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Introduction

The new coronavirus 2022 (COVID-19) is an epidemic in Wuhan and the population is believed to be immunologically naïve. As the epidemic progresses, in that location remains footling understanding of baby and childhood COVID-xix infections and their clinical picture show. As of 22 February 2020, 77,043 cases of novel COVID-19 infections have been confirmed and ii,445 people have died (http://2019ncov.chinacdc.cn/2019-nCoV/). During this epidemic, four live-born infants were born in our medical center, to meaning women with the COVID-19 infection. Three of the iv pregnant women gave birth by cesarean section due to concerns about symptomatic maternal infection. The other infant was born by vaginal delivery to a mother experiencing fever (highest temperature 38.3°C), with a diagnostically confirmed infection. The about of import question is whether the COVID-19 could exist transmitted vertically to the fetus from the pregnant female parent and crusade a clinically significant infection. Recently, a finding from nine other cases suggested that there is no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy (1). Nosotros believe this present report is the second case report on vertical transmission between COVID-19 pregnant women and their infants. Moreover, this report will focus more on infants. This case report describes the clinical course of four alive born infants born to pregnant women with the COVID-19 infection.

Example Report

Cases of the Mothers

All 4 mothers were symptomatically infected with COVID-19 during the tertiary trimester. On admission, the regular symptoms of meaning mothers with COVID-nineteen were fever (three out of iv patients), coughing (two out of four patients), myalgia or fatigue (two out of four patients), and headache (two out of 4 patients). Only one patient felt reduced fetal movement and i experienced dyspnea. Lymphocytes were below the normal range (lymphocyte count <1.one × x⁹/L) in all patients, and two patients showed lymphopenia (lymphocyte count <1.0 × 10^nine/L). Both leucocytes and platelet counts were below the normal range (white blood prison cell count <4 × ten⁹/50, platelet count <100 × 10^nine/L) in the mother in Case iv (shown in Table 1). The mother in Case three developed anemia (hemoglobin 83 g/Fifty) and dyspnea five days after being admitted. In that location was a meaning increase of the level of C-response poly peptide in all pregnant mothers. Coagulation role and claret biochemistry of all the mothers were normal. 5 respiratory pathogens (Mycoplasma, Chlamydia, Respiratory syncytial virus, Adenovirus, and Coxsackie virus) and the nucleic acid of influenza viruses A and B of all patients were negative (laboratory findings shown in Table 1). An RT-PCR assay confirmed that the throat swab of the four pregnant women were positive for COVID-19. Abnormalities in chest CT images and bilateral involvement were detected amongst all pregnant women. A cesarean section was performed for 3 patients in the acute stage of the illness while one patient underwent vaginal commitment because of the onset of labor. Four full-term infants were born. All infants were isolated from their mother immediately after birth. We describe the clinical course of these four infants (laboratory findings shown in Tabular array two). Three mothers of the infants recovered from their COVID-19 infections and were released iii–5 days after delivery. Nonetheless, one mother suffered severe dyspnea after delivery which required respiratory support—she did, yet, survive. All four infants and their mothers were healthy upon a post-belch follow-up.

Table 1. Clinic and laboratory characteristics of mothers.

Table 2. Clinic and laboratory characteristics of the newborns.

Cases of the Infants

Three male person, and one female person babe was built-in beyond 37 weeks' gestation and had a birthweight higher up three,000 g. All infants had a 1-min Apgar score of seven–eight and v-min Apgar score of 8–9 (Table two). They were isolated from their mothers immediately afterward nascence and received formula feeding. Three of the four infants tested negative for COVID-19 using a throat swab specimen in RT-PCR 72 h later on birth and 1 infant's parents did non provide consent for their baby to exist tested for COVID-19.

Two of the 4 infants were good for you. Two of the four infants had rashes afterward nascency, however, the rash distribution and shape differed. The infant in Case 2 had some maculopapules scattered all over the trunk, and i facial skin ulceration on the forehead (size virtually 0.3 × 0.5 cm²). The rash disappeared and skin desquamation appeared the adjacent day without any treatment. The rash of the infant in Case 3 was present on the forehead and seemed to diffuse pocket-sized miliary red papules on day ii. The rash disappeared on day 10 without handling (Table 2). The infant in Case 2, the mother of whom had cholecystitis, adult edema of the lateral thigh on day 3, and the level of serum albumin was just 26 g/L. The baby was taking full formula feeds on day iv. The babe was discharged from the NICU (neonatal intensive intendance unit of measurement) 6 days after nascency. The infant in Case iii, the female parent of whom had placenta previa, suffered transient tachypnea of the newborn (TTN) and required nasal- Continuous Positive Airway Pressure (nCPAP) subsequently birth. Breathing became regular within 3 days. The baby was taking full formula feeds on day 5 and was discharged from the NICU on twenty-four hours 7 (Table 2).

Give-and-take

In this study, four meaning women were confirmed to accept the COVID-19 infection. One mother experienced reduced fetal movement. One mother adult anemia and dyspnea after admission. Of the three infants whose parents provided consent to exist diagnostically tested, none tested positive for the virus. None of the infants developed serious clinical symptoms such as fever, coughing, or diarrhea. Two newborns had a rash, which disappeared spontaneously without treatment; one newborn had balmy dyspnea, and was considered to endure from TTN and supported by non-invasive mechanical ventilation for 3 days. All of the four babies are doing well and have been formula feeding since birth.

Coronavirus (CoVs) (two) is an enveloped positive-sense RNA virus, which infects humans and a wide variety of animals, causing diseases in the respiratory, enteric, hepatic, and neurological systems with varying severity (3). In the past few decades, newly evolved CoVs take posed a global threat to public wellness, such every bit severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) that were implicated in the 2003 outbreak in Guangdong, Mainland china and the 2012 outbreak in the Center East, respectively (2). On 10 January 2020, a new coronavirus causing a pneumonia epidemic in Wuhan City in key Red china was denoted as COVID-19 by the Globe Health Organization (WHO) (four). Equally of 22 February 2020, well-nigh 77,043 COVID-19 infections in humans accept been confirmed in China, with at least ii,445 reported deaths. As reported herein, iv significant women were confirmed to have the COVID-19 infection in our medical center, which is designated every bit one of the treatment centers for pregnant women with the COVID-xix infection. Importantly, we constitute neither SARS-CoV-2 diagnostic positivity nor immediate prove of symptomatic COVID-19 among the infants born to the symptomatic, exam-positive mothers.

On the footing of previous reports (5–7), SARS-CoV and MERS-CoV were associated with disquisitional maternal illness, spontaneous abortion, or even maternal decease. In these 4 significant women with the COVID-19 infection, iii had fever, two had a coughing and experienced headache. In laboratory data, at that place was lower lymphocyte count and higher CRP in blood assay. Typical CT images of COVID-xix infection with ground glass changes were presented in these pregnant patients. These four pregnant women had no critical maternal disease. Only i of them experienced reduced fetal motility and one had dyspnea. These symptoms, at onset of delivery, were similar to other populations (8). To preclude COVID-19 intrauterine, perinatal, and postnatal manual, three pregnant women received a cesarean department. One of the three meaning women suffered placenta previa, which made it necessary to opt for a cesarean section. Simply ane pregnant mother adopted a vaginal delivery because of an emergency labor procedure.

Shek et al. (9) reported that perinatal manual of the SARS-associated coronavirus was not detected in whatsoever of the 5 live born infants who were built-in to pregnant women with SARS during the community outbreak in Hong Kong in 2003. In addition, none of the infants adult clinical, radiologic, hematologic, or biochemical evidence suggestive of SARS. Consistent with these reports, in our study, RT-PCR analysis confirmed that the throat swab of the three cases were negative for COVID-19. Nosotros regret that the baby in Case two did not have a COVID-xix diagnosis as the babe'south guardian'south did not provide consent.

Assiri et al. (7) reported five cases of meaning women infected with MERS-CoV from Saudi Arabia, and all pregnancies were in the second or third trimester. Among the 5 pregnancies, two significant women died during their illnesses, two resulted in perinatal death (one pregnancy resulted in intrauterine fetal demise, and 1 infant died iv h afterwards an emergency cesarean delivery). It was reported that 12 pregnant women were diagnosed to have the SARS infection during the outbreak in Hong Kong (10). 7 mothers presented in the first trimester, and the residuum were in their late 2nd and third trimester. It was reported that the SARS infection in meaning women could lead to severe intrauterine growth retardation, which could be due to the prolonged usage of high dose systemic corticosteroids or antiviral agents and/or the affect of a severe maternal debilitating illness on normal fetal growth (9, 10). In this study, all 4 cases reported on were delivered during the astute phase of the illness, at 37–39 weeks of gestation, and the birth weight of all the babies were appropriate for their gestational age. Throughout the clinical form, there were no manifestations or radiologic, hematologic, or biochemical prove suggestive of COVID-nineteen infection. This study is similar to reports of SARS infection (9) (Table 2).

Coronaviruses crusade respiratory and intestinal infections in animals and humans (11). For developed patients, the clinical manifestations of COVID-19 infection include fever, coughing, shortness of breath, muscle ache, sore throat, diarrhea, and so on (eleven). The minority of patients showed severe and fifty-fifty fatal respiratory diseases such equally astute respiratory distress syndrome. According to imaging examination, near patients showed bilateral pneumonia, multiple mottling, or footing-glass opacity. In this study, only the babe in Case iii showed dyspnea and required oxygen therapy. A chest radiograph of the infant in Case 3 showed that the brightness of the left lung was slightly decreased, and the texture of the right lung was slightly blurred. His status was relieved gradually after 3 days of nCPAP treatment.

It has been confirmed that COVID-19 gravely damages leucocytes, and could atomic number 82 to multiple organ damage forth with the respiratory system (12). In this study, blood assays of the three baby cases were normal, and all the claret cell counts and hemoglobin concentrations fluctuated inside the normal reference range. It is worth noting that both Instance 2 and Case iii presented a transient peel rash after nativity. Whether this was attributable to the maternal inflammatory toxin effect requires farther study. At follow up, the four newborns were health and had grown on formula feeding.

This feature reveals that none of the 4 newborns of the mothers with COVID-19 developed COVID-19 infection. In this study, viral nucleic acid detection using existent-time polymerase chain reaction (RT-PCR) remains, is taken as the standard of COVID-19 infection. A contempo retrospective analysis in adults showed that the sensitivity of RT-PCR is 71% for COVID-19 infection (13). Therefore, the reliability of diagnostic testing should be further evaluated, especially in children. Another limitation of this report was the modest number of cases, and imperfect clinic data. No COVID-nineteen vertical transmission was detected. Farther studies for viral infection in placenta, amniotic fluid, neonatal blood, gastric fluid, and anal swab, and the viral depending receptor on children volition be detected in future.

Data Availability Statement

The datasets generated for this study are available on request to the corresponding writer.

Ethics Statement

The studies involving man participants were reviewed and approved by the Institutional Review Board of Marriage Hospital, Huazhong University of Science & Technology. Written informed consent to participate in this written report was provided by the participants' legal guardian/side by side of kin. Written informed consent was obtained from the individual(due south), and small(due south)' legal guardian/next of kin, for the publication of any potentially identifiable images or information included in this article.

Author Contributions

YC and HP designed the report, drafted the initial manuscript, and reviewed and revised the manuscript. LW, HG, YZ, and LZ designed the data collection instruments, collected the data, and reviewed and revised the manuscript. YL designed the written report, coordinated, and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the terminal manuscript as submitted and agree to be accountable for all aspects of the piece of work.

Funding

This written report was supported by the National Natural Science Foundation of China (81500218, 81601324, and 81300523).

Conflict of Interest

The authors declare that the research was conducted in the absence of whatsoever commercial or financial relationships that could be construed as a potential conflict of interest.

References

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Source: https://www.frontiersin.org/articles/10.3389/fped.2020.00104/full

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