Newborns With SARS-CoV-2 Show Ocular Injury

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SAN ANTONIO — Newborns infected with SARS-CoV-2 are showing signs of eye damage, researchers say.

The injuries could be related to prematurity, hemodynamic compromise, mechanical ventilation, or the virus itself, said Maria Ana Martinez-Castellanos, MD, professor of pediatric retina at the Association to Prevent Blindness of the National Autonomous University of Mexico in Toluca, Mexico.

“If you have a child with COVID, please perform angiograms because we may be missing retinal diseases that may give us problems later,” said Martinez-Castellanos.

Ocular manifestations of SARS-CoV-2 have been found in patients of other ages, but she believes that the cross-sectional study of 15 patients she presented at the American Society of Retina Specialists (ASRS) 2021 annual meeting is the largest to date. She and her colleagues also published the data in the Journal of AAPOS.

The Monica Pretelini Maternal Perinatal Hospital in Toluca near Mexico City was designated as the regional reference center for pregnant-puerperal women and newborns with suspected COVID-19 infection. There, every newborn with a positive RT-PCR test for SARS-CoV-2 from nasopharyngeal swabs was isolated in a neonatal intensive care unit designed for this purpose.

The researchers reported on clinical features in 15 such babies, 7 male and 8 female, with a mean gestational age of 35.2 weeks and an average birth weight of 2238 grams (4.9 lb).

Ten of the mothers were positive for SARS-CoV-2, but transmission of the disease was not vertical, Martinez-Castellanos told Medscape Medical News. Rather, the newborns appeared to have acquired the virus from close contact with their mothers and other relatives after birth. The hospital now separates newborns from mothers who are positive for the virus, but that was not always the case with the patients in this study. “At the beginning of the pandemic, we didn’t know to do that,” she said.

To determine how the virus is affecting them, Martinez-Castellanos and her colleagues conducted complete ophthalmic studies, including portable slit-lamp examination, fundus examination, color fundus photography, red-free imaging, and fluorescein angiography using a contact wide-angle imaging system.

All 15 newborns had periorbital edema and hyaline secretion. Eleven had chemosis and hemorrhagic conjunctivitis and 8 had ciliary injection.

As for corneal and anterior segment findings, six had corneal edema. One full-term newborn had rubeosis and posterior synechiae.

Seven newborns had normal fundus examinations. Two had oxygen-induced retinopathy, three had retinopathy of prematurity, two had subtle cotton wool spots, and one neonate — born at full term — had vitreous hemorrhage.

Changes consistent with retinopathy of prematurity showed up in fluorescein angiography in three patients. Oxygen-induced retinopathy affected two, patchy choroidal filling showed up in three, and peripapillary hyperfluorescence appeared in three others. Two had delayed retinal filling, venous laminar flow, and boxcarring.

These findings are similar to those reported in adults and older children, Martinez-Castellanos said, but the ramifications for the newborns’ long-term ocular health are unknown.

The researchers are following up on these patients, and so far they are doing well. The retinopathy of prematurity is persisting in some, but the other signs of injury appear to be fading. And the babies’ overall health is improving. “We don’t see them die, but the mothers do,” Martinez-Castellanos said. “The [number one] cause of maternal death in Mexico is COVID.

COVID-19 is very rare in newborns in the United States, said session moderator Audina Berrocal, MD, a pediatric retina specialist and assistant professor of ophthalmology at the University of Miami Health System, Miami, Florida. “In all my experience, I have not seen COVID in newborns,” she told Medscape Medical News.

Berrocal and Martinez-Castellanos have disclosed no relevant financial relationships.

American Society of Retina Specialists. Presented October 10, 2021.
J AAPOS. Published online February 15, 2021. Full text

Laird Harrison writes about science, health, and culture. His work has appeared in national magazines, in newspapers, on public radio and on websites. He is at work on a novel about alternate realities in physics. Harrison teaches writing at the Writers Grotto. Visit him at or follow him on Twitter: @LairdH

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