Neurodevelopment in infants with antenatal or early neonatal exposure to SARS-CoV-2

Early Hum Dev. 2022 Dec:175:105694. doi: 10.1016/j.earlhumdev.2022.105694. Epub 2022 Nov 12.


Background: Antenatal and neonatal viral exposure may put the developing brain at risk for abnormal neurodevelopment. A clinical program at Children's National Hospital provides detailed follow-up of infants with in utero or neonatal SARS-CoV-2 exposure.

Aims: To determine impact of early SARS-CoV-2 exposure on neurodevelopment.

Study design: We performed a prospective observational study of infant evaluations between 3/2020 and 11/2021. Demographics, pregnancy and birth details, SARS-CoV-2 data, specialty consultations, and NICU records were extracted from infants' medical records. Infants had neurologic exams and developmental screening with Ages and Stages Questionnaire (ASQ). Correlations between SARS-CoV-2 exposure type and neurodevelopmental outcomes were analyzed.

Subjects: Thirty-four infants evaluated in the SARS-CoV-2 follow-up program.

Outcome measures: Abnormal neurologic exams or ASQ scores near or below suggested cut-offs.

Results: Infants received up to three evaluations. Most (28/34; 82 %) were exposed in utero - 16 to symptomatic mothers (IU-S) and 12 to asymptomatic mothers (IU-A). Six were exposed only as a neonate. IU-S had abnormal neurologic exams at mean (SD) age 112 (24) days and ASQ scores near or below cut-offs for all domains more frequently than IU-A or neonatally exposed infants. IU-S were more likely to score below any ASQ cutoff compared to IU-A (P = .04); differences were significant for Fine Motor (P = .01) and Personal-Social (P = .02) domains.

Conclusions: Early SARS-CoV-2 exposure may impact neurodevelopment, especially among infants exposed in utero to symptomatic gestational parents. Vaccination and other precautions to reduce early-in-life infection may protect against neurodevelopmental delays. Children with early SARS-CoV-2 exposure should have additional longitudinal screening for neurodevelopmental delays.

Keywords: Ages and Stages Questionnaire; COVID-19; Congenital infection; Developmental screening; Infant development; Pregnancy.

Publication types

  • Observational Study

MeSH terms

  • Aged, 80 and over
  • COVID-19* / epidemiology
  • Child
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Pregnancy
  • Pregnancy Complications, Infectious* / diagnosis
  • Prospective Studies
  • SARS-CoV-2