ABSTRACT
INTRODUCTION: the impact of maternal SARS-CoV2 infection and its risk of vertical transmission is still not well known. Recommendations from scientific societies seek to provide safety for newborns without compromising the benefits of early contact. The aim of the study is to describe characteristics and evolution of newborns born to mothers with SARS-CoV2 infection, as well as the implemented measures following recommendations from the Sociedad Espanola de Neonatologia. METHODS: observational, prospective and single-center cohort study. A specific circuit was designed for mothers with SARS-CoV2 infection and their newborns. Epidemiological and clinical data were collected. PCR were performed in newborns at delivery and at 14 days of age. RESULTS: 73 mothers and 75 newborns were included in the study. 95.9% of maternal infections were diagnosed during the third trimester of pregnancy, 43.8% were asymptomatic. Median gestational age was 38 weeks (IQR:37-40), 25.9% of newborns required admission to Neonatology. Skin-to-skin mother care was performed in 68% of newborns, 80% received exclusive maternal or donated breast milk during hospital stay. No positive PCR results were observed in newborns at delivery, one case of positive PCR was observed in an asymptomatic neonate at 14 days of age. CONCLUSIONS: Risk of SARS-CoV2 transmission is low when complying to the recommendations issued by Sociedad Espanola de Neonatologia, allowing rooming-in and promoting breastfeeding.
ABSTRACT
Background: Knowledge about SARS-CoV2 infection in pregnancy and exposed newborns is deficient. We performed a longitudinal analysis of innate immune system status and determined soluble cytokines of women infected with SARS-CoV2 during pregnancy and their newborns Methods: Women with confirmed SARS-CoV2 infection (RT-PCR+ or SARS-CoV2 anti-IgM/IgG+) (COVID MOTHER group, CM n=29, median age of 31 years) and their SARS-CoV2 exposed uninfected newborns were recruited from Hospital Gregorio Marañón, Spain. Peripheral blood mononuclear cells (PBMCs), cord cells and plasma were collected at birth and 6 months later (n=15). The immunophenotyping of innate components (natural killer cells [NK] and monocytes) was studied on cryopreserved PBMCs and cord cells by multiparametric flow cytometry. Up to 4 soluble pro/anti-inflammatory cytokines were assessed in plasma and cord plasma by ELISA assay. CM was compared to a healthy non-SARS-CoV2 infected mothers' group matched by age (SARS-CoV2 PCR-and SARS-CoV2 anti-IgM/IgG-)(Uninfected Mothers, UM n=16) and their newborns (n=16) Results: On NK cell assays, CM show at baseline lower percentage of CD16++ subset, higher NKG2D and lower NKG2A expression on CD16++ and CD56++ subsets and reduced CD57 expression compared to UM;proportion of CD16++ subset and percentage of NKG2D reverted after 6 months(A). Regarding monocytes, CM show increased levels of CD62L and decreased CD49d expression on classical subset, elevated intermediate monocytes proportion and decreased CD40 expression on patrolling subset(B). No differences were found 6 months later. No newborn was infected by SARS-CoV2 and the phenotype analyzed on cord cells shows lower frequency of NK subsets compared with unexposed children and increased CD16++ subset after 6 months(C). In monocytes distribution, exposed children present lower frequency of total monocytes and its subsets than unexposed. Classical monocytes show significant changes at follow-up time-point(D). Increased TNFα and IL10 levels were found on CM compared to UM. Strong and direct correlations were observed between the age and IL6(E). No differences were observed in soluble cytokine levels comparing both groups of newborns Conclusion: SARS-CoV2 infection during pregnancy shows differences in activation, maturation and endothelial markers on innate immune system that could lead newborns clinical implications at birth. However, altered cell proportions and phenotypes found at SARS-CoV2 at birth time and on their exposed newborns is later reverted.
ABSTRACT
Background: Literature evaluating the effect of SARS-CoV-2 infection in exposed newborns during pregnancy is still scarce. Although a 3% rate of perinatal transmission has been described, there is not enough evidence of viral transmission in biological samples through microbiological techniques. Our aim is to describe perinatal transmission in newborns exposed to SARS-CoV-2 during pregnancy and their follow up. Methods: The study period is from March 15 to November 30, 2020. Exposed newborns of SARS-CoV-2 infected mothers (with microbiologically confirmed COVID-19 disease during pregnancy or delivery) were included at 13 hospitals in Spain. Demographic, clinical and microbiological data were collected. Biological samples including nasopharyngeal swab, blood, urine, and meconium from newborns and blood, placenta, and breast milk from mothers were collected for reverse transcription polymerase chain reaction (RT-PCR) analysis. Results: 282 exposed to SARS-CoV-2 neonates were recruited;130 cases during the first wave (March 15-July 31) and 152 during the second one (August 1- November 30). The prematurity birth-rate was 20% and 13% respectively. Overall, eleven newborns were positive for RT-PCR in nasopharyngeal swab, eight of them during the first 24-48 hours after birth. Three of them presented viral load in urine sample and another three in meconium sample. Only one RT-PCR was positive in maternal blood samples (1/115) and placenta (1/81). All newborns blood samples collected at delivery were negative for RT-PCR (0/70). There was no viral load either in breast milk samples (0/79). Placental immuno-histochemistry performed for SARS-CoV-2 showed no virus (0/16). Two newborn death were described none of them related to SARS-CoV-2. Those newborns exposed to SARS-CoV-2 were asymptomatic and with normal weight and psychomotor development at 6-months follow-up. Conclusion: Intrauterine SARS-CoV-2 transmission seems unlikely, describing a 3.9% rate of neonatal infection after delivery. A high rate of prematurity is described, mostly during the first wave. SARS-CoV-2 can be detected by RT-PCR in urine and meconium of neonates with positive nasopharyngeal RT-PCR, whereas it has not been detected in any newborn blood. The detection in maternal blood and placenta was anecdotal and it was not detected in breast milk samples. Except for the complications derived from prematurity, exposed newborns evolution was satisfactory.
ABSTRACT
Background: SARS-CoV2 infection severity during pregnancy and posible consequences for exposed newborns information is still unknown. The objective of this study is to analyse clinical and epidemiological characteristics of a SARS-CoV2 infected women during pregnancy and their newborns cohort. Methods: Multicentric observational study from the Spanish GENEO-COVID cohort (participating in RECLIP). Infected pregnant women and their newborns born from 15 March to 31 July with a 15 days follow up were included. Data regarding epidemiological, clinical, virological and immunological characteristics of the patients was collected. Results: Globally, 105 pregnant women with a median age of 34 (IQR: 29-37) years old and 107 newborns were included in the study. Median gestational age at diagnosis was 36.9 (IQR-33.4-39.2) weeks, and 6.7% os women were diagnosed in the second trimester. More than 34% of the women presented at least one comorbidity and almost 65% of women had COVID19 symptoms and 43% of them were treated for the infection. Overall, 30.8% had COVID-19 pneumonia and 4.8% were admitted to the intensive care unit (ICU) needing invasive mechanical ventilation. The rate of positive RT-PCR at delivery was 61.9%. There was a 36.2% rate of caesarean sections, associated with pneumonia during pregnancy OR:4.2 (95% CI 1.5,12.0) and lower gestational age at delivery OR:0.7 (95% CI: 0.6,0.9). Regarding newborns, 46.7% were male, 66.4% breastfed, with median Apgar 1' of 9 and Apgar 5' of 10. Almost 6% were small for gestational age and 16.8% needed admission to the neonatal ICU. Oxygen was needed by 12.1% and surfactant by 5.6% newborns. Prematurity rate was 20.6%, associated with pneumonia during gestation OR:7.0 (95% CI: 2.3,22.8) and with a positive RT-PCR at delivery OR:6.5 (95% CI: 1.8,31.8). No associations were found with age, comorbidities or blood group. No vertical transmission was reported but one newborn was horizontally infected. Two newborns died, one due to prematurity causes and another of unexpected sudden death during early skin-to-skin contact after delivery. Conclusion: Even there is no vertical transmission reported in this cohort, we found a case of horizontal transmission. SARS-CoV2 infection could produce COVID19 pneumonia during pregnancy, that increases caesarean sections and prematurity rates worsening exposed newborns prognosis. (Figure Presented).