Audina M. Berrocal, MD, and Hasenin Al-khersan, MD

In a recent article, Kiappe et al. screened newborns gestationally exposed to maternal COVID-19 infection in Brazil to determine if the neonates presented with associated ocular complications. In total, 165 neonates born to mothers with laboratory confirmed COVID-19 infections were screened. Six neonates (3.6%) tested positive at birth for COVID-19. None of these six infants presented with ocular abnormalities. Among exposed neonates that tested negative, seven demonstrated intraretinal hemorrhages, two had retinopathy of prematurity, and one had venous engorgement. The rates of these abnormalities were comparable to published rates among neonates in non-COVID-19 exposed populations.

Given the association of other congenital viral infections such as rubella with ocular complications in neonates, it is important to determine whether gestational COVID-19 exposure warrants increased ocular screening for neonates. Overall, the present study suggests that neonates exposed to maternal COVID-19 infection do not have an increased risk of ocular complications.

The results of Kiappe et al.’s study do not suggest a need for routine ocular screening of neonates exposed gestationally to COVID-19. However, larger controlled studies with standardized examinations would be useful in confirming these findings and ruling out lower incidence associations.

References:

Emerson MV, et al. Ophthalmology 2001;doi:108:36-9.

Quinn GE, et al. Ophthalmology 2016;doi:123:1595-600.

Yoser SL, et al. Surv Ophthalmol. 1993;doi:37:313-52.

R.V. Paul Chan, MD, MSc, MBA, FACS

This study describes a group of newborns in Brazil exposed to mothers who had COVID-19 during the pregnancy. What is interesting is that there continues to be a concern of whether or not, especially with the coronavirus, there is going to be some sort of horizontal or vertical transmission of COVID-19 to the child. The next question is, if that happens, what are the potential findings in the eye. Here, they are specifically looking at retinal findings, and that is still not fully understood.

Even in the adult population, seeing retinal changes from COVID-19 infection is not common. It has been reported, but there is nothing definitive saying that there is a direct relationship with COVID-19 in general. I think it is especially concerning because if there is transmission, the neonate is unable to express any symptoms, and so you may have to start screening all of these children who potentially have a COVID-19 infection with potential eye findings.

The study authors found in this group of 165 newborns, 123 born full term and 42 born preterm, five tested positive for COVID-19 infection in the first day of life and one tested positive within 18 days. There was some horizontal and vertical transmission. Of those who were exposed, none had any ocular abnormalities related to COVID-19, and I think that is the take-home point. In this large group, there was no evidence showing that there is a high risk for ophthalmological changes related to COVID-19 exposure.

This may support that there is no urgency to screen these children for eye findings related to COVID-19 if the mother has COVID-19 and then gives birth. That matters because there will always be a resource issue. Do you need an ophthalmologist available to screen all of these children? Having said that, there are studies that advocate for universal screening. In that world, this would not be an issue because all of these children would be screened regardless.

One of the limitations that the authors discuss is that there is no control group. This is mostly descriptive, but again, it is relevant because it provides us with more insight around what happens to newborns in mothers with COVID-19.

I think this study is important because as we are still dealing with the pandemic, how we communicate with our families and mothers about the potential eye changes in these children is important.