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Outcome of COVID-19 Positive Neonate Born to Mothers with SARS-CoV-2 Infection: A Case Series |
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CM Bokade, Milind M Suryawanshi, Bhagyashree B Tirpude, Leena Dhande 1. Professor, Department of Paediatrics, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India. 2. Assistant Professor, Department of Paediatrics, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India. 3. Assistant Professor, Department of Paediatrics, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India. 4. Associate Professor, Department of Paediatrics, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India. |
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Correspondence Address : Dr. Milind M. Suryawanshi, SHIVNERI Apt. F-13, Orange City Hospital Square, Khamala, Nagpur, Maharashtra, India. E-mail: dr.milind.suryawanshi@gmail.com |
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| ABSTRACT |  | ||||||||||||||||||||||||||||||||||||||||||||||||||
: Coronavirus Disease 2019 (COVID-19) the disease caused by the novel coronavirus, has led to an unprecedented global pandemic affecting people of all ages. In this case series, all COVID-19 positive neonates (=28 days of life) born to mothers with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection were selected from tertiary care hospital, in Central India from March 2020 to September 2020. There were 15 neonates affected by SARS-CoV-2 infection. In this case series, authors found that out of 15 neonates, 5 were male and 10 were female. Main symptoms were fever, shortness of breath, poor feeding and others (like-abdomen distension, vomiting) but, often these neonates did not showed other symptoms during stay in designated COVID-19 Neonatal Intensive Care Unit (NICU) with no mortality found in this case series. COVID-19 positive neonates showed a good prognosis, with low rate of severe complications and without any mortality. Treatment was mostly symptomatic or supportive. Most of the neonates tested positive for SARS-CoV-2 were asymptomatic or had mild disease. | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Keywords : Coronavirus disease 2019, Nasopharyngeal swab, Severe acute respiratory syndrome coronavirus, Vertical transmission | |||||||||||||||||||||||||||||||||||||||||||||||||||
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DOI and Others :
10.7860/IJNMR/2021/50119.2310
Date of Submission: Apr 27, 2021 Date of Peer Review: Jul 24, 2021 Date of Acceptance: Aug 17, 2021 Date of Publishing: Sep 30, 2021 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval Obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? No • For any images presented appropriate consent has been obtained from the subjects. No PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Apr 28, 2021 • Manual Googling: Aug 09, 2021 • iThenticate Software: Sep 01, 2021 (20%) Etymology: Author Origin |
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| INTRODUCTION |
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The COVID-19 pneumonia was firstly reported in Wuhan,China, in December 2019. The disease had a rapid spread all over the world becoming an international public health emergency (1). Emergence of 2019-nCoV has attracted global attention, and World Health Organization (WHO) has declared the COVID-19 a Public Health Emergency of International Concern (PHEIC). Immune profile and physiological changes in newborns immediately after birth may predispose them for infection and may attribute to high risk for COVID-19 related complications (2). Also, the possibility of SARSCoV-2 vertical transmission from mothers to foetuses does exist (3),(4),(5). Studies have predominantly described benign course in neonates (6),(7),(8). However, there have been some case reports suggesting adverse outcome in SARS-CoV-2 infected neonates (9). There is meagre data with respect to SARS-CoV-2 infected neonate. The information and knowledge of SARS-CoV-2 infections in neonates are still evolving with increasing reports of COVID-19 in pregnant women and neonates from India. In view of diversity in clinical profile, available data from China, Europe and US cannot be generalised to other population in world. There is a meagre data regarding clinical manifestations, clinical courses and prognosis of SARS-CoV-2 infected neonates. Authors hereby, report a case series on clinical, biochemical profile and outcome of COVID-19 positive neonate born to mothers with SARSCoV-2 infection. | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Case Report |
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This was a case series, retrospective analysis of SARSCoV-2 infected neonates born to COVID-19 mothers who admitted and delivered at Indira Gandhi Medical College, Nagpur, Central India from March 2020 to September 2020 which is registered Tertiary Care Hospital of National Registry of Pregnant women with COVID-19 in India. The ethical approval was obtained for the same from IGMC Ethics Committee (Reg. No. ECR/485/Inst/MH/2013/RR20 and IGGMC/Pharmacology/IEC/475/2020 on dated 20/11/2020). The nasopharyngeal swab specimens of neonate exposed to SARS-CoV-2 positive mother was sent to the local VDRL Lab which is authorised by Indian Council of Medical Research (ICMR), where the SARSCoV-2 RNA (Ribonucleic Acid) was detected by realtime Reverse Transcription-Polymerase Chain Reaction (RT-PCR) at 24 hours and 5th day of life of neonates.All COVID-19 positive neonates (≤28 days of life) born to mothers with confirmed SARS-CoV-2 infection were included in analysis. The diagnosis and management of newborn with or at risk of COVID-19 in accordance with guidelines provided by American Academy of Paediatrics (AAP), National Neonatology Forum of India (NNF) and Indian Academy of Paediatrics (IAP) (10),(11),(12). The information about SARS-CoV-2 infected neonates was retrieved from case record form from Medical Record Department (MRD). The data was extracted considering outcome variables as gestational age, sex, birth weight, clinical features, laboratory findings, chest X-ray images, treatment, duration in NICU and their outcomes in terms of morbidity and mortality. The data was entered in Excel sheet, was tabulated and analysed further. Fifteen neonates were reported to have SARS-CoV-2 infection. Out of 15 neonates, 5 were male and 10 were female. The mean gestational age was found 38.06±0.70 weeks and 1 neonate born before 37 weeks of gestation and 14 were born after 37 weeks of gestation. Amongst them, 12 were Appropriate for Gestational Age (AGA) and 3 were Small for Gestational Age (SGA). The mean birth weight was recorded as 2946±640 gm and 5 babies were low birth weight (<2500 gm) and 10 babies were >2500. Clinical Manifestations Asymptomatic neonates were clinically normal and stable taking feeds well. Three neonates were symptomatic and 12 neonates were asymptomatic. Symptomatic neonates treated according to their symptoms as per the protocol developed at Institutional level as per ICMR guidelines (13). Protocol included neonates who were symptomatic/sick and were born to a mother with suspected or proven SARS-CoV-2 infection should be managed in isolation NICU. This area should be separate from the regular NICU. This isolation facility should preferably have single closed rooms. Isolation NICU should have adequate ventilation. The treating doctors, nursing and other support staff working in these isolation NICU should be separate from the ones who are working in regular NICU. The staff should be given adequate supplies of PPE. The staff also must be trained for safe use and disposal of PPE. Respiratory support for neonates with suspected/proven SARS-CoV-2 infection is guided by principles of lung protective strategy including use of non invasive ventilation. Treatment was according to symptoms and sign of neonates. Case no- 4,7 and 8 were symptomatic in which case number 4 had initial symptoms of poor feeding, lethargy and fever. During the course of hospital stay, patient started deteriorating and developed respiratory distress.Chest X-ray showed no evidence of pneumonia. On serial, Complete Blood Count (CBC) monitoring showed decreased platelet count, increased White Blood Cells (WBC) count and initially C-Reactive Protein (CRP) was negative suggestive of sepsis. This case patient required Continuous Positive Airway Pressure (CPAP) for 5 days, intravenous antibiotics were started according to blood and umbilical tip culture sensitivity reports for 14 days and also platelets and fresh frozen plasma were given to patient. Gradually patient started improving; weaning off from CPAP to O2 by nasal prongs at the rate of 2 litre/min. Feeds were started via nasogastric tube; initially in small quantity which increased progressively as feeds were tolerated by patient. On 7th day of life, O2 was removed and saturation was maintained. Overall patient improved clinically, stable and well. Ultrasonography of abdomen and pelvis within normal and Neurosonography (NSG) was also normal. On discharge, patient was taking feeds very well with weight gain and called for follow-up for Otoacoustic Emission (OAE), Retinopathy of Prematurity (ROP) and routine vaccination. Case no. 7 patient complained of fever which had occurred on 3rd day of life. All required investigations were done and symptomatic treatment was given to the patient as per the protocol. Protocol and feeding was established simultaneously. No other clinical symptoms were developed during the hospital stay. On discharge, patient was taking feeds properly. Patient was called for follow-up in neonatology clinic. Case no. 8 patient showed abdomen distention and started vomiting which was greenish in colour. On clinical examination, abdomen was distended and shiny with initially sluggish bowel sound which were absent after 24 hours. All routine and necessary investigations were done. Ultrasonography of abdomen and pelvis, and standing abdomen X-ray showed signs of intestinal obstruction. Patient was kept Nil By Mouth (NBM) and i.v. fluids and antibiotics were started. Patient was referred to Government Medical College and Hospital for further management by Paediatric Surgery Department. On enquiry, patient was managed conservatively and his health was improved and was discharged on day 8. All other 12 asymptomatic neonates were taking feeds properly and no other symptoms were developed during the hospital stay. All asymptomatic neonates were discharged for home care with mother or parents (if mother is unwell) with appropriate precautions and recalled for follow-up in neonatology clinic [Table/Fig-(1),(2). | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Discussion |
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In this case series, signs and symptoms of COVID-19 positive neonates was less serious compared to adults. Main symptoms were poor feeding, lethargy, fever, shortness of breath abdomen distension and vomiting however, these newborns did not showed other symptoms or developed new symptoms during COVID-19 NICU stay. Present case series demonstrated almost similar findings as mentioned in (Table/Fig 3) (9),(14),(15),(16),(17),(18),(19),(20),(21),(22),(23),(24). Systematic review by Dhir SK et al., states that in India, most COVID-19 positive neonates found were symptomatic and required intensive care. Gale C et.al., in London UK by a prospective national cohort study using active surveillance showed that 66 neonates were mildly affected, with two cases of severe disease (14),(24). Case reports by Kulkarni R et al., Alzamora MC et al., Vivanti AJ et al., Sisman J et al., reported symptomatic neonate (9),(18),(22),(23); whereas Mehta H et al., and Dumiriu D et al., showed asymptomatic neonates (19),(20). Case series by Kalamdani P et al., Anand P et al., Nanavati R et al., and Zeng L et al., found most of the neonates were asymptomatic and thrive on breast feeding (15),(16),(17),(21). Limitation(s) However, as the present case series had the small number of cases, a large sample is required to come into any firm conclusion. Also, this was an observational retrospective case series in which authors had looked at the clinical and pathological status in neonates. Authors hereby, did not evaluate the presence of virus in amniotic fluid, cord blood, or placental tissue which might had clarified pathogenesis in neonates. In present study, follow-up of patients for a longer duration had not reported. | |||||||||||||||||||||||||||||||||||||||||||||||||||
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