Spectrum of neonatal COVID-19 in Iran: 19 infants with SARS-CoV-2 perinatal infections with varying test results, clinical findings and outcomes.

BACKGROUND: There have been few cohorts of neonates with coronavirus disease-2019 (COVID-19) reported. As a result, there remains much to be learned about mechanisms of neonatal infection including potential vertical transmission, best methods of testing, and the spectrum of clinical findings. This communication describes the epidemiology, diagnostic test results and clinical findings of neonatal COVID-19 during the pandemic in Iran. MATERIALS AND METHODS: This is a retrospective cohort study of 19 neonates infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from 10 hospitals throughout Iran. We analyzed obstetrical information, familial COVID-19 status, neonatal medical findings, perinatal complications, hospital readmissions, patterns of repeated testing, and clinical outcomes. RESULTS: Eleven neonates had family members infected. Five mothers were negative for COVID-19 and four neonates had no identifiable family source of infection. The neonatal mortality rate from COVID-19 was 10%. Seven newborns (37%) were discharged from the hospital as healthy but required readmission for symptoms of COVID-19. There were 2 multifetal gestations - one set each of twins and triplets, each with disparate testing and clinical outcomes. Premature delivery was common, occurring in 12 of 19 infants (63%). Initial testing for COVID-19 was negative in 4 of the 19 neonates (21%) who subsequently became positive. In 2 cases, neonates tested positive at 1 and 2 h after birth which was suspicious for vertical transmission of SARS-CoV-2. CONCLUSIONS: These cases have notable variation in the epidemiology, clinical features, results of testing and clinical outcomes among the infected newborns. Neonates initially testing negative for COVID-19 may require readmission due to infection. Two neonates were highly suspicious for intrauterine vertical transmission. Repeat testing of neonates who initially test negative for COVID-19 is recommended, without which 21% of neonatal infections would have been undiagnosed.

Confirming Vertical Fetal Infection With Coronavirus Disease 2019: Neonatal and Pathology Criteria for Early Onset and Transplacental Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Infected Pregnant Mothers.

Increasing numbers of pregnant women with coronavirus disease 2019 are being reported around the world. The majority of neonates delivered to pregnant women infected with severe acute respiratory syndrome coronavirus 2 have been negative for the virus, but a small number have tested positive for infection. It is important to determine whether vertical transmission of coronavirus disease 2019 occurs and the mechanisms for its development. Based on a number of clinical and laboratory findings, it has been suggested that transplacental transmission may be occurring, but a method to confirm this is necessary. This communication analyzes and evaluates the covariables that have been discussed as potential indicators of vertical and, specifically, intrauterine transmission, including the timing of onset of neonatal illness, neonatal viral test positivity, neonatal antibody testing for immunoglobulin (Ig) G and IgM, and viral analysis of swabs of whole specimens of placental tissue. None of these methods can provide confirmatory evidence that infection developed prior to labor and delivery, or that transplacental transmission occurred. This commentary proposes that diagnosis of early-onset neonatal coronavirus disease 2019 infection should be limited to neonates with positive reverse transcription polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 within the initial 72 hours of life. It also proposes that the occurrence of intrauterine transplacental severe acute respiratory syndrome coronavirus 2 among infected mother-infant dyads be based upon identification of severe acute respiratory syndrome coronavirus 2 in chorionic villus cells using immunohistochemistry or nucleic acid methods such as in situ hybridization. Evaluating placentas from neonates with coronavirus disease 2019 using these methods will be instrumental in determining the potential role and prevalence of transplacental transmission of the coronavirus.

Urinary parameters predictive and electrolyte disturbances of cisplatin-induced acute renal associated with cancer as a critical target of the chemotherapeutic agent in patients with solid tumors.

Cisplatin (CP) is a remarkably effective Pt-based anticancer drug, but it also exhibits severe toxic side effects, including nephrotoxicity and ototoxicity, and CP nephrotoxicity is a major constraint for the treatment of solid tumors. This study was designed to evaluate the electrolyte and biochemical changes in dogs with acute kidney injury (acute renal failure) following administration of CP as a chemotherapeutic agent to exhibit broad efficacy in solid tumors. A total of 10 adult male dogs were selected (treated dogs = 7 and control dogs = 3). Cisplatin-treated animals were received 0.75 mg/kg via intravenous for 5 consecutive days. Urine and blood samples on days 0 (pre-dosing), 1, 2, 3, 4, 7, 10, 14, and 28 (post-dosing) were collected. For tracking the signs of toxicity with cisplatin, clinical examination was performed for 2 times a day. Serum samples were assayed urea, creatinine, sodium, chloride, potassium, calcium, phosphorus, and urine samples were used to measure creatinine. Serum creatinine levels indicating renal function (glomerular filtration rate) was 0.66 and 0.94 mg/dL in day 0, respectively, in treatment and control animals. After day 2, a significant change in creatinine was observed in treatment animals. On the end day of the study control and treatments, creatinine was measured with mean of 1.35 and 1.00 mg/dL, respectively. Electrolyte disturbances were observed after several days of cisplatin administration including changes in levels of sodium, potassium, phosphorus, calcium, and chloride. Clinical observations also identified CP toxicity. This study for the first time showed that compensation electrolyte abnormalities in dogs following administration of cisplatin is essential to prevent deaths by daily monitoring and measurement of electrolytes in patients. This may be advantageous if repetitive cycles of chemotherapy or subsequent administration of high dose chemotherapy were planned.