21st century problems are definitely different from 15th century problems—but some issues still persist, no matter our best efforts. One of those is, quite unfortunately, infant mortality. In the thick of the COVID-19 pandemic, scientists couldn’t help but wonder if the pandemic had an effect on infant mortality. In October 2022, a research study funded by the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan aimed to determine predisposing factors for negative outcomes in infants with early neonatal sepsis during COVID-19. Early neonatal sepsis is a blood infection that occurs in newborns and can be deadly. While this specific study ultimately found no connection between COVID-19 and increased neonatal mortality, other studies have found the opposite: overall, this is an area that needs to be studied more, but is nevertheless a place mothers can take precautions.

The neonatal period is the most crucial and pivotal stage of life for babies. Babies are incredibly vulnerable to various infections in that time period: 1.3 to 3.9 million infants catch neonatal sepsis annually. Out of these numbers, 400,000 to 700,000 deaths from neonatal sepsis occur worldwide. Babies are vulnerable in our society, and if COVID-19 could put them more at risk, it is important to know, especially for families who hope to get pregnant or mothers who are expecting.

As a bit of context, previous studies have identified both pathogen type and lower weight as factors associated with mortality. During the COVID-19 pandemic, there have been cases of severe complications and death of newborns whose mothers acquired the SARS-CoV-2 virus during pregnancy or childbirth. To elaborate, COVID-19 is the name of the disease, but SARS-CoV-2 is the name of the virus that causes said disease. It is similar to how HIV is the name of the virus that causes AIDS, but the two are not the same. Further, pregnant women with COVID-19 often gave birth prematurely, which also increased the risk of morbidity and death. Because of this, scientists predicted that the COVID-19 disease in mothers would be associated with higher levels of neonatal sepsis.

How did they run the experiment? This does, after all, seem like a difficult topic to study. In Kazakhstan, researchers identified 172 newborns up to 4 days old, all diagnosed with neonatal sepsis, to study. They determined the cause of the bloodstream infection, and then used an ELISA—enzyme linked immunosorbent assay—to find the anti-SARS-CoV-2 antibodies in their systems. An ELISA uses enzymes, a type of protein, to detect the presence of another protein in a sample. These enzymes are created with a special type of antigen, or receptor, that will only bind to a unique receptor protein on the surface of the cell of the virus that is being detected. For example, in a COVID-19 ELISA, if anti-SARS-CoV-2 antibodies are present in the baby’s systems, the enzyme will bind to the receptor like a magnet and change colors, which scientists can detect. The more cells have changed colors, the more virus is in the baby’s system. Antibodies are special proteins that fight off viruses in our bodies—each antibody is specific to a virus. After that, scientists performed a statistical analysis to compare these factors to mode of delivery, birth weight, pathogen type, mother’s diseases, duration of hospitalization, and more. All could play a part in neonatal sepsis, and in determining whether COVID-19 was a deciding factor in neonatal sepsis.

It should be noted that not every baby with neonatal sepsis in that time period participated in the study. Patients with HIV, with an immunodeficiency disease, severe malformations, and a few more factors did not participate, along with parents who legally refused to participate in the study. 

What did the researchers find? 22% of infants with neonatal sepsis died. Anti-SARS-CoV-2 antibodies were found in 68.3% of newborns. Overall, neonatal sepsis mortality was associated with low birth weight and gestational age, just like in the non-pandemic time. There was no significant relationship between COVID-19 in the mother and neonatal mortality. There was, however, an unusually high level of anti-SARS-CoV-2 antibodies in newborns, and when this study was being performed, vaccination for pregnant women was not available. Thus, this level would be associated with the mother being infected with COVID-19 during or before pregnancy, but there were still no significant differences that could be associated with fatality.

This study was run cleanly. Many people studied the scientific method in school—this study adhered to it relatively well. There were plenty of studies and statistics from before COVID-19 as to neonatal sepsis and mortality that could be used for comparison as a negative control, though it should be noted that a positive control, or a case that can demonstrate what a true hypothesis looks like, did not exist in this study. After all, it was unsure whether COVID-19 and neonatal sepsis were linked, and it would regardless be immoral to purposefully give mothers COVID-19 in order to create a positive control.

There were issues with the study that can be expanded upon in the future by other researchers. The study was incredibly short term, which means we still have no idea as to the long term effects and outcomes of COVID-19 on infants. There was also no way to confirm whether the mothers had COVID-19 while pregnant. Finally, and most importantly, while this study in Kazakhstan did not find an association between COVID-19 and mortality, other researchers on other studies claim the opposite. This very cleanly demonstrates one of the complications that comes with the pandemic—insufficient resources and problems in efficient distribution of the resources, along with a deficiency in information, can lead to confusion on important problems. I have faith that as time goes on these will be cleared up, as we solve problem after problem, but for now, this area of research has a lot of potential for other researchers. The overall conclusion from this study in conjunction in other studies was simply that the pandemic may have indirectly caused an increase in infant mortality, but the leading causes remain the same and the connection to COVID-19 remains unknown.

Works Cited

Kolesnichenko, Svetlana I, et al. “Mortality Risk Factors of Early Neonatal Sepsis during COVID-19 Pandem: IDR.” Infection and Drug Resistance, Dove Press, 31 Oct. 2022, https://www.dovepress.com/mortality-risk-factors-of-early-neonatal-sepsis-during-covid-19-pandem-peer-reviewed-fulltext-article-IDR.