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      A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society

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          Abstract

          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.

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          Most cited references30

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          Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records

          Summary Background Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were based on information from the general population. Limited data are available for pregnant women with COVID-19 pneumonia. This study aimed to evaluate the clinical characteristics of COVID-19 in pregnancy and the intrauterine vertical transmission potential of COVID-19 infection. Methods Clinical records, laboratory results, and chest CT scans were retrospectively reviewed for nine pregnant women with laboratory-confirmed COVID-19 pneumonia (ie, with maternal throat swab samples that were positive for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) who were admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from Jan 20 to Jan 31, 2020. Evidence of intrauterine vertical transmission was assessed by testing for the presence of SARS-CoV-2 in amniotic fluid, cord blood, and neonatal throat swab samples. Breastmilk samples were also collected and tested from patients after the first lactation. Findings All nine patients had a caesarean section in their third trimester. Seven patients presented with a fever. Other symptoms, including cough (in four of nine patients), myalgia (in three), sore throat (in two), and malaise (in two), were also observed. Fetal distress was monitored in two cases. Five of nine patients had lymphopenia (<1·0 × 10⁹ cells per L). Three patients had increased aminotransferase concentrations. None of the patients developed severe COVID-19 pneumonia or died, as of Feb 4, 2020. Nine livebirths were recorded. No neonatal asphyxia was observed in newborn babies. All nine livebirths had a 1-min Apgar score of 8–9 and a 5-min Apgar score of 9–10. Amniotic fluid, cord blood, neonatal throat swab, and breastmilk samples from six patients were tested for SARS-CoV-2, and all samples tested negative for the virus. Interpretation The clinical characteristics of COVID-19 pneumonia in pregnant women were similar to those reported for non-pregnant adult patients who developed COVID-19 pneumonia. Findings from this small group of cases suggest that there is currently no evidence for intrauterine infection caused by vertical transmission in women who develop COVID-19 pneumonia in late pregnancy. Funding Hubei Science and Technology Plan, Wuhan University Medical Development Plan.
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            Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia

            The newly identified 2019-nCoV, which appears to have originated in Wuhan, the capital city of Hubei province in central China, is spreading rapidly nationwide. A number of cases of neonates born to mothers with 2019-nCoV pneumonia have been recorded. However, the clinical features of these cases have not been reported, and there is no sufficient evidence for the proper prevention and control of 2019-nCoV infections in neonates.
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              Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn

              This case report describes birth of an infant with elevated anti–SARS-CoV-2 IgM antibodies and cytokine levels to a mother with polymerase chain reaction–confirmed coronavirus disease 2019 (COVID-19) despite no physical contact.
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                Author and article information

                Contributors
                dryekta@gmail.com
                ilkemungan@gmail.com
                kanburoglumk@outlook.com
                ctayman22@gmail.com
                coskunsenay@yahoo.com
                fatmakaya06@yahoo.com.tr
                ilkayer7778@yahoo.com
                tgelenava@yahoo.com
                acinarmemisoglu@gmail.com
                drmerih@yahoo.com
                demoguz@hotmail.com
                omererdeve@yahoo.com
                esinkoc@gazi.edu.tr
                Journal
                Eur J Pediatr
                Eur. J. Pediatr
                European Journal of Pediatrics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-6199
                1432-1076
                10 August 2020
                : 1-10
                Affiliations
                [1 ]GRID grid.411795.f, ISNI 0000 0004 0454 9420, Department of Pediatrics, Division of Neonatology, School of Medicine, , İzmir Katip Çelebi University, ; İzmir, Turkey
                [2 ]GRID grid.414882.3, ISNI 0000 0004 0643 0132, Division of Neonatology, Tepecik Training and Research Hospital, , University of Health Sciences, ; Konak, 35180 İzmir, Turkey
                [3 ]GRID grid.417018.b, ISNI 0000 0004 0419 1887, Division of Neonatology, Umraniye Training and Research Hospital, , University of Health Sciences, ; İstanbul, Turkey
                [4 ]GRID grid.412216.2, ISNI 0000 0004 0386 4162, Department of Pediatrics, Division of Neonatology, School of Medicine, , Rize Recep Tayyip Erdoğan University, ; Rize, Turkey
                [5 ]GRID grid.415700.7, Division of Neonatology, Ankara City Hospital, , Ministry of Health, ; Ankara, Turkey
                [6 ]Division of Neonatology, Sancaktepe Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
                [7 ]GRID grid.415700.7, Division of Neonatology, Kartal Dr. Lütfi Kırdar City Hospital, , Ministry of Health, ; İstanbul, Turkey
                [8 ]Division of Neonatology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
                [9 ]GRID grid.415700.7, Division of Neonatology, Bornova Türkan Özilhan State Hospital, , Ministry of Health, ; İzmir, Turkey
                [10 ]GRID grid.16477.33, ISNI 0000 0001 0668 8422, Department of Pediatrics, Division of Neonatology, School of Medicine, , Marmara University, ; İstanbul, Turkey
                [11 ]Division of Neonatology, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
                [12 ]GRID grid.415700.7, Division of Neonatology, Haseki Training and Research Hospital, , Ministry of Health, ; İstanbul, Turkey
                [13 ]GRID grid.7256.6, ISNI 0000000109409118, Department of Pediatrics, Division of Neonatology, School of Medicine, , Ankara University, ; Ankara, Turkey
                [14 ]GRID grid.25769.3f, ISNI 0000 0001 2169 7132, Department of Pediatrics, Division of Neonatology, School of Medicine, , Gazi University, ; Ankara, Turkey
                Author notes

                Communicated by Daniele De Luca

                Author information
                https://orcid.org/0000-0003-0760-0773
                Article
                3767
                10.1007/s00431-020-03767-5
                7416592
                32776309
                55e90092-0dac-4bb8-a8ba-389591aeffe4
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 13 July 2020
                : 26 July 2020
                : 31 July 2020
                Categories
                Original Article

                Pediatrics
                sars-cov-2,covid-19,pregnancy,newborn
                Pediatrics
                sars-cov-2, covid-19, pregnancy, newborn

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