Table 2.

Clinical manifestations of COVID-19 in the neonatal period (with possibility of overlap in some patients).

Condition	Age of neonate at disease manifestation	Source of SARS-CoV-2 infection	Transmission and pathogenesis	Presentation	Diagnosis
Early neonatal COVID-19	Typically, <7 days after birth	Mother	Perinatal leading to acute infection	Respiratory distress, apnea, or asymptomatic38	Positive RT-PCR or antigen test from neonate after the first few hoursb
Late neonatal COVID-19	Typically, 2–3 weeks after birth	Family members (including mother)	Horizontal (postnatal transmission) leading to acute infection	Respiratory distress, congestion, apnea, fever	Positive RT-PCR or antigen test from neonate
MIS-N (?)a	Typically, <7 days after birth	Mother (or fetus?)	Transplacental antibodies? Or fetal infection? Leading to an immune-mediated disorder	Multisystem inflammation, coronary dilation,43 thrombosis, AV conduction block, ↑ inflammatory markers11,70	Meet criteria listed in Table 1 (with the exception of fever) AND evidence of maternal infection with SARS-CoV-2 during the antenatal period
MIS-C	Typically, 2–6 weeks after primary infection	Self (neonate with early neonatal COVID with or without clinical signs)	Primary SARS-CoV-2 infection leads to cytokine or antibody surge leading to an immune-mediated disorder	Multisystem inflammation, coronary dilation, thrombosis, ↑ inflammatory markers	Meet all criteria in Table 1

Modified from Lakshminrusimha et al.³⁴

^aIt is not clear if this is truly a distinct presentation of COVID-19 in the neonatal period.

^bTo rule out contamination from maternal secretions.^38,39