ABSTRACT
BACKGROUND AND AIM: The COVID-19 pandemic has changed the health landscape for the entire population but for future mothers facing the outbreak of the coronavirus pandemic (COVID-19) it has induced, uncertainty, social isolation, and fear for their unborn child, and has contributed to aggravated stress and anxiety. The purpose of a digital follow-up protocol is to study which specific aspects of the pandemic (e.g., viral exposure, psychological vulnerability) may lead to adverse mother and offspring outcomes and aims to understand how maternal physical and mental health is associated with symptoms observed in their offspring, and how these symptoms evolve over time. METHOD(S): The protocol uses a prospective cohort design to study the biological risks associated with pre- and post-partum SARS-CoV-2 exposure of mothers and the neurodevelopmental risk of their offspring. Given the multifaceted nature of Covid-19 exposure which seem to accumulate over time, network analyses will be conducted on data from three maternal (within the first 12 months after birth) and three child assessments (at 1,3 and 6 yrs. of age) collected using online digital questionnaires and surveys which includes (maternal) depression, anxiety, health and trauma symptoms, exposure to SARS-CoV-2, and psychosocial risk while their offspring will be assessed for cognitive and behavioral consequences. RESULT(S): Ultimately, we anticipate that an easily accessible digital follow-up facilitates early detection of neurocognitive and behavioral problems, based on recognition of maternal and child risk. CONCLUSION(S): The resulting risk stratification of child cognitive and behavioral difficulty over time may lead to the development of timely and personalized intervention programs.
ABSTRACT
Background : Since the pandemic caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV2), known as COVID-19, has started in February 2020, different cases of immune thrombocytopenia (ITP) in patients (pts) affected by SARS-CoV2 have been reported. The management of COVID-19 in pts with simultaneous/previous ITP is challenging for the involvement of the haemostatic system. Aims : To describe the management and outcome of pts with ITP and COVID-19. Methods : Data were collected from clinical charts. All pts expressed their agreement. Results : 17 pts had RT-PCR confirmed SARS-CoV2 infection on a nasopharyngeal swab (October 2020-January 2021). Six pts were male (35.3%), 11 female (64.7%);median age 57 years (30-90). At the time of the infection, as regards ITP, pts were grouped as follows: 3 had simultaneous newly-diagnosed (ND) ITP (17.6%) and 1 experienced a relapse (5.8%) [median platelet count 5.5 × 109 /L (2-30 × 109 /L)];7 had chronic ITP on treatment (41.2%) (eltrombopag, n = 5;romiplostim, n = 1;prednisone, n = 1) and 2 had stable chronic ITP off-therapy (11.8%) [(median platelet count 63 × 109 /L (30-100 × 109 /L)];4 pts had a previous ITP (complete responders, CR) on follow-up (23.6%) (platelet count >100 × 109 /L). Only 2 pts had no COVID-related symptoms (11.8%). The most common symptoms were fever, anosmia, articular pain, mild-to-moderate respiratory distress. Three pts required hospitalization for acute platelet decrease and mucocutaneous bleeding (ND-ITP, n = 2;relapse, n = 1) and were responsive to intravenous dexamethasone (40 mg/ day, days 1-4) and immunoglobulins (1 g/kg) (17.6%). Three pts were hospitalized for pneumonia (ND-ITP, n = 1;chronic ITP, n = 1;CR, n = 1) and required antibiotics and oral corticosteroid (17.6%). Eleven pts recovered at home without bleeding;their platelet count did not show any change at the evaluation after quarantine (64.7%). All pts had seroconversion;no death occurred. Conclusions : ND-ITP triggered by COVID-19 is responsive to immunoglobulins and steroids. Outcome is favourable also for COVID-19 pts with off-therapy or on treatment ITP.
ABSTRACT
Background: Immune thrombocytopenia (ITP) is an acquired immune disorder characterised by a platelet count < 100x109/L, leading to an increased bleeding risk. Infectious diseases, especially from viral agents, may potentially cause ITP. Since the novel pandemic caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV2), known as COVID-19, has started in February 2020, different cases of ITP in patients affected by SARS-CoV2 have been reported. The management of COVID-19 in patients with simultaneous or previous ITP can be challenging because of the great involvement of the haemostatic system in this viral infection. Aims: To describe the management and outcome of patients with newly diagnosed (ND), chronic and previous ITP, infected by COVID-19. Methods: Data were collected from clinical charts and updated through telephone contacts. All patients expressed their agreement to participate to the study. Results: Seventeen patients had RT-PCR confirmed SARS-CoV2 infection on a nasopharyngeal swab (October 2020-January 2021). Six patients were male (35.3%) and 11 female (64.7%). The median age was 57 years (range 30-90). At the time of the COVID-19 infection, as regards ITP, patients were grouped as follows: 3 had simultaneous ND ITP (17.6%) and 1 experienced a relapse (5.8%) (median platelet count 5.5x109/L;range 2-30x109/L);7 had chronic ITP on treatment (41.2%) (eltrombopag, n=5;romiplostim, n=1;prednisone, n=1) and 2 patients had stable chronic ITP off-therapy (11.8%) (median platelet count 63x109/L;range 30-100x109/L);4 patients had a previous ITP on follow-up (FU) (23.6%) (platelet count >100x109/L). Fever, anosmia, dysgeusia, articular pain and mild-to-moderate respiratory distress were considered typically COVID19-related symptoms. Overall, 15 patients were symptomatic: 11 had only COVID19- related symptoms (64.8%), 1 presented with isolated mucocutaneous bleeding (5.8%) and 3 reported both (17.6%). Two patients did not refer any symptoms throughout the course of the infection (11.8%). Six cases required hospitalization (35.3%): 3 for acute decrease of platelet count and bleeding symptoms (17.6%) (ND ITP=2;ITP relapse=1);3 for pneumonia (17.6%) (ND ITP=1;chronic ITP on treatment=1;ITP on FU=1). Patients with bleeding symptoms were responsive to dexamethasone (40 mg/day, days 1-4) and immunoglobulins (1 g/kg). Patients with pneumonia were successfully treated with antibiotics and oral corticosteroids. The median duration of stay in the hospital was 10.5 days (range 3-20). Eleven patients recovered at home without any bleeding;they did not show any significant change in the platelet count at the first evaluation after quarantine (64.7%). Twelve patients had previously received either steroids (n=8) or steroid+splenectomy (n=4) (70.5%). Serious respiratory distress, requiring mechanic ventilation, was not recorded. Anti-thrombotic prophylaxis of COVID-related thromboembolism was not used and no cases of thrombosis were observed. The viral seroconversion was observed in all patients and no death occurred. Summary/Conclusion: In our experience, ND ITP triggered by COVID- 19 has been responsive to immunoglobulins and steroids. Overall outcome has been favourable also for COVID-19 patients with a stable off-therapy or on treatment ITP.