory for a healthy newborn who contracts the virus is toward recovery, not toward the ICU.
How COVID During Pregnancy Affects the Baby Indirectly
Even when the virus never reaches the baby directly, a mother’s COVID-19 infection during pregnancy can create problems by increasing the odds of preterm birth and low birth weight. A large population-based study in California found that the preterm birth rate among mothers with a COVID diagnosis was about 12%, compared with roughly 9% in those without the virus.9The Lancet Regional Health – Americas. Association of reported COVID-19 diagnosis in pregnancy with very preterm, preterm, and early term birth: a population-based study in California The multinational INTERCOVID study found an even larger effect, with about a 60% higher risk of preterm birth and a 58% higher rate of low birth weight in COVID-positive mothers. Roughly 83% of those preterm births were medically indicated rather than spontaneous, meaning the pregnancies were ended early because of complications like preeclampsia or fetal distress.10JAMA Pediatrics. Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection
A review pooling data from 13 studies reported an average preterm birth incidence of about 19% in infected mothers versus 10% in uninfected controls.11PubMed Central. Preterm Birth and SARS-CoV-2: Does a Correlation Exist? The upshot is that COVID during pregnancy can harm the baby by pushing delivery earlier and reducing birth weight, even when the baby never tests positive for the virus. Prematurity itself carries its own set of health risks that can overshadow any direct viral effect.
Maternal Vaccination and Antibody Transfer
One of the most effective shields for a newborn is the mother’s own immune response, passed along through the placenta. When a pregnant person is vaccinated, antibodies cross to the baby in a process called transplacental transfer. Research on mRNA COVID vaccines found that vaccination earlier in pregnancy produced higher transfer ratios, meaning cord blood had more antibodies relative to the mother’s blood. First and second trimester vaccination yielded median transfer ratios of about 1.5 and 1.3, respectively, compared with 1.0 for third trimester vaccination.12Nature Communications. Maternal immune response and placental antibody transfer after COVID-19 vaccination across trimester and platforms Not all vaccine types performed equally: the mRNA vaccines showed more robust transfer of functional antibodies compared to the adenoviral vector vaccine.
Booster doses appear to amplify the effect further. A study examining boosted pregnant individuals found efficient transplacental transfer across all regimens studied, with median transfer ratios for neutralizing antibodies ranging from about 1.0 to 2.4, depending on the assay.13PubMed Central. COVID-19 booster vaccination during pregnancy enhances maternal binding and neutralizing antibody responses and transplacental antibody transfer to the newborn In plain terms, a vaccinated and boosted mother can provide her baby with a meaningful head start against the virus, and the timing and type of vaccine both matter.
Breastfeeding and Rooming-In
Early in the pandemic, some hospitals separated COVID-positive mothers from their babies as a precaution. Evidence that emerged over subsequent months largely reversed that practice. An Italian study of 62 newborns born to infected mothers who roomed-in with their babies and breastfed found that only one infant (about 2%) tested positive before discharge, and even that baby developed only mild symptoms that resolved spontaneously.14JAMA Pediatrics. Evaluation of Rooming-in Practice for Neonates Born to Mothers With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Italy The remaining 61 babies stayed negative and clinically well.
Breast milk itself appears to be more help than risk. Although rare instances of viral RNA in milk have been reported, live virus has not been successfully cultured from these samples, suggesting transmission through breastfeeding is unlikely. Meanwhile, mothers who have recovered from COVID or been vaccinated pass protective antibodies through their milk.15PubMed Central. Breast Milk Conferred Immunity to Infants Against COVID-19 The consensus among researchers is that prolonged skin-to-skin contact and early, exclusive breastfeeding remain the best strategies for reducing risks to both mother and baby during a COVID infection.16PubMed Central. Appropriate care for neonates born to mothers with COVID-19 disease
Testing Challenges in Newborns
Confirming COVID in a newborn is not always straightforward. Standard RT-PCR tests, which are the workhorse of COVID diagnosis, can miss low viral loads. In one documented case, standard PCR tests on throat and anal swabs came back negative repeatedly through the first two weeks of life, while a more sensitive digital droplet PCR detected the virus on day seven.17PubMed Central. Possible intrauterine SARS-CoV-2 infection: Positive nucleic acid testing results and consecutive positive SARS-CoV-2-specific antibody levels within 50 days after birth A larger retrospective analysis of 688 babies born to positive mothers found that the earliest positive PCR results came at birth, with an average timing of about 22 hours. Some babies who initially tested negative converted to positive on a second test around day six or seven.18PubMed Central. Retrospective observational RT-PCR analyses on 688 babies born to 843 SARS-CoV-2 positive mothers, placental analyses and diagnostic analyses limitations suggest vertical transmission is possible
What this means in practice is that a single negative test at birth does not fully rule out infection. If a mother is positive and the baby develops symptoms days later, retesting is warranted. The timing of testing matters as much as the test itself.
How COVID Compares to RSV in Newborns
Parents often wonder whether COVID or RSV is more dangerous for a very young baby. Based on available data, RSV tends to hit the respiratory tract harder. A study comparing hospitalized infants with COVID versus RSV found that RSV caused significantly more coughing, wheezing, and difficulty breathing, and required oxygen therapy far more often (about 49% vs. 8%). Hospital stays were also longer with RSV, averaging eight days compared to three for COVID. On the other hand, COVID-positive infants had higher rates of fever and, in children under three, a higher rate of seizures.19PubMed Central. Comparison of COVID-19 and RSV Infection Courses in Infants and Children under 36 Months Hospitalized in Paediatric Department in Fall and Winter Season 2021/2022
A smaller study focused specifically on the neonatal period echoed this pattern. RSV-positive newborns needed oxygen support significantly more often and spent longer in the NICU than their COVID-positive counterparts.20PubMed. Is respiratory syncytial virus infection more dangerous than COVID 19 in the neonatal period? The takeaway is not that COVID is harmless in newborns, but that RSV, which has circulated for decades with less public attention, is often the more aggressive respiratory pathogen in this age group.
Do Variants Make a Difference?
Yes. Variant differences changed both the infection rate and the severity profile in young children. In the U.S., incidence in infants was about seven times higher during the initial Omicron wave compared with the pre-Delta period.21The Pediatric Infectious Disease Journal. Epidemiology of COVID-19 in Infants in the United States: Incidence, Severity, Fatality, and Variants of Concern More cases did not necessarily mean worse outcomes, though. A large Brazilian study of children under two found that the original wild-type strain was responsible for the most deaths, while Omicron, despite causing more respiratory discomfort and oxygen desaturation, was a protective factor against intubation and death. Delta fell somewhere in between.22PubMed Central. Coronavirus disease 2019 infection severity among different variants in children under 2-years old in Brazil The general direction of viral evolution toward higher transmissibility but lower severity has been somewhat reassuring for parents of newborns, though new variants always carry an element of uncertainty.
Long-Term Developmental Concerns
The question parents often care about most is whether neonatal COVID leaves lasting marks. The evidence here is mixed and still accumulating. A prospective study that followed infected newborns to 18–24 months found developmental delay in nearly half of the children assessed, with mild delay in language, motor, or cognitive domains in 45% and moderate delay in 10%. Encouragingly, none of the children had hearing loss, blindness, or clinically severe growth problems.23PubMed Central. Long-Term Growth and Neurodevelopmental Outcomes of Neonates Infected with SARS-CoV-2 during the COVID-19 Pandemic at 18-24 Months Corrected Age
A separate prospective study found that SARS-CoV-2-positive infants had poorer psychomotor development scores and slightly smaller head circumferences in the first year, though head growth caught up by the second year. The Delta variant appeared to be associated with lower developmental scores compared with other strains.24PubMed Central. The long-term neurodevelopmental outcomes of toddlers with SARS-CoV-2 infection in the neonatal period: a prospective observational study Meanwhile, a larger study looking at infants born to mothers who tested positive during pregnancy (regardless of whether the babies themselves tested positive) found that exposed offspring were roughly twice as likely to receive a neurodevelopmental diagnosis within the first year.25JAMA Network Open. Neurodevelopmental Outcomes at 1 Year in Infants of Mothers Who Tested Positive for SARS-CoV-2 During Pregnancy
These findings are preliminary. The sample sizes are relatively small, follow-up periods are short, and many confounding factors, including the stress and social disruption of the pandemic itself, could influence developmental scores. They are worth taking seriously as signals, not as predictions for any individual child. Pediatric follow-up is wise for any baby who was infected or born to an infected mother, but the data do not support panic.
Treatment Options for Infected Newborns
Pharmacological options are extremely limited for the youngest patients. Of the antiviral drugs approved or authorized for COVID-19, remdesivir can be used in children but not neonates. The combination of nirmatrelvir plus ritonavir (Paxlovid) is approved only for older children and adults. Molnupiravir is off-limits in pediatric patients entirely due to concerns about bone growth. Monoclonal antibodies have faced similar age restrictions.26PubMed Central. Update on COVID-19 Therapy in Pediatric Age For most newborns, treatment consists of supportive care: oxygen if needed, intravenous fluids, temperature management, and close monitoring.
Prevention at Home
Because treatment options for newborns are so thin, prevention carries outsized importance. Recommendations from neonatal care reviews center on a few practical measures:
- Limit close contacts: Keep the baby away from anyone with fever or respiratory symptoms, and minimize the number of different caregivers.
- Hand hygiene: Wash hands thoroughly before handling the baby, feeding equipment, or anything that goes near the baby’s face.
- Ventilation: Good airflow in the rooms where the baby spends time reduces the concentration of airborne virus.
- Visitor restrictions: Postponing visits from extended family and friends, or requiring masks and handwashing when visits happen, reduces exposure.
- Clean surfaces: Daily disinfection of the baby’s bottles, pacifiers, and other frequently touched items adds another layer of protection.
These precautions apply to any respiratory virus, not just COVID.27Texto & Contexto – Enfermagem. Best Practices in Newborn Care in Covid-19 Times: An Integrative Review Maternal vaccination before or during pregnancy, as discussed earlier, is the single most impactful preventive measure because it protects the baby before the baby can protect itself.
Socioeconomic Factors and Unequal Risk
Not all families face the same odds. A study in Massachusetts found that after adjusting for symptoms, delivery mode, and rooming-in, mothers living in areas of high social vulnerability were nearly five times more likely to have a newborn test positive for SARS-CoV-2. Individual-level race or ethnicity was not independently associated with a positive neonatal test once social vulnerability was accounted for, suggesting that the disparity is driven by neighborhood-level factors like housing density, access to healthcare, and economic stress rather than biology.28JAMA Network Open. Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts Families in under-resourced communities may face more barriers to vaccination, prenatal care, and the kind of controlled postnatal environment that reduces transmission.
The Toll on Mothers and Bonding
The conversation about neonatal COVID tends to focus on the baby, but the pandemic reshaped the experience of new motherhood in ways that also affect the child. Research found that fear of contamination, social isolation, limited partner presence in the maternity ward, and having to wear a mask during early interactions with the newborn all disrupted mother-child bonding.29PubMed Central. Postnatal mental health during the COVID-19 pandemic: Impact on mothers’ postnatal sense of security and on mother-to-infant bonding A comparative study found that COVID-positive women reported significantly higher depressive symptoms, anxiety, and bonding difficulties. When anxiety was accounted for statistically, the COVID diagnosis itself stopped being the independent predictor; it was the anxiety fueled by the diagnosis that drove bonding problems.30PubMed. Maternal bonding and psychological symptoms among women with and without COVID-19 infection: a comparative cross-sectional study
This distinction matters. It means that supporting a mother’s mental health, keeping her informed, and avoiding unnecessary separation from her baby are not peripheral concerns. They are part of the baby’s health equation. The shift away from routine mother-baby separation in COVID cases was driven partly by evidence like the Italian rooming-in study, and partly by growing recognition that the psychological costs of separation outweighed the modest infection risk.