RESUMEN
World Health Organization declared a COVID-19 pandemic in March 2020. SARS-CoV-2 causes COVID-19 infection. It presents as acute respiratory distress syndrome and infects all age groups. In adults, COVID-19 causes acute respiratory failure. In children, COVID-19 usually has a milder clinical course and more favorable outcome than in adults. In contrast to adults and older children, covid-19 infection is uncommon in neonates. The low incidence of COVID-19 infection in neonates is attributed to the low availability of angiotensin-converting enzyme two receptors in the nasal epithelium, which is thought to be the principal point of access for COVID-19 in the human body. However, hyperinflammatory shock and organ failure cases were reported in neonates and older children with previous COVID-19 and positive antibodies. Following this, a different disease entity associated with COVID-19 in children was described as a multisystem inflammatory syndrome associated with covid-19 (MIS-C). This condition has also been referred to as pediatric multisystem inflammatory syndrome (PMIS) or pediatric inflammatory,y multisystem syndrome (PIMS). Multisystem inflammatory syndrome associated with COVID-19 (MIS-C) in children is defined as persistent fever, evidence of inflammation, and signs of multiorgan dysfunction with or without confirmation of previous COVID-19 infection. Other infectious and inflammatory causes with similar signs and symptoms must be excluded before diagnosing MIS-C. MIS-C is considered an immune sequela of COVID-19. MIS-C is typically known to occur after a latency period of 4 to 5 weeks following COVID-19 exposure. MIS-C has broad evolving symptomatology and severity, ranging from asymptomatic to a life-threatening multiorgan failure. Although rare, MISC is known to affect neonates and infants as well.
RESUMEN
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in newborns is extremely rare, and there is a scarcity of research pertaining to epidemiology, clinical presentation, transmission, and prognosis in this population. We present five newborns who tested positive while colocating with their SARS-CoV-2 positive mothers from March 19 to May 15, 2020, at a large public hospital in Queens, New York that was severely affected by the coronavirus disease 2019 (COVID-19) pandemic. All the newborns subsequently tested negative and remained asymptomatic, including through median outpatient follow-up of three weeks.
RESUMEN
BACKGROUND: Universal screening for SARS-CoV-2 infection on Labor and Delivery (L&D) units is a critical strategy to manage patient and health worker safety, especially in a vulnerable high-prevalence community. We describe the results of a SARS-CoV-2 universal screening program at the L&D Unit at Elmhurst Hospital in Queens, NY, a 545-bed public hospital serving a diverse, largely immigrant and low-income patient population and an epicenter of the global pandemic. METHODS AND FINDINGS: We conducted a retrospective cross-sectional study. All pregnant women admitted to the L&D Unit of Elmhurst Hospital from March 29, 2020 to April 22, 2020 were included for analysis. The primary outcomes of the study were: (1) SARS-CoV-2 positivity among universally screened pregnant women, stratified by demographic characteristics, maternal comorbidities, and delivery outcomes; and (2) Symptomatic or asymptomatic presentation at the time of testing among SARS-CoV-2 positive women. A total of 126 obstetric patients were screened for SARS-CoV-2 between March 29 and April 22. Of these, 37% were positive. Of the women who tested positive, 72% were asymptomatic at the time of testing. Patients who tested positive for SARS-CoV-2 were more likely to be of Hispanic ethnicity (unadjusted difference 24.4 percentage points, CI 7.9, 41.0) and report their primary language as Spanish (unadjusted difference 32.9 percentage points, CI 15.8, 49.9) than patients who tested negative. CONCLUSIONS: In this retrospective cross-sectional study of data from a universal SARS-Cov-2 screening program implemented in the L&D unit of a safety-net hospital in Queens, New York, we found over one-third of pregnant women testing positive, the majority of those asymptomatic. The rationale for universal screening at the L&D Unit at Elmhurst Hospital was to ensure safety of patients and staff during an acute surge in SARS-Cov-2 infections through appropriate identification and isolation of pregnant women with positive test results. Women were roomed by their SARS-CoV-2 status given increasing space limitations. In addition, postpartum counseling was tailored to infection status. We quickly established discharge counseling and follow-up protocols tailored to their specific social needs. The experience at Elmhurst Hospital is instructive for other L&D units serving vulnerable populations and for pandemic preparedness.