694 - Optimal delivery management for the prevention of early neonatal SARS-CoV-2 infection: Systematic review and meta-analysis

The influence of delivery management interventions (DMI) on SARS-CoV-2 transmission from mother to fetus or neonate remains unclear. Few studies have attempted to address how specific DMI are associated with early neonatal SARS-CoV-2 infection (ENI) and neonatal death before 28 days of life (ND).

Objective: To systematically compare combinations of DMIs that may decrease ENI or ND.

Design/Methods:

Articles published 1 January 2020 - 31 December 2021 from Cochrane review databases, Medline and Google Scholar were searched.

The Inclusion criteria were:

< !1.     mothers with SARS-CoV-2 PCR positive status within 10 days before delivery or symptomatic at delivery with a positive test within 48 hours after delivery

< !2.     delivery method described

< !3.     infant SARS-CoV-2 PCR result reported

Meta-analysis of extracted data was based on combinations of delivery management:

<   1.physical environment

< !2. delivery specific interventions

< !3. infant care practices

11,075 publications were screened as depicted in the PRISMA diagram in Figure 1. 117 publications containing data of 244 infants and 230 mothers were included as the rest lacked detailed information on DMI. DMI were evaluated by individual category and each category in combination as depicted in Figure 2. Primary outcomes were confirmation of ENI by a positive PCR and neonatal death occurring before 28 days of life. All analyses were carried out using individual patient level data. All maternal and infant characteristics were pooled using DerSimonian-Laird inverse variance method. Primary outcome analyses were carried out using logit transformation and random effect. The heterogeneity of included studies was evaluated with I² statistics. 

Results:

Pooled frequencies of ENI and ND reported as random effect with all 6 DMI and DMI combinations are shown in Table 1. No routine care was described in these publications so the primary comparison of DMI combinations to routine care was not possible. Sample size for each combination was too small to conduct any valid comparison of the 6 different DMI combinations.

Conclusion(s):

Published literature which include detailed description of DMI in SARS-CoV-2 infected mothers is lacking. This meta-analysis highlights the need for rigorous and multinational studies on the guidelines best suited to prevent transmission of air-borne illnesses from mother to neonate.