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1.
JAMA Pediatr ; 175(2): 157-167, 2021 02 01.
Article in English | MEDLINE | ID: mdl-33044493

ABSTRACT

Importance: Limited data on vertical and perinatal transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and health outcomes of neonates born to mothers with symptomatic or asymptomatic coronavirus disease 2019 (COVID-19) are available. Studies are needed to inform evidence-based infection prevention and control (IP&C) policies. Objective: To describe the outcomes of neonates born to mothers with perinatal SARS-CoV-2 infection and the IP&C practices associated with these outcomes. Design, Setting, and Participants: This retrospective cohort analysis reviewed the medical records for maternal and newborn data for all 101 neonates born to 100 mothers positive for or with suspected SARS-CoV-2 infection from March 13 to April 24, 2020. Testing for SARS-CoV-2 was performed using Cobas (Roche Diagnostics) or Xpert Xpress (Cepheid) assays. Newborns were admitted to well-baby nurseries (WBNs) (82 infants) and neonatal intensive care units (NICUs) (19 infants) in 2 affiliate hospitals at a large academic medical center in New York, New York. Newborns from the WBNs roomed-in with their mothers, who were required to wear masks. Direct breastfeeding after appropriate hygiene was encouraged. Exposures: Perinatal exposure to maternal asymptomatic/mild vs severe/critical COVID-19. Main Outcomes and Measures: The primary outcome was newborn SARS-CoV-2 testing results. Maternal COVID-19 status was classified as asymptomatic/mildly symptomatic vs severe/critical. Newborn characteristics and clinical courses were compared across maternal COVID-19 severity. Results: In total, 141 tests were obtained from 101 newborns (54 girls [53.5%]) on 0 to 25 days of life (DOL-0 to DOL-25) (median, DOL-1; interquartile range [IQR], DOL-1 to DOL-3). Two newborns had indeterminate test results, indicative of low viral load (2.0%; 95% CI, 0.2%-7.0%); 1 newborn never underwent retesting but remained well on follow-up, and the other had negative results on retesting. Maternal severe/critical COVID-19 was associated with newborns born approximately 1 week earlier (median gestational age, 37.9 [IQR, 37.1-38.4] vs 39.1 [IQR, 38.3-40.2] weeks; P = .02) and at increased risk of requiring phototherapy (3 of 10 [30.0%] vs 6 of 91 [7.0%]; P = .04) compared with newborns of mothers with asymptomatic/mild COVID-19. Fifty-five newborns were followed up in a new COVID-19 Newborn Follow-up Clinic at DOL-3 to DOL-10 and remained well. Twenty of these newborns plus 3 newborns followed up elsewhere had 32 nonroutine encounters documented at DOL-3 to DOL-25, and none had evidence of SARS-CoV-2 infection, including 6 with negative retesting results. Conclusions and Relevance: No clinical evidence of vertical transmission was identified in 101 newborns of mothers positive for or with suspected SARS-CoV-2 infection, despite most newborns rooming-in and direct breastfeeding practices.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/transmission , Infectious Disease Transmission, Vertical/statistics & numerical data , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome/epidemiology , COVID-19/epidemiology , Female , Humans , Infant, Newborn , Male , New York City , Outcome Assessment, Health Care , Pregnancy , Retrospective Studies , SARS-CoV-2/isolation & purification , Young Adult
2.
Semin Perinatol ; 44(7): 151286, 2020 11.
Article in English | MEDLINE | ID: mdl-32826081

ABSTRACT

As the COVID-19 pandemic continues to spread worldwide, it is crucial that we determine populations that are at-risk and develop appropriate clinical care policies to protect them. While several respiratory illnesses are known to seriously impact pregnant women and newborns, preliminary data on the novel SARS-CoV-2 Coronavirus suggest that these groups are no more at-risk than the general population. Here, we review the available literature on newborns born to infected mothers and show that newborns of mothers with positive/suspected SARS-CoV-2 infection rarely acquire the disease or show adverse clinical outcomes. With this evidence in mind, it appears that strict postnatal care policies, including separating mothers and newborns, discouraging breastfeeding, and performing early bathing, may be more likely to adversely impact newborns than they are to reduce the low risk of maternal transmission of SARS-CoV-2 or the even lower risk of severe COVID-19 disease in otherwise healthy newborns.


Subject(s)
Baths , Breast Feeding , COVID-19/epidemiology , Infectious Disease Transmission, Vertical/statistics & numerical data , Patient Isolation , Pregnancy Complications, Infectious , Female , Humans , Infant, Newborn , Organizational Policy , Postnatal Care , Pregnancy , Rooming-in Care , SARS-CoV-2
3.
Case Rep Pathol ; 2018: 8378769, 2018.
Article in English | MEDLINE | ID: mdl-29854529

ABSTRACT

Gastroschisis most often occurs as an isolated anomaly and extragastrointestinal associations are rare. Most commonly, the anomalies associated with gastroschisis are cardiac and central nervous system abnormalities. Respiratory insufficiency has sometimes been reported in association with giant abdominal wall defects. Poor outcomes and prolonged ventilator support have been reported in giant gastroschisis and omphalocele, especially if associated with herniation of the majority of the liver. We report a case of a large gastroschisis that was associated with a kyphoscoliosis and pulmonary hypoplasia.

4.
Ann Pediatr Cardiol ; 11(2): 194-196, 2018.
Article in English | MEDLINE | ID: mdl-29922018

ABSTRACT

We report a term female infant with congenital heart block and total anomalous of pulmonary venous return. The results of single nucleotide polymorphism oligonucleotide microarray analysis showed an interstitial duplication of approximately 818 Kb, which involved 11 genes, including the entire LAMB3 gene which is known to associate with cardiac conduction defect. Our report adds to the collective knowledge that the cardiac conduction defect is a clinical feature of chromosome 1q32.2 duplication.

5.
Case Rep Pathol ; 2018: 6829586, 2018.
Article in English | MEDLINE | ID: mdl-29670795

ABSTRACT

We report a term male neonate with congenital myeloproliferative disorder, thrombocytopenia, a horseshoe kidney, feeding difficulty secondary to dysphagia/foregut dysmotility, and respiratory failure. Prenatal molecular genetic analysis revealed a fetus carrying c.184T>G (p.Tyr62Asp) pathogenic variant in PTPN11. The infant eventually succumbed to respiratory failure. Bacterial and viral cultures/studies were all no growth/negative. Pulmonary capillaritis and vasculitis were noted at autopsy. This report presents a new case of Noonan syndrome with unusual associated disorders and a review of the literature.

6.
J Med Case Rep ; 11(1): 254, 2017 Sep 06.
Article in English | MEDLINE | ID: mdl-28874174

ABSTRACT

BACKGROUND: Green-stained amniotic fluid does not always indicate that meconium was passed in utero. CASE PRESENTATION: We report the case of a 2280-g Hispanic preterm female born at 32 weeks of gestation with congenital jejunal atresia. The amniotic fluid was greenish stained; the initial impression was meconium-stained amniotic fluid. Postnatal findings revealed no meconium in her rectum. The content of her first stool appeared sticky and white. CONCLUSION: In the absence of meconium in the rectum, the pediatrician should consider the possibility that the greenish amniotic fluid is not meconium stained, but rather stained with bile due to the fetus vomiting in utero secondary to intestinal obstruction.


Subject(s)
Amniotic Fluid/chemistry , Bile , Fetal Diseases , Intestinal Atresia , Intestinal Obstruction , Meconium , Pregnancy Complications , Vomiting/etiology , Adult , Diagnosis, Differential , Female , Fetal Diseases/diagnosis , Fetal Diseases/physiopathology , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Intestinal Atresia/complications , Intestinal Atresia/physiopathology , Intestinal Obstruction/complications , Intestinal Obstruction/physiopathology , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/physiopathology
7.
Pediatr Dev Pathol ; 20(5): 426-431, 2017.
Article in English | MEDLINE | ID: mdl-28812467

ABSTRACT

We report an extremely low-birth-weight neonate who developed umbilical artery perforation and false tracking. There was no life-threatening event relating to the complication. Diagnosis was made at postmortem examination. Little information exists regarding the anatomic and vascular effects of umbilical artery catheterization placement in newborns. We report a new complication of umbilical artery catheterization. We raise the awareness regarding the potential life threat due to this rare but very serious complication.


Subject(s)
Catheterization, Peripheral/adverse effects , Infant, Extremely Low Birth Weight , Umbilical Arteries/injuries , Vascular System Injuries/etiology , Fatal Outcome , Humans , Infant, Newborn , Infant, Premature , Male , Umbilical Arteries/pathology , Vascular System Injuries/diagnosis , Vascular System Injuries/pathology
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