key: cord-1031214-1yp6hhcr
authors: Pérez-Chimal, Luis Gilberto; Cuevas, Gabriela García; Di-Luciano, Andreas; Chamartín, Pablo; Amadeo, Gabriela; Martínez-Castellanos, María A.
title: Ophthalmic manifestations associated with SARS-CoV-2 in newborn infants: a preliminary report
date: 2021-02-16
journal: J AAPOS
DOI: 10.1016/j.jaapos.2020.11.007
sha: 0b47a620c5b28de4509ccdf7b32ec20d315af20e
doc_id: 1031214
cord_uid: 1yp6hhcr

COVID-19, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), affects people of all ages. The virus can cause multiple systemic infections, principally in the respiratory tract, as well as microvascular damage. Ocular manifestations of COVID-19 are uncommon in adults and children. We describe ophthalmic manifestations in newborns detected by slit-lamp examination, fundus examination, and fluorescein angiography. All patients showed edema and hemorrhagic conjunctivitis; fundus examinations revealed cotton wool spots and vitreous hemorrhage, and microvascular damage manifested as patchy choroidal filling, peripapillary hyperfluorescence, delayed retinal filling and venous laminar flow, and boxcarring on fluorescein angiography.

Coronavirus disease (COVID-19), caused by the novel SARS-CoV-2 has been associated with ophthalmological changes at all levels 1 ; ocular external diseases, such as conjunctivitis, and intraocular changes, including inflammation and microvascular alterations. 2, 3 The virus affects people of all ages and may be encountered as well in pregnant women and newborns. 4, 5 

The protocol was approved by the Institutional Review Board Ethics Committee of Hospital Materno Perinatal Monica Pretelini. During the hospital reconversion project carried out by the federal health authorities in Mexico, the Hospital Materno Perinatal Monica Pretelini was designated as the regional reference center for pregnant-puerperal women and newborns with suspected COVID-19 infection. On admission, both mothers and newborns were tested for SARS-CoV2. Newborns with positive RT-PCR tests (from nasopharyngeal swabs) for SARS-CoV-2, who were isolated in a neonatal intensive care unit designed for this purpose, were included in the present cross-sectional study.

All subjects received complete ophthalmic exploration, including portable slit-lamp J o u r n a l P r e -p r o o f examination, fundus examination, color fundus photography, and red-free imaging and fluorescein angiography using a contact wide-angle imaging system (RetCam 3, Natus).

Fifteen newborns (8 females [53%]) were enrolled. The mean gestational age was 35.2 weeks (range, 30-40), and the average birth weight was 2238.7 g (range, 1140-4350 g). Ten mothers were positive for SARS-CoV-2. See Table 1 .

The systemic findings were as follows. Nine newborns (60%) had low Apgar scores (<7 at 5 minutes), most (87%) had a fever, and 13 (87%) had tachypnea. Neonatal jaundice was present in 6 newborns (40%) and sepsis in 5 (33%). Four had cardiovascular alterations, and 9 had respiratory alterations. Seven newborns required a blood transfusion for anemia, 2 had seizures, and 3 had a cardiac arrest with successful resuscitation. Of the 15 newborns, 7 (47%) required mechanical ventilation, and the other 8 (53%) received supplemental oxygen.

The most frequent periorbital finding was edema, present in all 15 newborns. Chemosis and hemorrhagic conjunctivitis were present in 11 newborns (73%), and 8 (53%) had ciliary injection. All 15 newborns had hyaline secretion. The most frequent corneal and anterior segment finding was corneal edema, present in 6 newborns (40%). One full-term newborn had rubeosis and posterior synechiae. Figure 2 and Video 1.

Several reports describe the ocular involvement of SARS-CoV-2. Wu and colleagues, 6 Zhou and colleagues, 7 and Seah and colleagues 8 describe ophthalmological manifestations of SARS-CoV-2 in adult patients, including conjunctivitis, red-eye, tearing, blurring vision in 1 of 3 patients.

Valente and colleagues 4 describe ocular involvement in children, the symptoms were mild, those were present in 15%, mainly viral conjunctivitis. Invernizzini and colleagues 9 reported hemorrhages (9.25%), cotton wools spots (7.4%), dilated veins (27.7%), tortuous vessels (12.9%) in their patient cohort.

All newborns in our study had ocular manifestations, the most common being periorbital edema and hemorrhagic conjunctivitis; 53% had retinal findings. The most frequent presentation at this age could be explained by the overlap of COVID-19 and comorbidities associated with prematurity. This is, to our knowledge, the first report of ophthalmic findings in newborn babies possibly associated with COVID-19 infection in humans. As it is a new virus, all ocular manifestations in newborns are unknown, and the higher frequency of findings may be due to the multiple comorbidities and weakness in the patients. The mechanism of ocular injury in this study is unknown and may be related to prematurity, hemodynamic compromise, mechanical ventilation, or SARS-CoV2. We are following all the cases reported here for long-term complications.

J o u r n a l P r e -p r o o f 

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Review of maternal COVID-19 infection: considerations for the pediatric ophthalmologist

Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19

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