COVID-19 Infections in Newborns

Year 2020, Issue: Special Issue on COVID 19, 23 - 35, 20.03.2020

Fahri Ovalı

https://doi.org/10.21673/anadoluklin.708589

Cited By: 19

Abstract

Novel type Coronavirus-19 is seen mainly in elderly people but it may be encountered in pregnant women and newborns also. The information about its clinical features, laboratory findings and prognosis in children and newborns is scarce. Since the immunological systems of the newborns have not developed completely, it may be considered that their risks are larger. All the reported cases in pregnant women were in the 3rd trimestr and only 1% of them developed severe disease. There is no data yet on the materno-fetal transmission of the disease. Case reports of newborns are similar to those of adults. Definitive diagnosis can be made by a history of contact with a proven case, fever, pneumonia and gastrointestinal disorder. Lymphopenia, liver and renal function disorders may be seen. Suspected or proven cases of newborns should be isolated in the neonatal intensive care unit for at least 14 days with standart and droplet isolation precautions. If needed, the transport of the neonate should be performed in a transport incubator with isolation precautions. The incubator and the ambulance should be disenfected before and after the transport. There is no specific treatment for the disease, but hemodynamic stabilization of the infant, respiratory management and other daily care are essential. Some drugs are under investigation. Routine antibiotics are not recommended. No deaths have been reported in infected cases. Possible hyperbilirubinemia of the infant should be managed appropiately. Families and healthcare staff should receive pyschological support. Since the infection is quite new and knowledge is constantly accumulating, following scientific developments is crucial. 

Keywords

Newborn, COVID-19, vertical transmission

Yenidoğanlarda COVID-19 Enfeksiyonları

Abstract

Yeni tip Coronavirüs-19, genellikle yaşlı bireylerde görülmesine rağmen gebelerde ve yenidoğan bebeklerde de görülebilmektedir. Virüsün çocuklarda ve yenidoğanlardaki klinik özellikleri, laboratuvar bulguları ve prognozu hakkında yeteri kadar bilgi yoktur. Yenidoğanların immün sistemleri yeteri kadar gelişmemiş olduğundan daha büyük risk altında oldukları düşünülebilir. Şimdiye kadar bildirilen gebelerin hemen hepsi 3. trimestrde enfekte olmuşlardır. Bu kadınların ancak % 1’inde kritik hastalık gelişmiştir. Ancak şimdiye kadar materno-fetal vertikal geçişi kanıtlayabilecek bir veri elde edilememiştir. Yenidoğanlardaki vaka tanımları erişkinlerdekine benzerdir. Kesin tanılı hasta biriyle temasın yanı sıra, ateş, solunum yolu bulguları, pnömoni ve gastrointestinal bulgular gözlenebilir. Hastalarda lenfopeni bulunabileceği gibi karaciğer ve böbrek fonksiyon bozukluklarına da rastlanabilir. Şüpheli veya kesin tanılı yenidoğanların yenidoğan yoğun bakım ünitesinde 14 gün süreyle izole edilmeleri ve standart ve damlacık enfeksiyonu temas önlemlerinin alınması gerekir. Yenidoğanların transportu gerekirse, küvöz içinde, gerekli önlemler alınarak transport edilmeli, transport öncesi ve sonrasında ambulans dahil tüm ekipman dezenfekte edilmelidir. Hastalığın kesin bir tedavisi olmadığı için yenidoğanın hemodinamik stabilitesinin sağlanması, solunum desteği verilmesi ve diğer rutin bakımlarının yapılması yerinde olur. Rutin antibiyotik kullanımına gerek yoktur. Şimdiye kadar enfekte olan yenidoğanlar arasında ölüm bildirilmemiştir. Taburcu edilen bebeklerde muhtemel sarılık gelişimine karşı da önlem alınmalıdır. Ailelere de psikolojik ve sosyal destek sağlanması yerinde olur. Hastalık hakkındaki bilgiler az olduğu için yeni gelişmeler takip edilmelidir. 

Keywords

Yenidoğan, COVID-19, vertikal geçiş

References

• 1) Wu Z, McGoogan JM. Characteristics of and important lessons from the coronvirus 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 (epub ahead of print) 2) Lu Q, Shi Y. Coronavirus disease (COVID-19) and neonate: what the neonatologist need to know. J Med Virol 2020; 1-4 3) Hoffmann M, Kleine-Weber H, Krügir N, Müller M, Drosten C, Pöhlmann S. The novel coronavirus 2019 (2019-nCov) uses the SARS-coronavirus receptor 2 ACE2 and the cellular protease TMPRSS2 for entry into target cells. BioRxiv 2020. https://doi.org/10.1101/2020. 01.31.929042 4) Zhang Q, Cong M, Wang N et al. Association of angiotensin converting enzyme 2 gene polymorphism and enzymatic activity with essential hypertension in different gender: a case-control study. Medicine 2018; 97(42): e12917 5) Zhao Y, Zhano Z, Wang Y, Zohu Y, Ma Y, Zuo W. Single cell RNA exepression profiling of ACE2 the putative receptor of Wuhan 2019nCov. bioRxiv. 2020. https://doi.org/10.1101/2020.01.26.91998510 6) Huynh J, Li S, Yount B, et al. Evidence supporting a zoonotic origin of human coronavirus strain NL63. J Virol. 2012;86:12816–12825. 7) Vijgen L, Keyaerts E, Moes E et al. Complete genomic sequence of human coronavirus OC43: molecular clock analysis suggests a relatively recent zoonotic coronavirus transmission event. J Virol 2005; 79: 1595-1604 8) Shi Z, Hu Z. A review of studies on animal reservoirs of the SARS coronavirus. Virus Res 2008; 133: 74-87 9) Chan JF, Yuan S, Kok KH et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person to person transmission: a study of a family cluster. Lancet 2020; 395: 514-523 10) Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and intirnational spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet 2020; 395: 689-697 11) Chowel G, Abdirizak F, Lee S et al. Transmission charcteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med 2015; 13: 210 12) Leung GM, Hedley AJ, Ho LM et al. The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients. Ann Intern Med 2004; 141: 662-673 13) https://www.worldometers.info/coronavirus/#countries 14) Vabret A, Mourez T, Gouarin S et al. An outbreak of coronavirus OC43 respiratory infection in Normandy, France. Clin Infect Dis 2003; 36: 985-989 15) Gaunt ER, Hardie A, Claas EC et al. Epidemiology and clinical presentations of the four human coronaviruses 229E, HKU1, NL63, and OC43 detected over 3 years using a novel multiplex real time PCR method. J Clin Microbiol 2010; 48: 2940-2947 16) Lina B, Valette M, Foray S et al. Surveillance of community acquired viral infections due to respiratory viruses in Rhone-Alpes (France) during winter 1994 to 1995. J Clin Microbiol 1996; 34: 3007-3011 17) Zhang SF, Tuo JL, Huang XB et al. Epidemiology characteristics of human coronaviruses in patients with respiratory infection symptoms and pylogenetic analysis of HCoV-OC43 during 2010-2015 in Guangzhou. PLoS One 2018; 13: e0191789 18) Davis BM, Foxman B, Monto AS et al. Human coronaviruses and other respiratory infections in young adults on a university campus: prevalence, symptoms, and shedding. Infulenza Other Respir Viruses 2018; 12: 582-590 19) Zhang W, Du RH, Li B et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect 2020; 9(1): 386-389 20) Lauer SA, Grantz KH, bi Q et al. The incubaton period of 2019-nCoV from publicly reported confirmed cases: estimation and application. Med rxiv 2020. https://dou.org.10.1101/2020.02.02.20020016 21) Lu X, zhang L, Du H. Et al. SARS-CoV infection in children (letter). N Engj J Med doi. 10.1056/NEJMc2005073 22) Wang XF, Yuan J, Zheng YJ et al. [Clinical and epidemiological chacteristics of 34 children with 2019 novel coronavirus infection in Shenzhen]. Zhonghua Er Ke Za Zhi 2020; 58: E008 (In Chinese) 23) Virlogeux V, Fang VJ, Park M et al. Comparison of incubation period distribution of human infections with MERS-CoV in South Korea and Saudi Arabia. Sci Rep 2016; 6: 35839 24) Wei M, Yuan J, Liu Y et al. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA 2020 (Epub ahead of print) 25) Hon KL, Leung CW, Cheng WT et al. Clinical presentations and outcome of severe acute respiratory syndrome in children. Lancet 2003; 361: 1701-1703 26) The Society of Pediatrics of Hubei Medical Association, The Society of Pediatrics of Wuhan Medical Association, Hubei Pediatric Medical Quality Control Center. Suggestions on the diagnosis and treatment of novel coronavirus infection in children in Hubei province (trial version 1). CJCP. 2020;22:96–9 (in Chinese) 27) Shen K, Yang Y, Wang T et al. Diagnosis, treatment and prevention of 2019 novel coronavirus infection in children: expersts’ consensus statement. World J Pediatrics 2020. https: doi.org/10.1007/s12519-020-00343-7 28) Cao Q, Chen YC, Chen CL, Chiu CH. SARS-CoV-1 infection in children: transmission Dynamics and clinical characteristics. J Formosan Med Assoc 2020; 119: 670-673. 29) Li ZZ, Shen KL, Wei XM et al. Clinical analysis of pediatrics SARS cases in Beijnig. Chin J Pediatr 2003; 41: 574-7 (in Chinese). 30) Thabet F, Chebab M, Bafaqih H, Al MS. Middle East respiratory syndrome coronavirus in children. Saudi Med J 2015; 36: 484-6 31) Gottfredsson M. The Spanish flu in Iceland 1918. Lessons in medicine and history. Laeknabladid 2008; 94: 737-45 (ın Icelandic). 32) Wong SF, Chow KM, Leung TN et al. Pregnancy and Perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191: 292-297 33) Schwartz DA, Graham Al. Potential maternal and infant outcomes from Coronavirus 2019-nCoV (SARS-CoV-1) infecting pregnant women: Lessons from SARS MERS, and other human coronavirus infections. Viruses 2020; 12: 194 34) Xu Z, Shi L, Wang Y et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome The Lancet Resp Med 2020. Doi: https://doi.org/10.1016/S2213-2600(20)30076-X 35) Zhang I, Jiang Y, Wei M et al. Analysis of pregnancy outcomes in pregnat women with COVID-10 in Hubei Province Zhonghua Fu Chan Ke Za Zhi 2020; 55)0)E009 (in Chinese) 36) Wong SF, Chow KM, Leung TN et al. Pregnancy and Perinatal outcomes of women with severe acute respiratory syndrome. Am J Obstet Gynecol 2004; 191(1): 292-297 37) National Health Commission of the People’s Republic of China. Transcript of Press Conference on feb 7, 2020. http://www.nhc.gov.cn/xcs/s3574/202002/5bc099fc9144445297e8776838e57ddcshtml 38) Lam CM, Wong SF, Leung TN et al. A case controlled study comparing clinical course and outcomes of pregnant and non pregnant women with severe acute respiratory sydrome. BJOG 2004; 111: 771-774 39) Shek CC, Ng PC, fung GPG et al. Infants born to mothers with severe acute respiratory syndrome Pediatrics 2003; 112: e254-e256 40) Lu R, Zhao X, Li J et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virüs origins and receptor binding. Lancet 2020; Published online Jan. 30, https://dou.org/10/1016/S0140-6736(20)30251-8 41) World Health Organization. Report of the WHO_China joint mission on coronavirus Disease 2019 (COVID-19). https://www.who.int/docs/default-source/coronaviruse/who-china-jointmission-on-covid-19-final-report.pdf 42) National Health Commission of the People’s Republic of China. Notice on strengthening maternal disease treatment and safe midwifery during the prevention and control of new coronavirus pneumonia. http://www.nhc.gov.cn/xcs/zhengcwj/202002/4f80657b346e4d6ba76e2cfc3888c630.shtml (accessed Feb 8, 2020). 43) Chen H, Guo J, Wang C et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet Published online Feb 12, 2020 https://doi.org/10.1016/S0140-6736(20)30360-3 44) Bouthry E, Picone O, Hamdi G et al. Rubella and pregnancy: diagnosis, management and outcomes. Prenat Diagn 2014; 34: 1246-53 45) National Health Commission of People’s Republic of China. Diagnosis and treatment of pneumonia caused by novel coronavirus (trial version 4). https ://www.nhc.gov.cn/xcs/zheng cwj/202001/42945 63ed3 5b4320 9b31 739bd 0785e 67/files /7a930 91112 67475 a99d4 30696 2c8bf 78.pdf. Access 28 Feb 2020. 46) Fang F, Luo XP. Facing the pandemic of 2019 novel coronavirus infections: the pediatric perspectives. Chin J Pediatr 2020; 58; 81-5 47) Li AM, Ng PC. Severe Acute respiratory syndrome (SARS) in neonates and children. Arch Dis Child Fetal Neonatal ed. 2005; 90: F461-5 48) Cai JH, Wang XS, Ge YL et al. First case of 2019 novel coronavirus infection in children in Shanghai. Chin J Periadtr 2020; 58: E002 49) Wang L, Shi Y, Xiao T et al. Chinese expert consensus on the Perinatal and neonatal management for the prevention and control of the 2019 novel coronavirus infection (first edition). Ann Transl Med 2020; 8(3): 47 50) Diagnosis and management plan of pneumonia with new coronavirus infection (trial version 4). Beijing: National Health and Health Commission, 2020 51) Wang J, Qi H, Bao L et al. A contingency plan for the management of the 2019 novel coronavirus outberak in neonatal intensive care units. www.thelancet.com/child-adolescent Published online February 7, 2020 https://doi.org/10.1016/S2352-4642(20)30040-7 52) T.C. Sağlık Bakanlığı COVID-19 Çocuk Hasta yönetimi ve Tedavisi. Güncelleme tarihi: 23.03.2020 53) Zhou Y, Hou Y, Shen J et al. Network based drug repurposing for human coronavirus. MedRxiv. https://doi.org/10.1101/2020/2020.02.03.200220263 54) Academyof Breastfeeding Medicine Statement on coronavirus 2019 (COVID-19). Academy of Breast feeding Medicine. Erişim: https://www.bfmed.org/abm-statemnt-coronavirus. 20.03.2020 55) Centers for Disease Control. https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeedin. Erişim: 21.03.2020 56) Gökçay G, Keskindemirci G. Anne sütü ve COVID-19. İst Tıp Fak Derg 2020. DOI: 10.26650/İUİTFD.2020.0025 57) Ma XL, Chen Z, Zhu JJ et al. Management strategies of neonatal jaundice during the coronavirus disease 2019 outbreak. World J Pediatrics https://doi.org/10.1007/s12519-020-00347-3 58) Union of European Neonatal and Perinatal Societies. Breastfeeding and SARS-CoV İnfection. 28 February 2020 https://www.uenps.eu/2020/03/16/sars-cov-2-infection-sin-recommendations-endorsed-by-uenps/ Erişim: 24.03.2020 59) Qiao J. What are the risks of COVID-19 infection in pregnant women? [Published online ahead of print February 12, 2020]. The Lancet. doi: https://doi.org/10.1016/S0140-6736(20)30365-2 Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30365-2/fulltext (accessed 26 February 2020). 60) Schwartz DA. COVID-19, SARS-CoV-2 and pregnancy: Does the past predict the present? ContagionLive. 28 February 2020. Available from: https://www.contagionlive.com/news/covid19-sarscov2-and-pregnancy-does-the-past-predict-the-present (erişim: 1 Mart 2020) 61) 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:E009 [Article in Chinese]. 62) 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 [Published online ahead of print February 12, 2020]. The Lancet. 2020.https://doi.org/10.1016/S0140-6736(20)30360-3. 63) Liu W, Wang Q, Zhang Q, Chen L, Chen J, Zhang B. et al. Coronavirus disease 2019 (COVID-19) during pregnancy: A case series. Preprints 2020;2020020373. Available from: https://www.preprints.org/manuscript/202002.0373/v1 (accessed 28 February 2020). 64) Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020;9(1):51-60. doi: 10.21037/tp.2020.02.06. Available from: http://tp.amegroups.com/article/view/35919/28274 (accessed 1 March 2020). 65) 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 [Published online ahead of print February 28, 2020]. Clin Infect Dis. 2020. 66) Zhang I, 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(0), E009. Available from: http://rs.yiigle.com/yufabiao/1184338.htm (accessed and translated 12 March 2020). 67) Cui Y, Tian M, Huang D et al. A 55 day old female infant infected with COVID19: presenting with pneumonia, liver injury and heart damage. J Infect Dis 2020 March 17 (online ahead of print). 68) Huang C, Wang Y, Li X,et al.Clinical features of patients infected with 2019 coronavirus in Wuhan, China.Lancet 2020; published online Jan 24. https://doi.org/10.1016/ S0140-6736(20)30183-5. 69) Dawei Wang, Bo Hu,Chang Hu, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA 2020 ; published online February 7, 2020. doi:10.1001/jama.2020.1585. 70) Michelle L. Holshue, Chas DeBolt, Scott Lindquist,et al. First Case of 2019 Novel Coronavirus in the United States. The New England Journal of Medicine 2020; published on January 31,2020, at NEJM.org.DOI: 10.1056/NEJMoa2001191. 71) Chen Y, Peng H, Wang L. Infants born to mothers with a new coronavirus (COVID-19). Front Pediatr 2020, 8: published 16 March 2020, doi: 10.3389/fped.2020.00104 72) Fang Y, Zhang H, Xie J et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology 2020; 19: 200432. DOI: 10.1148/radiol.20202004325