Optimal Delivery Management for the Prevention of Early Neonatal SARS-CoV-2 Infection: Systematic review and Meta-analysis

Objective Review how specific delivery management interventions (DMI) are associated with early neonatal SARS-CoV-2 infection (ENI) and neonatal death <28 days of life (ND). Design Systematic review and meta-analysis of individual patient-specific data from articles published 1 January 2020 - 31 December 2021 from Cochrane review databases, Medline and Google Scholar. Setting International publications specifying DMI, ENI, and ND. Patients Pregnant women infected with SARS-CoV-2 and their infants Main outcome measures Article inclusion criteria: 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. Primary outcomes were 1) ENI confirmed by positive neonatal PCR and 2) ND. Results Among 11,075 screened publications, 117 publications containing data for 244 infants and 230 mothers were included. Maternal and infant characteristics were pooled using DerSimonian-Laird inverse variance method. Primary outcome analyses were completed using logit transformation and random effect. Heterogeneity of included studies was evaluated with I2 statistics. No routine care was described so comparison of DMI combinations to routine care was not possible. Sample size for each combination was too small to conduct any valid comparison of different DMI combinations. Conclusion Support for specific DMI in SARS-CoV-2 infected mothers is lacking. This review highlights the need for rigorous and multinational studies on the guidelines best suited to prevent transmission from mother to neonate. What is already known on this topic Several specific delivery management interventions (DMI) have been recommended for women with active SARS-CoV-2 to prevent early neonatal SARS-CoV-2 infection. What this study adds This systematic review shows that support for specific DMI in SARS-CoV-2 infected mothers is lacking. How this study might affect research, practice or policy This review highlights the need for rigorous and multinational studies on the guidelines best suited to prevent transmission from mother to neonate. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study used ONLY openly available human data from articles published 1 January 2020 - 31 December 2021 from Cochrane review databases, Medline and Google Scholar. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors * DMI : delivery management interventions ENI : early neonatal SARS-CoV-2 infection ND : neonatal death (<28 days of life) SARS-CoV-2 : severe acute respiratory syndrome coronavirus 2 COVID-19 : coronavirus disease of 2019, the disease caused by SARS-CoV-2 virus