ABSTRACT
INTRODUCCTION: Methemoglobinemia (MetaHb) is a condition where the erythrocyte is unable to release oxygen into tissues causing tissue hypoxia and metabolic acidosis with high lactate. In adult patients with SARS-CoV2 infection, some cases of coexistence of MetaHb and refractory hypoxemia have been reported;although there are no reports of this association in the neonatal stage. CLINICAL CASES: We show two cases of premature newborns with SARS-CoV-2 infection who had multisystemic deterioration and MetaHb in the second to the thrid week of life, without microbiological isolation, or temperary relationship with known MetaHb triggers, normal G6PD levels, and partial response to exchange transfusion or infusion of methylene blue. CONCLUSION: The relationship between MetaHb and SARS-CoV-2 infection is still unknown, but its pro-inflammatory activity has recently been documented, which can increase cytokine storm and worsen the evolution and prognosis of the patient with moderate to severe infection. Further studies of these associations are therefore necessary to enable timely interventions. © 2023 Instituto Nacional de Pediatria. All rights reserved.
ABSTRACT
Coronavirus disease 2019 (COVID-19) in a vulnerable population, such as the pregnant woman, fetus, and newborn, requires an establishment of effective and safe strategies focused on the safety of the mother-child binomial. The objective of this report is to present the results of the review of secondary information sources (meta-analysis and systematic review), of the state of the art in the advancement of knowledge of the disease due to COVID-19 during pregnancy. Different reports have insisted that maternal mortality from COVID-19 is low. However, the maternal mortality ratio (MMR) increased from 30.9 to 45.5 deaths per 100,000 births, that is, it showed an increase of 36.32% compared to the same week of 2019. Due to its unprecedented condition and the particular behavior of the COVID-19 disease during the perinatal period, the generation of new data, its integration into accessible information and its epidemiological clinical analysis will inevitably provide new evidence that must be integrated into clinical management and practice. But the issue is not limited to COVID-19, the increase in MMR is 24% for maternal obstetric hemorrhage, 20% for hypertensive disease, and 28.5% for puerperal sepsis. There is no characteristic hematological behavior and the appearance of thrombotic or hemorrhagic complications in the patient with COVID-19, without clinical characteristics similar to those seen in her non-pregnant peers. The global increase in all causes of maternal mortality are not exclusive to COVID-19, which exposes the deficiencies of the health system in terms of primary health care, prenatal surveillance, family planning, among other programs;additional to the impact of COVID-19. The redesign of public policies in terms of primary health care for the entire population is an urgent need, particularly for pregnant women.