SARS-CoV-2 infection during pregnancy and necrotizing enterocolitis: case report and review of the literature

Abstract

Background: Necrotizing enterocolitis (NEC) is a severe intestinal disease primarily affecting premature newborns, with high morbidity and mortality. Although typically linked to prematurity and low birth weight, recent reports have suggested a potential association between NEC and maternal SARS-CoV-2 infection during pregnancy. This study aims to explore this relationship through a systematic literature review and the presentation of a novel clinical case. Case presentation: A female neonate born at 37 + 2 weeks of gestation to a mother with third-trimester SARS-CoV-2 infection presented with feeding intolerance, abdominal distension, and bloody stool at 8 days of life. Diagnostic evaluation confirmed necrotizing enterocolitis, necessitating multiple surgeries for bowel resection, stoma creation, and repair of perforations. Despite intensive multidisciplinary care, the patient developed severe complications, including short bowel syndrome and intestinal failure, leading to death at 18 months. SARS-CoV-2 IgG positivity in the neonate suggested transplacental antibody transfer after maternal infection, while most of the other possible risk factors were excluded. Conclusions: The presented case highlights the potential role of maternal SARS-CoV-2 infection in necrotizing enterocolitis pathogenesis. Literature review identified 10 studies documenting similar associations. Cases ranged in severity, with outcomes influenced by gestational age, infection timing, and neonatal risk factors. The proposed mechanisms include virus-induced inflammation, placental dysfunction, and altered neonatal gut microbiota. Our findings emphasize the importance of considering maternal SARS-CoV-2 infection as a contributing factor in NEC, especially in term neonates without known predisposing conditions. Further research is crucial to elucidate the possible link between COVID-19 and NEC, and guide management of affected neonates. Preventive strategies, including vaccination and optimized prenatal care, are essential to mitigate risks.