Short-term developmental outcomes in neonates born to mothers with COVID-19 from Wuhan, China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging disease. The consequences of SARS-CoV-2 exposure in infants remain unknown. Therefore, this study aims to investigate whether neonates born to mothers with COVID-19 have adverse brain development. METHODS: This multicenter observational study was conducted at two designated maternal and children's hospitals in Hubei Province, mainland China from February 1, 2020 to May 15, 2020. Neonates born to mothers with COVID-19 were enrolled. Brain magnetic resonance imaging (MRI) findings, and volumes of grey and white matters, and physical growth parameters were observed at 44 weeks corrected gestational age. RESULTS: Of 72 neonates born to mothers with COVID-19, 8 (11%) were diagnosed with COVID-19, 8 (11%) were critically ill, and no deaths were reported. Among the eight neonates that underwent brain MRI at corrected gestational age of 44 weeks, five neonates were diagnosed with COVID-19. Among these five neonates, three presented abnormal MRI findings including abnormal signal in white matter and delayed myelination in newborn 2, delayed myelination and brain dysplasia in newborn 3, and abnormal signal in the bilateral periventricular in newborn 5. The other three neonates without COVID-19 presented no significantly changes of brain MRI findings and the volumes of grey matter and white matter compared to those of healthy newborns at the equivalent age (P > 0.05). Physical growth parameters for weight, length, and head circumference at gestational age of 44 weeks were all above the 3rd percentile for all neonates. CONCLUSIONS: Some of the neonates born to mothers with COVID-19 had abnormal brain MRI findings but these neonates did not appear to have poor physical growth. These findings may provide the information on the follow-up schedule on the neonates exposed to SARS-CoV-2, but further study is required to evaluate the association between the abnormal MRI findings and the exposure to SARS-CoV-2.

Effects of SARS-CoV-2 infection on neuroimaging and neurobehavior in neonates.

BACKGROUND: We collected neonatal neurological, clinical, and imaging data to study the neurological manifestations and imaging characteristics of neonates with coronavirus disease 2019 (COVID-19). METHODS: This case-control study included newborns diagnosed with COVID-19 in Wuhan, China from January 2020 to July 2020. All included newborns had complete neurological evaluations and head magnetic resonance imaging. We normalized the extracted T2-weighted imaging data to a standard neonate template space, and segmented them into gray matter, white matter, and cerebrospinal fluid. The comparison of gray matter volume was conducted between the two groups. RESULTS: A total of five neonates with COVID-19 were included in this study. The median reflex scores were 2 points lower in the infected group than in the control group (P = 0.0094), and the median orientation and behavior scores were 2.5 points lower in the infected group than in the control group (P = 0.0008). There were also significant differences between the two groups in the total scale score (P = 0.0426). The caudate nucleus, parahippocampal gyrus, and thalamus had the strongest correlations with the Hammersmith neonatal neurologic examination (HNNE) score, and the absolute correlation coefficients between the gray matter volumes and each part of the HNNE score were all almost greater than 0.5. CONCLUSIONS: We first compared the neurological performance of neonates with and without COVID-19 by quantitative neuroimaging and neurological examination methods. Considering the limited numbers of patients, more studies focusing on the structural or functional aspects of the virus in the central nervous system in different age groups will be carried out in the future.

[Value of arterial blood lactic acid in the evaluation of disease severity and prognosis in neonatal shock].

OBJECTIVE: To evaluate the value of blood lactic acid (BLA) as a predictor for the severity and prognosis of neonatal shock. METHODS: A total of 326 neonates with shock were enrolled and divided into three groups based on the severity, namely mild group (n=147), moderate group (n=105), and severe group (n=74). BLA level was measured during and early after (about 6 hours later) fluid resuscitation, and lactate clearance rate (LCR) was calculated. The receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of BLA in neonatal shock. RESULTS: BLA level was high in all subjects prior to treatment, and was highest in the severe group and lowest in the mild group (P<0.01). BLA level was significantly higher among patients with septic shock than among those with hypovolemic, cardiogenic, and asphyxiating shock (P<0.05). BLA level was significantly reduced in patients in recovery after treatment (P<0.05). Mortality was significantly lower in patients with BLA level ≤4 mmol/L or LCR ≥10% than in those with BLA level >4 mmol/L or LCR <10% (P<0.01). BLA at 11.15 mmol/L had 100% sensitivity and 96.8% specificity in predicting severe shock. BLA at 10.65 mmol/L had 88.9% sensitivity and 74.1% specificity in predicting the prognosis (survival or dead) of newborns with shock. CONCLUSIONS: In neonates with shock, arterial BLA level increases as the disease severity increases and is associated with prognosis, so it is a useful predictor of the severity and prognosis of neonatal shock.

[Change of Thrombelastography in Children's DIC and Analysis of Its Sensitivity and Specificity for Diagnosis of DIC].

OBJECTIVE: To investigate the influence of thrombelastography index changes on its sensitivity and specificity for diagnosis of disseminated intravascular coagulation (DIC) in children. METHODS: A total of 149 children with DIC in our hospital from June 2013 to June 2016 were selected in DIC group, while 106 cases of non-DIC, including healthy children and children with diseases easily confused with DIC, were selected as non-DIC(control) group. The thrombelastography, D-dimer, coagulation functions including prothrombintime (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and fibin degradation product (FDP), congental coagulation disorders and platelet count were detected in DIC and non-DIC groups; the statistics of data was performed and the sensitivity and specificity of thromelastraphy indexes such as R time, α angle MA value and A value were evaluated; the relationship of DIC with indexes was analyzed. Moreover, the result difference of thromelastography and routine coagulation function test was compared at diagnosis of DIC. RESULTS: According to statistical analysis of clinical data in 2 groups, the average R time in non-DIC group was significantly less than that in DIC group (P<0.05); the average α angle in non-DIC group was larger than that in DIC group (P<0.05), both the MA and A values in the non-DIC group were significantly higher than those in DIC group (P<0.05). The specificity of routine coagulation function test for diagnosis of DIC was as follow: PT-27.2%, APTT-42.2%, international normalized ratio(INR)-47.9%, FIB-44.4%, FDP-42.7% and D-dimer-68.3%, which were significantly lower than that of R time,α angle and MA value for diagnosis of DIC (85.1%, 74.1% and 73%). The α angle and MA value of healthy children were greater than those of children with severe liver disease(P<0.05). while the average R time of healthy children was less than that of children with severe liver disease(P<0.05), but the difference of A value between them did not statistically significant (P>0.05) . The average R time of healthy children was less than that of children with congenital coagulation disorders (P<0.05). but there was no significant differences in α angle MA and Avalues between them. CONCLUSION: As compared with routine coagulation function test, the thrombelastography shows more high specificity for diagnosis of DIC, and can more precisely diagnose the DIC; moreover, the thrombelastography combined with roatime coagulation function test can more early find and diagnose the DIC in children, therefore it can improve the survival rate of children with DIC.

[Substances transport in an underground river of typical karst watershed during storm events].

Hydrologic process, turbidity, suspended particles matters (SPM), major cations and TOC concentrations during two storm events in late April 2008 were monitored at Jiangjia Spring which is the outlet of Qingmu Guan underground river system. Scanning electron microscopy (SEM) and energy disperse spectroscopy (EDS) analyses of SPM were also performed in order to investigate the transport characteristics of substances, such as SPM, turbidity and major cations in the underground river of typical karst watershed. The results show that at a single and well-developed karst conduit of Jiangjia Spring, discharge, turbidity, and concentrations of SPM, major cations and TOC respond promptly to the rainfall. The carbonate-derived cations including Ca2+, Mg2+ and Sr2+ are subject to dilution effect during the rising limb of discharge. The elevation in turbidity and SPM concentration is a result of the gradual increase of allochthonous substances (soil) flux input from the surface. Al3+, Fe, Mn, Ba2+ and TOC are concomitant substances of SPM. And their concentrations are ascending with turbid rise. The flux of SPM in diameter > 0.45 microm in the underground river is about 9.7 tons during the events. The bad water quality suggests us that the spring water is unfit to drink without purification during the period of rising and recession time of discharge at Jiangjia Spring. Thus, soil erosion and nutrient losing not only strongly destroy the fragile karst ecological environment, but also lead to non-point source pollution, and seriously threaten the drinking water safety of locals.

[Temporal and spatial variations of the nitrate-nitrogen sources in an underground river using 15N isotope technique].

Groundwater in Qingmuguan underground river was monitored using hydro-chemical and 15N isotope techniques to investigate temporal and spatial variations of nitrate-nitrogen and its possible sources from October, 2007 to October, 2008. The results show that nitrate concentrations are 3.20 mg/L of the inlet (D1) and 20.35 mg/L of the outlet (S2) of the underground river. Affected by the fertilizers in agricultural field and the rainfall flush and dilution,nitrate concentrations of groundwater are higher but less stable from April to July, 2008 than that from October, 2007 to March, 2008. They are elevated during August and September, 2008 due to the residual fertilizers and decreased rainfall events. According to the NO3- -delta 15N values of -0.857% per hundred +/- 2.01% per hundred (n=9), the sources of nitrate-nitrogen of D1 are dominated by residual fertilizers from the paddy fields from October, 2007 to March, 2008 and from July to October, 2008, while the NO3- -delta 15N values of 2.50% per hundred +/- 0.29% per hundred (n=3) demonstrate that the mixture of soil organic nitrogen and fertilizers are the sources from April to middle and late June, 2008. And the NO3- -delta 15N values of -3.74% per hundred in late May and 0.52% per hundred in early June indicate that the nitrate-nitrogen comes from fertilizers applied in the paddy fields in 2008. The nitrate-nitrogen of S2 is partly from fertilizers in the upper basin, and also from fertilizers and soil organic nitrogen carried by lateral fissure and soil permeation water of forest and farm land in the middle and lower basin. The NO3- -delta 15N values of 4.77% per hundred (n=9) show nitrate-nitrogen of S2 mainly originates from fertilizers from October, 2007 to March, 2008 and from July to October, 2008, while NO3- -delta 15N values of 3.16% per hundred +/- 0.39% per hundred (n=5) explain that the nitrate-nitrogen derives from the mixture of soil organic nitrogen and fertilizers from April to June, 2008.