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In infants born to mothers with COVID-19, those who tested positive themselves or had asphyxia were at greater risk for necrotizing enterocolitis (NEC), an observational study from Indonesia found.

Of the cohort's 125 newborns, five were diagnosed with NEC -- a condition that causes intestinal tissue to die and which mostly affects preterm infants -- only one of whom survived, reported Risa Etika, PhD, of the Airlangga University in Surabaya, Indonesia, and colleagues.

Risk for NEC was significantly higher among infants who tested positive for SARS-CoV-2 (OR 15.3, 95% CI 2.07-113.4), those with asphyxia at birth (OR 13.1, 95% CI 1.41-122.4), and those with lower birth weight (<5.5 lb) or who were of younger gestational age (<37 weeks), according to the findings.

"This study demonstrated that the existence of coronavirus infection in expectant mothers could be a significant factor in the incidence of NEC in their babies," the group wrote in . "Diagnosis of NEC is challenging because the symptoms may go unnoticed by the clinician even though it is progressive and causes high mortality."

Overall, seven of the infants in the cohort died, with NEC, delivery by C-section, lower gestational age, and asphyxia each associated with a higher mortality risk.

During the pandemic, multiple reports have demonstrated that pregnant women remain at risk for , and infection in pregnancy has been associated with worse birth outcomes. The new findings build upon a prior report from the researchers showing that may contribute to an infant's asphyxia.

For the current study, Etika and colleagues examined data on 125 hospitalized newborns who were born to mothers who tested positive for SARS-CoV-2 infection from May 2020 to March 2021. Diagnosis for NEC was based on clinical presentation and abnormal findings on x-ray, and SARS-CoV-2 was diagnosed via PCR testing.

Overall, most of the newborns were delivered by C-section (62%), which was "primarily aimed to prevent the transmission of coronavirus infection in the environment," the researchers noted.

Most of the children were born at term (70%), three-fourths had a birth weight above 5.5 lb, seven tested positive for COVID-19 (5.6%), and 25.6% had asphyxia at birth.

Among the five infants with NEC, four were born via C-section, two were positive for COVID-19, and four had asphyxia. Those with NEC were more likely to weigh less than 5.5 lb (100% vs 22% in those without NEC) and be born prior to 37 weeks' gestation (100% vs 27%).

Maternal comorbidities included pre-eclampsia (16%), hypertension (4%), and obesity (2%).

The authors acknowledged several limitations to the data, including the small sample size and that the study was conducted during Indonesia's first COVID-19 wave and the start of the second wave there, which may limit the generalizability.

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