Limited data are available on pregnant women with COVID-19 and their neonates. We aimed to evaluate the epidemiological and clinical characteristics of newborns born to women infected with COVID-19. A multicenter cohort study was conducted among newborns born to mothers with COVID-19 in 34 neonatal intensive care units (NICUs) in Turkey. Pregnant women ( n = 125) who had a positive RT-PCR test and their newborns were enrolled. Cesarean section, prematurity, and low-birthweight infant rates were 71.2%, 26.4%, and 12.8%, respectively. Eight of 125 mothers (6.4%) were admitted to an intensive care unit for mechanical ventilation, among whom six died (4.8%). Majority of the newborns (86.4%) were followed in isolation rooms in the NICU. Four of 120 newborns (3.3%) had a positive RT-PCR test result. Although samples taken on the first day were negative, one neonate became positive on the second day and the other two on the fifth day. Sample from deep tracheal aspirate was positive on the first day in an intubated case. Conclusion : COVID-19 in pregnant women has important impacts on perinatal and neonatal outcomes. Maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission, and low rate of breastfeeding show that family support should be a part of the care in the NICU. Trial registration : ClinicalTrials.gov identifier: NCT04401540 What is Known: • The common property of previous reports was the conclusions on maternal outcomes, rather than neonatal outcomes. • Published data showed similar outcomes between COVID-19 pregnant women and others. What is New: • Higher maternal mortality, higher rates of preterm birth and cesarean section, suspected risk of vertical transmission especially in a case with deep tracheal aspiration during the intubation, and the possible role of maternal disease severity on the outcomes are remarkable findings of this study. • In contrast to recommendation for breastfeeding, parents’ preference to formula and expressed breast milk due to anxiety and lack of information shows that family support should be a part of the care in the NICU.

Management of pregnant women with COVID-19 infection should be conducted by a multidisciplinary team within the framework of an individualized patient approach for favorable outcomes.

Objective To evaluate the course and effect of coronavirus disease 2019 (COVID‐19) on pregnant women followed up in a Turkish institution. Methods A prospective, single tertiary pandemic center cohort study was conducted on pregnant women with confirmed or suspected severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Positive diagnosis was made on a real‐time polymerase chain reaction (RT‐PCR) assay of a nasopharyngeal and oropharyngeal specimen. Demographic features, clinical characteristics, and maternal and perinatal outcomes were evaluated. Results SARS‐CoV‐2 was suspected in 100 pregnant women. Of them, 29 had the diagnosis confirmed by RT‐PCR. Eight of the remaining 71 cases had clinical findings highly suspicious for COVID‐19. Ten (34.5%) of the confirmed cases had co‐morbidities. Cough (58.6%) and myalgia (51.7%) were the leading symptoms. COVID‐19 therapy was given to 10 (34.5%) patients. There were no admissions to the intensive care unit. Pregnancy complications were present in 7 (24.1%) patients. Half of the births (5/10) were cesarean deliveries. None of the neonates were positive for SARS‐CoV‐2. Samples of breastmilk were also negative for the virus. Three neonates were admitted to the neonatal intensive care unit. Conclusion The clinical course of COVID 19 during pregnancy appears to be mild in the present study.

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ABSTRACT:We evaluated the potential therapeutic use of exogenous human bone marrow-derived mesenchymal stem cells (hBMMSCs) in an experimental rat model of necrotizing enterocolitis (NEC). Thirty-six newborn Sprague-Dawley rats were randomly divided into three groups: NEC, NEC ϩ hBM-MSC, and a control (control and control ϩ hBM-MSC). NEC was induced by enteral formula feeding, exposure to hypoxia-hyperoxia, and cold stress. After NEC was induced, iron-labeled hBM-MSCs were administered by intraperitoneal injection. All pups were killed on the fourth day following injection, and the terminal ileum was excised for a histopathological and immunohistochemical evaluation. The pups in the NEC ϩ hBM-MSC group showed significant weight gains and improvements in their clinical sickness scores (p Ͻ 0.01). Bowel damage severity observed in the histopathological evaluation was significantly lower in the NEC ϩ hBM-MSC group than that in the NEC group (p ϭ 0.012). The number of MSCs homing to the bowel was significantly higher in the NEC ϩ hBM-MSC group than that in the control ϩ hBM-MSC group. In conclusion, this is the first study that has evaluated the effectiveness of hBM-MSCs in a neonatal rat NEC model. MSCs reduced histopathological damage significantly. (Pediatr Res 70: 489-494, 2011) N ecrotizing enterocolitis (NEC) is the most common gastrointestinal emergency and a leading cause of mortality and morbidity in newborn infants. The etiology and pathophysiology of NEC remains unclear. Although prematurity is the most consistent risk factor, hypoxic-ischemic injury, formula feeding, abnormal bacterial colonization, antenatal and postnatal risk components, and genetic aspects comprise other potential risk factors (1-3). Medical management of severe cases is often inadequate, and surgical intervention may be warranted. Thus, ϳ20 -40% of neonates eventually require a surgical procedure (1,4,5). In addition, morbid sequelae among survivors include impaired growth, short bowel syndrome, prolonged neonatal hospitalization, and poor longterm neurodevelopment (1-5). Therefore, the introduction of new strategies for the prevention and/or therapy for this devastating disease is essential to increase the survival rate and to reduce significant complications.Mesenchymal stem cells (MSCs) are multipotent cells capable of differentiating into multiple cell types. In addition, MSCs secrete a wide variety of cytokines and chemokines that have beneficial paracrine actions during tissue repair (6 -11). Because of these unique properties, MSCs could be a future option for treating various diseases. Studies on the potential use of stem cells in pediatric diseases have recently aroused interest among clinicians (12-15), although stem cell therapy has not yet been studied as a treatment modality for neonatal intestinal disorders such as NEC. In this study, the therapeutic potential of exogenous human bone marrow-derived (hBM)-MSC therapy was evaluated in an experimental neonatal rat model of NEC. MATERIALS AND METHODSAnimal model. Fatih Uni...

Background: Coronavirus disease 2019 (COVID-19) primarily affects adults and spares children, whereas very little is known about neonates. We tried to define the clinical characteristics, risk factors, laboratory, and imagining results of neonates with community-acquired COVID-19. Methods: This prospective multicentered cohort study included 24 neonatal intensive care units around Turkey, wherein outpatient neonates with COVID-19 were registered in an online national database. Full-term and premature neonates diagnosed with COVID-19 were included in the study, whether hospitalized or followed up as ambulatory patients. Neonates without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) via reverse transcriptase-polymerase chain reaction testing or whose mothers had been diagnosed with COVID-19 during pregnancy were excluded. Results: Thirty-seven symptomatic neonates were included. The most frequent findings were fever, hypoxemia, and cough (49%, 41%, 27%, respectively). Oxygen administration (41%) and noninvasive ventilation (16%) were frequently required; however, mechanical ventilation (3%) was rarely needed. Median hospitalization was 11 days (1–35 days). One patient with Down syndrome and congenital cardiovascular disorders died in the study period. C-reactive protein (CRP) and prothrombin time (PT) levels were found to be higher in patients who needed supplemental oxygen (0.9 [0.1–8.6] vs. 5.8 [0.3–69.2] p = 0.002, 11.9 [10.1–17.2] vs. 15.2 [11.7–18.0] p = 0.01, respectively) or who were severe/critical (1.0 [0.01–8.6] vs. 4.5 [0.1–69.2] p = 0.01, 11.7 [10.1–13.9] vs. 15.0 [11.7–18.0] p = 0.001, respectively). Conclusions: Symptomatic neonates with COVID-19 had high rates of respiratory support requirements. High CRP levels or a greater PT should alert the physician to more severe disease.

Providing safe and effective drug therapy to neonates requires knowledge of the impact of development on the pharmacokinetics and pharmacodynamics of drugs. Although maturational changes are observed throughout childhood, they are most prominent during the first year of life. Several of these processes overlap, making development an extremely dynamic system in the newborn compared with that in infants, children, or adults. Changes in body composition and porportions, liver mass, metabolic activity, and renal function collectively affect the pharmacokinetic behavior of medications. Instead of simply adapting doses by scaling adult or pediatric doses on the basis of a patient's weight and/or body surface area, integrated knowledge of clinical maturation and developmental pharmacology is critical to the safe and effective use of medications in neonates. Unfortunately, the effects of human ontogeny on both pharmacokinetics and pharmacodynamics have not been well established in these early stages of life, and information regarding the influence of developmental changes on the pharmacodynamics of medications is even more limited. Theoretically, age-dependent variations in receptor number and affinity for drugs have significant potential to influence an individual's response to drug therapy. In this review, some of the relevant covariates of pharmacokinetics and pharmacodynamics in neonates are reviewed and illustrated based on the published literature.