Clinical Characteristics of Newborn Infants Delivered to Pregnant Women With Laboratory-Confirmed COVID-19: A Single-Center Experience From Saudi Arabia

Abstract

IntroductionIn Saudi Arabia and countries around the world, clinical health practice has been transformed by the coronavirus 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During the early days of the pandemic, it was a major challenge to care for pregnant women with laboratory-confirmed COVID-19 and their newborn infants. In this article, we share our experience in the management of newborn infants delivered to mothers with laboratory-confirmed COVID-19. MethodsA prospective single-center observational study was conducted at King Abdulaziz Medical City in Jeddah, National Guard Health Affairs, Saudi Arabia. Data collection started in March 2020 and was completed in October 2020. The inclusion criteria included mothers with laboratory-confirmed COVID-19 and their newborn infants. ResultsA total of 45 pregnant women with polymerase chain reaction (PCR)-confirmed COVID-19 were included in the study. Their mean age was 30.23±5.92 years. The mode of delivery was spontaneous vaginal delivery in 27 women (60%), cesarean section in 15 women (33.3%), and assisted vaginal delivery in three women (6.7%). Three mothers (6.7%) required intensive care unit admission. A total of 45 babies were born and 25 were females (55.6%), 20 males (44.4%). None of the babies had specific symptoms related to COVID-19. All babies were tested negative on the two COVID-19 nasopharyngeal swabs. Babies were initially admitted to the NICU and one baby required prolonged NICU stay due to extreme prematurity (23 weeks), one baby died due to hypoxic-ischemic encephalopathy and respiratory distress syndrome, and the remaining babies were discharged home in a stable condition. ConclusionOur experience suggests that maternal outcomes are generally favorable and no difference between vaginal and cesarean delivery in the risk of virus transmission. With strict implementation of infection prevention measures, mother-to-infant transmission is very unlikely. Early bathing of the newborn infant is preferred to reduce the risk of transmission of infection to newborn infants and the hospital staff. Breastfeeding is safe if performed under strict infection prevention measures.

Mother-to-child transmission of SARS-CoV-2 infection in high-income countries: a systematic review and meta-analysis of prospective observational studies

“…All studies included infants born through vaginal and cesarean sections. In 14 studies the mother-infant dyad was enabled to stay together after birth 24 h a day 13 , 14 , 18 , 19 , 21 , 23 – 27 , 29 , 31 , 32 , 36 , in 6 it was not allowed 17 , 20 , 28 , 30 , 33 , 33 and in the remaining 6 studies 15 , 16 , 22 , 35 , 37 , 38 , there was no information about it. In 12 studies two or more preventive measures were undertaken 14 , 17 , 19 , 21 , 23 , 26 , 27 , 29 – 31 , 33 , 34 , in 10 only one or no one 13 , 15 , 16 , 18 , 20 , 22 , 24 , 25 , 28 , 36 and in the remaining 4 studies there was no information about preventive measures 32 , 35 , 37 , 38 .…”

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…The low mortality rate and ICU admission reported from Iran and KSA are similar to the one observed in several studies worldwide conducted on pregnant women infected with SARS-CoV-2 ( Allotey et al, 2020 ; Elshafeey et al, 2020 ; Juan et al, 2020 ; Smith et al, 2020 ). In pregnant women with COVID-19 in this country, vaginal delivery was more prevalent than the cesarian one ( Algadeeb et al, 2020 ; Alhamoud et al, 2020 ; Al-Matary et al, 2021 ; AlQurashi et al, 2021 ). The most frequent adverse pregnancy outcomes were premature followed by fetal distress, and preeclampsia which occurred in pregnant women <37 weeks of gestational age ( Al-Matary et al, 2021 ).…”

“…One study found that the most common symptoms were cough, fever, and dyspnea ( Al-Matary et al, 2021 ). The majority of infected pregnant women did not have comorbidities and experienced a mild or moderate disease ( Alhamoud et al, 2020 ; Al-Matary et al, 2021 ; AlQurashi et al, 2021 ). A small proportion only, required intensive care and respiratory support as they developed symptoms of pneumonia; this finding was reported in pregnant women between 26 and 36 weeks of gestational age ( Al-Matary et al, 2021 ).…”

“…The most frequent adverse pregnancy outcomes were premature followed by fetal distress, and preeclampsia which occurred in pregnant women <37 weeks of gestational age ( Al-Matary et al, 2021 ). No vertical transmission was reported ( Al-Matary et al, 2021 ; AlQurashi et al, 2021 ). This is except for one case where the female infant experienced severe respiratory symptoms together with persistent pulmonary hypertension that led consequently to her death ( Algadeeb et al, 2020 ).…”

Manejo da amamentação e contato pele a pele em mulheres com COVID-19: uma revisão integrativa

“…Os demais estudos revisados (evidências 2, 3, 4, 10, 11, 16, 17 e 18) demonstram condutas negativas no que diz respeito às ações referentes tanto à amamentação a respeito do contato pele a pele e separação das mães e dos bebês, entretanto, em alguns estudos, verificou-se que a coleta de dados foi feita antes da publicação em Junho das recomendações da OMS (2020) que orientam a manutenção do aleitamento materno e contato pele a pele em mães e neonatos confirmados ou suspeitos com COVID-19, além de indicar também o alojamento conjunto para a díade (Neo-COVID-19 Research Group, 2021;Gabriel et al 2020;Gonçalves-Ferri et al, 2021;Conti et al, 2021;Farghaly, Kupferman, Castillo, Kim, 2020;Wróblewska-Seniuk, et al, 2021;Zaharie, Hasmasanu, Muresan, Kovacs, Matyas, 2021;AlQurashi et al, 2021).…”