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COVID-19 Clinical Outcomes

COVID-19 in Newborns: What are the Clinical Features and Outcomes?

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BACKGROUND AND PURPOSE:

  • There have been few studies on infants born to mothers with COVID-19
  • Zeng et al. (JAMA Pediatrics, 2020) reviewed the clinical course of neonates born to mothers with COVID-19

METHODS:

  • Cohort study
  • Setting
    • Wuhan Children’s Hospital from January 2020 to February 2020
  • Participants
    • Neonates born to mothers with COVID-19
  • Study design
    • Neonates were tested for SARS-CoV-2 using standard RT-PCR (nasopharyngeal and anal swabs)
    • Medical records were used to obtain data on demographic, epidemiologic, and clinical features

RESULTS:

  • 33 neonates were born to women with COVID-19
    • Strict infection control and prevention procedures in place during delivery
    • 3 male neonates were COVID-19 positive
    • Maternal pneumonia: All mothers with COVID-19 had pneumonia on CT
  • Neonatal clinical features
    • Most common symptom: Shortness of breath (4 neonates)
    • Neonatal deaths: 0 neonates
  • Patient 1
    • Cesarean delivery at 40 weeks
    • Presenting symptoms: Lethargy and fever
    • Chest radiographic images: Pneumonia
    • Lab tests: All normal except procalcitonin
    • Nasopharyngeal and anal swabs: Positive on days 2 and 4, and negative on day 6
    • ICU LOS 2 days | Stable vitals at day 10
  • Patient 2
    • Cesarean delivery at 40+ weeks
    • Symptoms: Lethargy, vomiting, and fever
    • Chest radiographic images: Pneumonia
    • Lab tests: Leukocytosis, | Lymphocytopenia | Elevated CK-MB
    • Nasopharyngeal and anal swabs: Positive days 2 and 4 and negative on day 6
    • ICU LOS 4 days | Vital signs stable at day 12
  • Patient 3
    • Cesarean delivery at 31+ weeks
      • Resuscitation required | Apgars were 3 (1 min), 4 (5 min) and 5 (10 min)
    • Diagnosis: RDS, suspected sepsis and pneumonia (confirmed with chest radiographic imaging)
      • Resolved at day 14
      • Treated with noninvasive ventilation, caffeine, and antibiotics
    • Lab tests
      • Blood cultures: Enterobacter
      • Leukocytosis
      • Thrombocytopenia
      • Coagulopathy (PT 21 seconds; aPTT 81.9 seconds) leading to DIC with active rescue
    • Nasopharyngeal and anal swabs: Positive days 2 and 4 and negative on day 7
    • ICU LOS 11 days | Vital signs stabilizing by day 14

CONCLUSION:

  • Neonates with relatively mild symptoms recovered
  • The authors point out that patient 3 may have had a more complicated course due prematurity, asphyxia and sepsis, rather than COVID-19
  • The authors do not rule out vertical transmission in this cohort

Learn More – Primary Sources:

Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China

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Related ObG Topics:

Vertical Transmission in Pregnancies with Confirmed COVID-19
Infants Born to Mothers with COVID-19 Have Detectable Levels of Antibodies
Clinical Characteristics of Pregnant Women with COVID-19 Pneumonia

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