Background
Limited evidence exists on perinatal transmission and outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in neonates.
Objective
To describe clinical outcomes and risk factors for transmission in neonates born to mothers with perinatal SARS-CoV-2 infection.
Design
Prospective cohort of suspected and confirmed SARS-CoV-2 infected neonates entered in National Neonatology Forum (NNF) of India registry.
Subjects
Neonates born to women with SARS-CoV-2 infection within two weeks before or two days after birth and neonates with SARS-CoV-2 infection.
Outcomes
Incidence and risk factors of perinatal transmission.
Results
Among 1713 neonates, SARS-CoV-2 infection status was available for 1330 intramural and 104 extramural neonates. SARS-CoV-2 positivity was reported in 144 intramural and 39 extramural neonates. Perinatal transmission occurred in 106 (8%) and horizontal transmission in 21 (1.5%) intramural neonates. Neonates roomed-in with mother had higher transmission risk (RR1.16, 95% CI 1.1 to 2.4;
P
=0.01). No association was noted with the mode of delivery or type of feeding. The majority of neonates positive for SARS-CoV2 were asymptomatic. Intramural SARS-CoV-2 positive neonates were more likely to be symptomatic (RR 5, 95%CI 3.3 to 7.7;
P
<0.0001) and need resuscitation (RR 2, 95%CI 1.0 to 3.9;
P
=0.05) compared to SARS-CoV-2 negative neonates. Amongst symptomatic neonates, most morbidities were related to prematurity and perinatal events.
Conclusion
Data from a large cohort suggests perinatal transmission of SARS-CoV-2 infection and increased morbidity in infected infants.
This review seeks to highlight the pathophysiologic phenomena implicated in vascular and valvular calcification and summarize the literature available regarding the use of bisphosphonates in animal and human models. We also discuss novel treatment approaches for vascular calcification, with emphasis on chronic kidney disease and calciphylaxis.
Percutaneous mitral valve repair is emerging as a reasonable alternative especially in
those with an unfavorable surgical risk profile in the repair of mitral regurgitation. At this time, our
understanding of the effects of underlying renal dysfunction on outcomes with percutaneous mitral
valve repair and the effects of this procedure itself on renal function is evolving, as more data
emerges in this field. The current evidence suggests that the correction of mitral regurgitation via
percutaneous mitral valve repair is associated with some degree of improvement in cardiac
function, hemodynamics and renal function. The improvement in renal function was more significant
for those with greater renal dysfunction at baseline. The presence of Chronic Kidney Disease
(CKD) in turn has been associated with poor long-term outcomes including increased mortality and
hospitalization among patients who undergo percutaneous mitral valve repair. This was true regardless
of the degree of improvement in GFR post repair advanced CKD. The adverse impact of CKD
on long-term outcomes was consistent across all studies and was more prominent in those with
GFR<30 mL/min/1.73 m². It is clear that from these contrasting evidences of improved renal function
post mitral valve repair but poor long-term outcomes including increased mortality in patients
with CKD, that proper patient selection for percutaneous mitral valve repair is key. There is a need
to have better-standardized criteria for patients who should qualify to have percutaneous mitral
valve replacement with Mitraclip. In this new era of percutaneous mitral valve repair, much work
needs to be done to optimize long-term patient outcomes.
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