Neonatal SARS-CoV-2 Infection: Practical Tips

Abstract

The recent viral pandemic in Wuhan, Hubei, China has led to the identification of a new species of beta-coronavirus, able to infect humans, the 2019-nCoV, later named SARS-CoV-2. SARS-CoV-2 causes a clinical syndrome named COVID-19, which presents with a spectrum of symptoms ranging from mild upper respiratory tract infection to severe pneumonia, with acute respiratory distress syndrome and frequent death. All age groups are susceptible to the infection, but children, especially infants, seem to be partially spared, having a more favorable clinical course than other age groups. There is currently no clear evidence showing vertical transmission and intrauterine SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy, and even if transmission is possible, the SARS-CoV2 positivity of the mother does not require delivery by caesarean section, does not contraindicate the management of the infant in rooming-in and allows breastfeeding. This review provides an overview on the biology of the virus, on the pathogenesis of the infection, with particular attention to pregnancy and neonatal age, on the clinical presentation of infection in newborns and young infants and summarizes the international recommendations currently available on the clinical care of neonates with SARS-CoV2 infection or at risk of catching the virus. The main objective of the review is to provide an update especially focused to the clinical management of COVID-19 infection in the perinatal and neonatal age.

The Effects of COVID-19 on the Placenta During Pregnancy

“…These include direct damage to the villous tree with a break in the protective syncytiotrophoblast layer, which could be caused by virus-induced apoptosis and vascular damage in the placenta, spread through the virus-infected maternal endothelium to the extravillous trophoblast, trafficking of infected maternal immune cells throughout the syncytiotrophoblast, paracellular or transcellular transport (for example, immunoglobulin-mediated transcytosis) into fetal capillaries, transmission via swallowed or aspirated amniotic fluid ( 65 , 66 ), as well as ascending infection from the vagina ( Figure 3 ) ( 31 ). To define the possibility of vertical transmission of SARS-CoV-2 infection in different studies, a classification system has been proposed by a multidisciplinary team of the WHO ( 67 ). Given the timing of vertical transmission, in utero , intrapartum, and early postnatal period, four possibilities exist: confirmed, possible, unlikely, and indeterminate ( 67 ).…”

“…To define the possibility of vertical transmission of SARS-CoV-2 infection in different studies, a classification system has been proposed by a multidisciplinary team of the WHO ( 67 ). Given the timing of vertical transmission, in utero , intrapartum, and early postnatal period, four possibilities exist: confirmed, possible, unlikely, and indeterminate ( 67 ). Vertical transmission is considered “possible” if evidence suggests it but cannot confirm infection.…”

“…However, if there is poor support of diagnosis, but vertical transmission cannot be completely ruled out, this is considered as “unlikely”. The “indeterminate” possibility is when the tests required to define the classification have not been performed ( 67 ). Recent findings confirming the presence of SARS-CoV-2 mRNA or virions in syncytiotrophoblasts have strongly suggested transplacental infection caused by the SARS-CoV-2 ( 68 , 69 ).…”

SARS-CoV-2 Infection and Possible Neonatal Neurological Outcomes: A Literature Review

“…Nucleic acid amplification is the most reliable test for diagnosing COVID-19, and the most sensitive test is reverse transcriptase real-time polymerase chain reaction (RT-qPCR) [ 63 ]. The technique consists of two PCRs in sequence: RT-PCR followed by real-time PCR for detection of viral RNA [ 64 ]. This exam targets different genes of SARS-CoV-2, such as RNA-dependent RNA polymerase (RdRp)/helicase (Hel), spike (S), and nucleocapsid (N) [ 65 ].…”

Perinatal COVID-19

“…Leucopenia and lymphocytopenia, mild to moderate thrombocytopenia and increased creatine phosphokinase, transaminases and lactate dehydrogenase are reported while C-reactive protein and procalcitonin are usually within normal limits. 8 Decisions regarding additional testing including monitoring of inflammatory markers such as ferritin, D-dimers or interleukin-6 as well as high resolution computational tomography are individualized.…”