Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China
Autoři:
Yan-Ting Wu aff001; Jun Liu aff002; Jing-Jing Xu aff001; Yan-Fen Chen aff004; Wen Yang aff003; Yang Chen aff003; Cheng Li aff001; Yu Wang aff001; Han Liu aff001; Chen Zhang aff001; Ling Jiang aff001; Zhao-Xia Qian aff001; Andrew Kawai aff005; Ben Willem Mol aff005; Cindy-Lee Dennis aff006; Guo-Ping Xiong aff004; Bi-Heng Cheng aff002; Jing Yang aff002; He-Feng Huang aff001
Působiště autorů:
International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
aff001; Renmin Hospital, Wuhan University, Wuhan, China
aff002; Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
aff003; The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
aff004; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
aff005; Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
aff006
Vyšlo v časopise:
Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China. PLoS Med 17(7): e1003195. doi:10.1371/journal.pmed.1003195
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003195
Souhrn
Background
As of June 1, 2020, coronavirus disease 2019 (COVID-19) has caused more than 6,000,000 infected persons and 360,000 deaths globally. Previous studies revealed pregnant women with COVID-19 had similar clinical manifestations to nonpregnant women. However, little is known about the outcome of neonates born to infected women.
Methods and findings
In this retrospective study, we studied 29 pregnant women with COVID-19 infection delivered in 2 designated general hospitals in Wuhan, China between January 30 and March 10, 2020, and 30 neonates (1 set of twins). Maternal demographic characteristics, delivery course, symptoms, and laboratory tests from hospital records were extracted. Neonates were hospitalized if they had symptoms (5 cases) or their guardians agreed to a hospitalized quarantine (13 cases), whereas symptom-free neonates also could be discharged after birth and followed up through telephone (12 cases). For hospitalized neonates, laboratory test results and chest X-ray or computed tomography (CT) were extracted from hospital records. The presence of antibody of SARS-CoV-2 was assessed in the serum of 4 neonates.
Among 29 pregnant COVID-19-infected women (13 confirmed and 16 clinical diagnosed), the majority had higher education (56.6%), half were employed (51.7%), and their mean age was 29 years. Fourteen women experienced mild symptoms including fever (8), cough (9), shortness of breath (3), diarrhea (2), vomiting (1), and 15 were symptom-free. Eleven of 29 women had pregnancy complications, and 27 elected to have a cesarean section delivery.
Of 30 neonates, 18 were admitted to Wuhan Children’s Hospital for quarantine and care, whereas the other 12 neonates discharged after birth without any symptoms and had normal follow-up. Five hospitalized neonates were diagnosed as COVID-19 infection (2 confirmed and 3 suspected). In addition, 12 of 13 other hospitalized neonates presented with radiological features for pneumonia through X-ray or CT screening, 1 with occasional cough and the others without associated symptoms. SARS-CoV-2 specific serum immunoglobulin M (IgM) and immunoglobulin G (IgG) were measured in 4 neonates and 2 were positive. The limited sample size limited statistical comparison between groups.
Conclusions
In this study, we observed COVID-19 or radiological features of pneumonia in some, but not all, neonates born to women with COVID-19 infection. These findings suggest that intrauterine or intrapartum transmission is possible and warrants clinical caution and further investigation.
Trial registration
Chinese Clinical Trial Registry, ChiCTR2000031954 (Maternal and Perinatal Outcomes of Women with coronavirus disease 2019 (COVID-19): a multicenter retrospective cohort study).
Klíčová slova:
Computed axial tomography – Neonates – Pneumonia – SARS CoV 2 – Throat – X-ray radiography – COVID 19 – Virus testing
Zdroje
1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33. http://doi.org/10.1056/NEJMoa2001017 31978945.
2. WHO Health Alert for coronavirus launches on WhatsApp. 2020 [cited 2020 May 6]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen.
3. Epidemiology Working Group for Ncip Epidemic Response CCfDC, Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–51. http://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003 32064853.
4. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. http://doi.org/10.1001/jama.2020.2648 32091533.
5. Wong SF, Chow KM, Leung TN, Ng WF, Ng TK, Shek CC, et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol. 2004;191(1):292–7. http://doi.org/10.1016/j.ajog.2003.11.019 15295381.
6. Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020;395(10226):809–15. http://doi.org/10.1016/S0140-6736(20)30360-3 32151335.
7. Wang X, Zhou Z, Zhang J, Zhu F, Tang Y, Shen X. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis. 2020. http://doi.org/10.1093/cid/ciaa200 32119083.
8. Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi. 2020;55(3):166–71. http://doi.org/10.3760/cma.j.cn112141-20200218-00111 32145714.
9. Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51–60. http://doi.org/10.21037/tp.2020.02.06 32154135.
10. Chen Y, Peng H, Wang L, Zhao Y, Zeng L, Gao H, et al. Infants Born to Mothers With a New Coronavirus (COVID-19). Front Pediatr. 2020;8:104. http://doi.org/10.3389/fped.2020.00104 32266184.
11. Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol. 2020;55(5):586–92. http://doi.org/10.1002/uog.22014 32180292.
12. Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020;222(6):521–31. http://doi.org/10.1016/j.ajog.2020.03.021 32217113.
13. Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. AJR Am J Roentgenol. 2020;215:127–132. http://doi.org/10.2214/AJR.20.23072 32186894.
14. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang ZJ. Novel Coronavirus Infection in Hospitalized Infants Under 1 Year of Age in China. JAMA. 2020;323(13):1313–1314. http://doi.org/10.1001/jama.2020.2131 32058570.
15. National Health Commission of the People's Republic of China. Notice on the issuance of a program for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial fifth edition). 2020 Feb 6 [cited 2020 May 6]. http://www.gov.cn/zhengce/zhengceku/2020-02/05/content_5474791.htm
16. National Health Commission of the People's Republic of China. Notice on the issuance of a program for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial sixth edition). 2020 Feb 18 [cited 2020 May 6]. http://www.gov.cn/zhengce/zhengceku/2020-02/19/content_5480948.htm
17. National Health Commission of the People's Republic of China. Notice on the issuance of a program for the diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (trial seventh edition). 2020 Mar 3 [cited 2020 May 6]. http://www.gov.cn/zhengce/zhengceku/2020-03/04/content_5486705.htm
18. Nissen MD. Congenital and neonatal pneumonia. Paediatr Respir Rev. 2007;8(3):195–203. http://doi.org/10.1016/j.prrv.2007.07.001 17868917.
19. Jiang Y, Lu XX, Jin RM, Zheng YJ, Xu BP, Xie ZD, et al. [Diagnosis, treatment and prevention of 2019 novel coronavirus in children: experts′ consensus statement (Second Edition)]. Chin J Appl Clin Pediatr. 2020;35(2):143–150. http://doi.org/10.3760/cma.j.issn.2095-428X.2020.02.012. http://rs.yiigle.com/CN101070202002/1185574.htm
20. Xu WZ, Li J, He XY, Zhang CQ, Mei SQ, Li CR, et al. [The diagnostic value of joint detection of serum IgM and IgG antibodies to 2019-nCoV in 2019-nCoV infection]. Chin J Lab Med. 2020;43. http://doi.org/10.3760/cma.j.cn114452-20200223-00109. http://rs.yiigle.com/yufabiao/1182736.htm
21. Zeng H, Xu C, Fan J, Tang Y, Deng Q, Zhang W, et al. Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA. 2020;323(18):1848–1849. http://doi.org/10.1001/jama.2020.4861 32215589.
22. Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. JAMA. 2020;323(18):1846–1848. http://doi.org/10.1001/jama.2020.4621 32215581.
23. World Health Organization. Laboratory testing of human suspected cases of novel coronavirus (nCoV) infection: interim guidance. World Health Organization. 2020 Jan 10 [cited 2020 May 6]. https://apps.who.int/iris/handle/10665/330374.
24. Qiao J. What are the risks of COVID-19 infection in pregnant women? Lancet. 2020;395(10226):760–2. http://doi.org/10.1016/S0140-6736(20)30365-2 32151334.
25. Zeng LK, Tao XW, Yuan WH, Wang J, Liu X, Liu ZS. [First case of neonate infected with novel coronavirus pneumonia in China]. Zhonghua Er Ke Za Zhi. 2020;58(0):E009. http://doi.org/10.3760/cma.j.issn.0578-1310.2020.0009 32065520.
26. Yu N, Li W, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis. 2020;20(5):559–64. http://doi.org/10.1016/S1473-3099(20)30176-6 32220284.
27. Tongji hospital, Tongji medical college, Huazhong university of science & technology. [Guidance on Management of Pregnant Women and Newborns During the Epidemic of New Coronavirus Infection in Wuhan Tongji Hospital (1st Edition)]. Chinese Journal of Obstetric Emergency (Electronic Edition). 2020; 9(1): 1–4. http://doi.org/10.3877/cma.j.issn.2095-3259.2020.01.001. http://www.hubei.gov.cn/zhuanti/2020/gzxxgzbd/fkkp/202002/t20200211_2023560.shtml
28. Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020:200642. http://doi.org/10.1148/radiol.2020200642 32101510.
29. Vecchie A, Bonaventura A, Carbone F, Maggi D, Ferraiolo A, Carloni B, et al. C-Reactive Protein Levels at the Midpregnancy Can Predict Gestational Complications. Biomed Res Int. 2018;2018:1070151. http://doi.org/10.1155/2018/1070151 30533423.
30. Spann MN, Monk C, Scheinost D, Peterson BS. Maternal Immune Activation During the Third Trimester Is Associated with Neonatal Functional Connectivity of the Salience Network and Fetal to Toddler Behavior. J Neurosci. 2018;38(11):2877–86. http://doi.org/10.1523/JNEUROSCI.2272-17.2018 29487127.
31. de Oliveira LC, Franco-Sena AB, Farias DR, Rebelo F, Kac G. Maternal C-reactive protein concentrations during pregnancy and birth weight in a prospective cohort in Rio de Janeiro, Brazil. J Matern Fetal Neonatal Med. 2017;30(19):2346–53. http://doi.org/10.1080/14767058.2016.1248395 27756170.
32. Fink NR, Chawes B, Bonnelykke K, Thorsen J, Stokholm J, Rasmussen MA, et al. Levels of Systemic Low-grade Inflammation in Pregnant Mothers and Their Offspring are Correlated. Sci Rep. 2019;9(1):3043. http://doi.org/10.1038/s41598-019-39620-5 30816254.
33. Ingvorsen C, Brix S, Ozanne SE, Hellgren LI. The effect of maternal Inflammation on foetal programming of metabolic disease. Acta Physiol (Oxf). 2015;214(4):440–9. http://doi.org/10.1111/apha.12533 26011013.
34. Liu H, Liu F, Li J, Zhang T, Wang D, Lan W. Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children. J Infect. 2020;80(5):e7–e13. http://doi.org/10.1016/j.jinf.2020.03.007 32171865.
35. Liszewski MC, Lee EY. Neonatal Lung Disorders: Pattern Recognition Approach to Diagnosis. AJR Am J Roentgenol. 2018;210(5):964–75. http://doi.org/10.2214/AJR.17.19231 29489412.
36. Reiterer F. Neonatal pneumonia. In: Resch B, editor. Neonatal Bacterial Infection. Rijeka, Croatia: IntechOpen; 2013. p. 19–32. https://dx.doi.org/10.5772/54310
37. Xiong Z, Fu L, Zhou H, Liu JK, Wang AM, Huang Y, et al. [Construction and evaluation of a novel diagnosis pathway for 2019-Corona Virus Disease]. Zhonghua Yi Xue Za Zhi. 2020;100(16):1223–9. http://doi.org/10.3760/cma.j.cn112137-20200228-00499 32157849.
38. Chen S, Huang B, Luo DJ, Li X, Yang F, Zhao Y, et al. [Pregnancy with new coronavirus infection: clinical characteristics and placental pathological analysis of three cases]. Zhonghua Bing Li Xue Za Zhi. 2020;49(5):418–23. http://doi.org/10.3760/cma.j.cn112151-20200225-00138 32114744.
39. Williams CB, Eisenstein EM, Cole FS. Immunology of the Fetus and Newborn. Avery's Diseases of the Newborn. 2012. p. 445–67.
40. Shek CC, Ng PC, Fung GP, Cheng FW, Chan PK, Peiris MJ, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics. 2003;112(4):e254. http://doi.org/10.1542/peds.112.4.e254 14523207.
Článek vyšel v časopise
PLOS Medicine
2020 Číslo 7
- Distribuce a lokalizace speciálně upravených exosomů může zefektivnit léčbu svalových dystrofií
- O krok blíže k pochopení efektu placeba při léčbě bolesti
- Prof. Jan Škrha: Metformin je bezpečný, ale je třeba jej bezpečně užívat a léčbu kontrolovat
- FDA varuje před selfmonitoringem cukru pomocí chytrých hodinek. Jak je to v Česku?
- Vánoční dárky s přidanou hodnotou pro zdraví – nechte se inspirovat a poraďte svým pacientům
Nejčtenější v tomto čísle
- Obesity, clinical, and genetic predictors for glycemic progression in Chinese patients with type 2 diabetes: A cohort study using the Hong Kong Diabetes Register and Hong Kong Diabetes Biobank
- Participation in adherence clubs and on-time drug pickup among HIV-infected adults in Zambia: A matched-pair cluster randomized trial
- Estimation of SARS-CoV-2 mortality during the early stages of an epidemic: A modeling study in Hubei, China, and six regions in Europe
- Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China