Maternal and Neonatal COVID Data Review
Review performed by:
Julia Johnson, MD, PhD
Assistant Professor of Pediatrics
Division of Neonatology
Johns Hopkins University
Data sources:
Published literature - LitCovid (https://www.ncbi.nlm.nih.gov/research/coronavirus/), PubMed, individual journal sites
Unpublished literature - medRxiv (medrxiv.org), preprints (preprints.org)
Review/synthesis of published literature: Don’t Forget the Bubbles (www.dontforgetthebubbles.com), OBG Project (https://www.obgproject.com/2020/04/07/covid-19-research-watch-with-dr-jim-thornton/) - excellent brief summaries, including analysis of which published studies may report duplicate cases
News - regular search of common news outlets (NYT, CNN, Guardian, etc.)
Personal communication - email, webinars
Expert opinion - guidelines released by experts
Organizations - CDC, WHO, AAP, ACOG, and other relevant organizations
For non-English language articles that were readily available via PubMed, Google Scholar, or journal website, Google Translate was used to review manuscripts - useful for getting summary of manuscript but does not serve as an official translation.
Most articles that were solely reviews/added no new data or simply expressed author opinion are not included in this document.
For community onset disease in infants, only publications for infants <3 months of age are included; case series that describe outcomes in children that include infants but describe no individual or infant-specific outcomes were not included.
***Of note, several of the case reports, case series, and cohort studies (primarily from China) may report overlapping patient populations based on cited sources of data. Complete disambiguation of study results is not possible. A few studies do specifically report overlap with other publications but do not break down data further.
Source: Published literature | ||||
Title/Source | Date | Country | Study Type and Population | Summary |
Novel coronavirus infection in febrile infants aged 60 days and younger McLaren et al. Pediatrics https://pediatrics.aappublications.org/content/early/2020/06/09/peds.2020-1550 | 6-13-20 | US | Case series Infants | Case series of 7 infants 60 days and younger with COVID-19 who presented to the ED or were transferred to the inpatient ward at a single center over a 1 month period -Mixed retrospective and prospective study -20 infants were potentially eligible; 13 were tested and 7 (54%) were positive -All 7 infants were febrile and tested positive for SARS-CoV-2; all were admitted -Age range 11-56 days -2 had underlying medical conditions (1 with complex congenital heart disease, 1 with imperforate anus, inguinal hernia, Meckel’s, sacral hypoplasia, spinal dysraphism, tethered cord, and multicystic dysplastic kidney) -No information on maternal SARS-CoV-2 status at delivery -1 infant had confirmed positive contact at home -3 infants only had fever; none were ill appearing or in respiratory distress at time of presentation -2 infants had E. coli UTI -None required respiratory support during admission -Median length of hospitalization 2 days -One readmission within 14 days for fever, PCR again positive, no bacterial source for fever identified |
Successful anesthetic management in Cesarean section for pregnant woman with COVID-19 Bani Habi et al. American Journal of Case Reports https://www.ncbi.nlm.nih.gov/research/coronavirus/publication/32527990 | 6-13-20 | Jordan | Case report Pregnant woman Neonate | Case report of 29-year-old pregnant woman with confirmed SARS-CoV-2 infection at 37 4/7 weeks gestation -C-section performed at term -No complications -Neonate tested negative for COVID-19 |
Clinical course and treatment efficacy of COVID-19 near Hubei Province, China: a multicenter, retrospective study Zeng et al. Transboundary and Emerging Diseases | 6-12-20 | China | Retrospective cohort study | Multicenter retrospective cohort study of COVID-19, not limited to pregnant patients, at 12 hospitals in two provinces near Hubei -Cohort of 149 hospitalized patients with COVID-19 included 3 pregnant women -2 pregnant women in third trimester; course complicated by non-reassuring fetal heart rate tracing and possible fetal distress, necessitating C-section at 30 and 37 weeks -Both neonates had negative testing -One pregnant woman reported to have ARDS and require mechanical ventilation and ECMO; death on postpartum day 33 (**this may represent the same case reported by Zheng 3-31-20 and multiple other publications) |
Neonatal SARS-CoV-2 infection Carvalho et al. Clinics (Sao Paulo) https://www.clinicsjournal.com/article/neonatal-sars-cov-2-infection/ | 6-11-20 | Brazil | Case report Neonate | Case report of neonate presenting from community with COVID-19 -Birth history notable for term vaginal birth, early respiratory distress requiring supplemental oxygen, negative sepsis evaluation, left clavicular fracture; discharged home on day of life 3 -Breastfed exclusively -Presented at 11 days with fever and respiratory distress; NP/OP swab PCR positive -Transferred at 13 days to another facility for NICU care -No respiratory support required, afebrile throughout admission, mildly abnormal chest US, sepsis evaluation unremarkable -Admitted for 7 days |
Acute respiratory decompensation requiring intubation in pregnant women with SARS-CoV-2 (COVID-19) Silverstein et al. https://www.thieme-connect.de/products/ejournals/html/10.1055/s-0040-1712925 | 6-9-20 | US | Case series | Case series of two pregnant women with third trimester COVID-19 infections, both critically ill Case 1: -17-year-old pregnant woman at 36 1/7 weeks presented with contractions, sore throat, and chills; fetal assessment reassuring, received IV fluids, discharged home -Presented 2 days later with chills, malaise, cough, chest pain, shortness of breath; SARS-CoV-2 PCR positive, abnormal CXR -Admitted to pediatric service with MFM consult, treated with IV antibiotics with concern for superimposed bacterial infection -Worsening respiratory status hospital day 3, started on hydroxychloroquine, required NC -Transferred to ICU, intubated, and delivered via C-section -Neonate delivered at 36 6/7 and did well, negative testing, discharged on day of life 2 -Mother initially extubated after delivery but required reintubation on POD 2 - eventually extubated POD 7 -Discharged home POD 11/HD 15 Case 2: -34-year-old pregnant woman at 34 weeks gestation presented to ED with malaise, fever, cough, and shortness of breath, as well as decreased fetal movement -Admitted, treated with IV antibiotics due to concern for possible superimposed bacterial infection -Worsening respiratory status on HD 2, eventually required intubation, delivery via C-section, and admission to ICU -Neonate admitted to NICU, negative PCR testing, further course not described -Mother treated with azithromycin and hydroxychloroquine as well as tocilizumab -Percutaneous tracheostomy performed on POD 6 -Transitioned to trach collar POD 12, decannulated POD 20, discharged home on POD 21/HD 23 (**Unclear whether overlap with larger studies that have overlapping authors, including Penfield et al.) |
Association between mode of delivery among pregnant women with COVID-19 and maternal and neonatal outcomes in Spain Martinez-Perez et al. JAMA | 6-8-20 | Spain | Prospective cohort study Pregnant women Neonates | Prospective cohort of women with singleton pregnancies and positive SARS-CoV-2 PCR testing to assess impact of mode of delivery on maternal complications and neonatal transmission -82 pregnant women, 4 of whom had severe symptoms -78 women with no or mild symptoms; 11 required supplemental oxygen -Among women with no or mild symptoms, 53% delivered vaginally and 47% delivered via C-section; no patients with vaginal delivery developed severe adverse outcomes, whereas 5 (13.5%) with C-section required ICU admission -All 4 women with severe symptoms required ICU admission and were delivered via C-section -Delivery via C-section was associated with increased risk of NICU admission -3 of 72 (4.6%) neonates tested within 6 hours after birth had positive PCR test; all had negative testing at 48 hours; none had symptoms -2 neonates delivered via C-section at term developed COVID symptoms within 10 days after birth - both tested positive after initial negative test - presumed postnatal transmission in the setting of contact with infected parents; symptoms resolved within 48 hours |
Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study Knight et al. BMJ | 6-8-20 | UK | Population-based cohort study Pregnant women Neonates | UK population based cohort study using national surveillance system -427 pregnant women admitted with SARS-CoV-2 (laboratory confirmed and clinically diagnosed), representing a rate of 4.9 per 1000 pregnancies -Overrepresentation of black and other minority groups -41 (10%) required respiratory support, 5 (1%) died -266 (62%) delivered or had pregnancy loss, 196 of women (73%) gave birth at term -12 (5%) neonates had positive PCR testing; 6 (50%) had positive testing within first 12 hours; no detailed neonatal course provided |
Manifestations in neonates born to COVID-19 positive mothers Jain et al. Indian Journal of Pediatrics Jain et al. https://link.springer.com/article/10.1007%2Fs12098-020-03369-x | 6-5-20 | India | Case series Neonates | Case series of 2 neonates with perinatal exposure -Case 1: Term infant delivered via emergent C-section for fetal distress, healthy and roomed in with mother; mother’s test resulted positive after delivery; neonate tested negative at 18 hours; mother breastfed with masking - both mother and neonate asymptomatic -Case 2: Term infant delivered via C-section to COVID+ mother for fetal distress; neonate required resuscitation at birth, intubated and placed on mechanical ventilation; abnormal CXR, acidosis, thrombocytopenia, shock requiring pressors; extubated day of life 3; developed seizures, abnormal MRI (likely HIE based on description); NP PCR negative day of life 3, 5, 8; discharged home day of life 12 |
Point-of-case lung ultrasound in three neonates with COVID-19 Gregorio-Hernandez et al. European Journal of Pediatrics https://link.springer.com/article/10.1007%2Fs00431-020-03706-4 | 6-5-20 | Spain | Case series Neonates | Case series of 3 neonates with COVID-19 in whom lung ultrasound was used to help guide management -Case 1: Term infant with severe HIE, meconium aspiration, multi-organ failure (mother SARS-CoV-2 positive after postpartum fever) -Case 1 diagnosis prompted testing of all other neonates in unit, regardless of exposure and symptom status, leading to diagnosis of cases 2 and 3 -Case 2: 28 week preterm neonate with chronic lung disease diagnosed on day of life 78 (mother SARS-CoV-2 positive, probable postnatal infection) -Case 3: Neonate with Hirschsprung disease diagnosed on day of life 6(parents negative, probable postnatal infection) |
Neonates hospitalized with community-acquired SARS-CoV-2 in a Colorado neonatal intensive care unit White et al. Neonatology | 6-4-20 | US | Case series Neonates/infants | 3 infants aged 17 days, 27 days, and 33 days with community-onset COVID-19 -2 had family sick contacts -Work-up for other viral or bacterial etiologies negative -All neonates neutropenic -All required supplemental oxygen via NC, all with abnormal CXR -None had multi-organ failure -Length of stay 77-81 hours |
A snapshot of the COVID-19 pandemic among pregnant women in France Kayem et al. Journal of Gynecology Obstetrics and Human Reproduction https://www.sciencedirect.com/science/article/pii/S2468784720301707?via%3Dihub | 6-4-20 | France | Case series (per authors) Pregnant women Neonates | Case series of pregnant women in a research network of 33 maternity units in France -617 pregnant women with COVID-19, both laboratory confirmed and clinically diagnosed cases included -93 (15.1%) required respiratory support -35 (5.7%) were critically ill; 6 required ECMO -1 maternal death -High rates of preterm delivery, including 48.3% of those who were critically ill -2 neonates with positive SARS-CoV-2 PCR testing; course not described -One neonate died due to complications of prematurity |
Tetralogy of Fallot palliation in a COVID-19 positive neonate Salik et al. Journal of Clinical Anesthesia https://www.sciencedirect.com/science/article/pii/S0952818020308540?via%3Dihub | 6-1-20 | US | Case report Neonate | Term neonate with Tetralogy of Fallot diagnosed with COVID-19 after presenting with worsening respiratory status and feeding intolerance in the setting of maternal postpartum COVID diagnosis -Neonate prenatally diagnosed with TOF -GA 37 weeks, SGA at 1.9 kg -Neonate presented with desaturation, tachypnea, worsening cyanosis, feeding intolerance, and lethargy -CXR with bilateral opacities, NP PCR positive -Frequent Tet spells, sustained hypoxemia -Decision made for surgical palliation with BT shunt on day of life 15 -Intra-operative course complicated by significant ETT leak requiring replacement with cuffed ETT -Transferred to ICU post-operative on phenylephrine drip -Extubated POD 6 -Repeat PCR testing negative |
Clinical course of coronavirus disease-2019 in pregnancy Pereira et al. Acta Obstet Gynecol Scand https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13921 | 5-22-20 | Spain | Unclear whether retrospective or prospective Pregnant women Neonates | Data from first 60 pregnant women with COVID-19 at single center in Spain over a 1 month period -All women were either evaluated due to COVID symptoms or because they were in labor -18 had evidence of pneumonia on CXR (9 mild, 7 moderate, 2 severe) -All women had confirmatory PCR testing -No maternal deaths -23 delivered (2 preterm), 18 vaginal, 5 C-sections; 5 of those delivered had pneumonia -One woman who delivered required ICU admission in the setting of HELLP -All neonates tested within first 2 hours (NP PCR); if respiratory distress, repeat sample obtained 24h later - all tested negative -21 neonates breastfed -2 required NICU admission - one for RDS, one for hemolytic anemia -6 placentas tested, all negative |
A case report of neonatal acute respiratory failure due to severe acute respiratory syndrome coronavirus-2 Precit et al. Journal of the Pediatric Infectious Diseases Society https://academic.oup.com/jpids/advance-article/doi/10.1093/jpids/piaa064/5842097 | 5-22-20 | US | Case report Neonate | Case report of 10-day-old neonate presenting to ED with rhinorrhea and increased work of breathing in the setting of exposure to sick family contacts 1 week prior -Neonate admitted -Required supplemental oxygen via NC, escalating to HHFNC 5L in the setting of hypoxic respiratory failure -Sepsis evaluation initiated and started on systemic antibiotics -Transferred to PICU at children’s hospital -Improved rapidly and able to wean back to low flow cannula within 24 hours of transfer -CXR with bilateral ground glass opacities on day of transfer -NP PCR positive -Weaned to room air by day 3 of admission -Blood culture positive for S. epidermidis, thought to be contaminant -Discharged home by hospital day 4 -Returned to ED 5 days after discharge with increased congestion, work of breathing, and decreased feeding -Mother newly symptomatic with nasal congestion -Patient and mother both tested positive (NP PCR) - patient’s viral load lower than previously but also positive for human metapneumovirus -Stool SARS-CoV-2 PCR positive -Admitted overnight, required no respiratory support, discharged home next day |
Lack of viral transmission to preterm newborn from a COVID-19 positive breastfeeding mother at 11 days postpartum Perrone et al. Journal of Medical Virology | 5-21-20 | Italy | Case report Postpartum woman Neonate | Case report of woman who became symptomatic 11 days after delivery at 32 weeks gestation -32 week neonate delivered vaginally, required CPAP at birth -Admitted to NICU and weaned off CPAP by 24 hours of life -Neonate breastfeeding, receiving expressed breast milk, and receiving Kangaroo Mother Care (KMC) -Mother developed fever, anosmia, malaise - positive NP PCR; breast milk sample negative → continued use of expressed breast milk -Mother quarantined at home -Neonate with unremarkable course and 3 negative NP PCR samples -Discharged home |
Pregnancy affected by SARS-CoV-2 infection: a flash report from Michigan Qadri et al. The Journal of Maternal-Fetal & Neonatal Medicine https://www.tandfonline.com/doi/epub/10.1080/14767058.2020.1765334?needAccess=true | 5-20-20 | US | Case series Pregnant women | Case series of first 16 pregnant women with COVID-19 admitted to community hospital in Michigan -Gestational age 22-40 weeks -All women had positive NP PCR -4 women had positive risk factor screening, 2 of whom had positive testing prior to admission; all 4 had CXR consistent with pneumonia, 2 required supplemental oxygen; all discharged home undelivered -2 patients admitted for PROM at 31 and 34 weeks with negative risk factor screen, tested when became febrile during labor -8 vaginal deliveries, 4 C-sections -1 preterm birth at 22 weeks (this mother was asymptomatic, PCR test resulted after hospital discharge) - neonatal course not described, presumed no attempt at resuscitation given gestational age and characteristics of delivered neonates do not include this 22 week delivery -Birth weight 2830-4215g, all with reassuring APGAR scores -All neonates isolated, all tested negative at 48h -All discharged -One neonate readmitted day 4 for hyperbilirubinemia |
Testing of patients and support persons for coronavirus disease 2019 (COVID-19) infection before scheduled deliveries Bianco et al. Obstetrics & Gynecology | 5-19-20 | US | Prospective cohort study Pregnant women Support persons | Prospective cohort study assessing rates of SARS-CoV-2 infection among pregnant women scheduled for planned delivery at a single site and their support persons -Patients and support persons underwent telephone risk screening; support persons not permitted to attend birth if screening positive -All patients and screen-negative support persons were tested for SARS-CoV-2 -155 pregnant women and 146 support persons tested -Prevalence of asymptomatic infection was 15.5% (pregnant women) and 9.6% (support persons) -Among pregnant women who were infected, 58% had support persons who were infected; in pregnant women who were negative, <3% had support persons who were infected |
The relationship between status at presentation and outcomes among pregnant women with COVID-19 London et al. American Journal of Perinatology https://www.thieme-connect.de/products/ejournals/html/10.1055/s-0040-1712164 | 5-19-20 | US | Retrospective cohort study | Retrospective cohort study of pregnant women with COVID-19 assessing differences in outcomes between asymptomatic and symptomatic women -81 women tested for positive screen (60 symptomatic, 21 with exposure) and 75 tested due to universal testing (all asymptomatic) -46 symptomatic women tested positive and 22 asymptomatic women tested positive -All but 3 infections were in the third trimester; one symptomatic woman presented with in utero fetal demise at 17 weeks and two were diagnosed at 25 and 26 weeks -Among symptomatic women, 27.3% had preterm delivery and 26.1% required respiratory support during admission; none of the asymptomatic women had preterm delivery or required respiratory support -There were no maternal deaths -55 (80.9%) women delivered, 12 had ongoing pregnancies -9 preterm deliveries - 7 due to maternal respiratory distress, 1 due to non-reassuring fetal heart rate tracing, 1 not reported -48 neonates tested by NP PCR on DOL 0, all negative -No detailed neonatal course presented |
Clinical findings and disease severity in hospitalized pregnant women with coronavirus disease 2019 (COVID-19) Savasi et al. Obstetrics & Gynecology | 5-19-20 | Italy | Prospective cohort study Pregnant women | Prospective cohort study of pregnant women with SARS-CoV-2 admitted to 12 Italian maternity hospitals over a ~5 week period -73 pregnant women, including 14 (18%) with severe disease -Gestational age range 9-39 weeks, most were third trimester infections -84% symptomatic on admission -6 required ICU admission; 1 required ECMO -No maternal deaths -11 delivered for respiratory status -20 women remained pregnant at discharge -Preterm delivery in 12% -9 neonates required NICU admission -4 neonates born to mothers with postpartum diagnosis had roomed in and breastfed prior to maternal diagnosis; none of the neonates developed respiratory symptoms -4 neonates tested positive (3 after vaginal delivery, on DOL 1, 1 after C-section on DOL 7) - unclear whether these were the 4 neonates who roomed in; authors do report that these neonates likely had postnatal transmission |
Effects of SARS-CoV-2 infection on pregnant women and their infants: A retrospective study in Wuhan, China Yang et al. Archives of Pathology & Laboratory Medicine https://www.archivesofpathology.org/doi/10.5858/arpa.2020-0232-SA | 5-19-20 | China | Retrospective cohort study | To be completed |
Vertical transmission of coronavirus disease 2019: severe acute respiratory syndrome coronavirus 2 RNA on the fetal side of the placenta in pregnancies with coronavirus disease 2019-positive mothers and neonates at birth Patane et al. AMJOG MFM https://www.sciencedirect.com/science/article/pii/S2589933320300896?via%3Dihub | 5-18-20 | Italy | To be completed | |
Evidence and possible mechanisms of rare maternal-fetal transmission of SARS-CoV-2 Egloff et al. Journal of Clinical Virology https://www.sciencedirect.com/science/article/pii/S138665322030189X?via%3Dihub | 5-18-20 | France | To be completed | |
Neonatal coronavirus 2019 (COVID-19) infection: A case report and review of the literature Dumpa et al. Cureus | 5-17-20 | US | Case report | To be completed |
Coronavirus disease 2019 in newborns and very young infants: A series of six patients in France Meslin et al. The Pediatric Infectious Disease Journal | 5-15-20 | France | Case series Neonates | To be completed |
Probable congenital SARS-CoV-2 infection in a neonate born to a woman with active SARS-CoV-2 infection Kirtsman et al. Canadian Medical Association Journal | 5-14-20 | Canada | Case report Neonate | To be completed |
Visualization of SARS-CoV-2 virus invading the human placenta using electron microscopy Algaborra et al. American Journal of Obstetrics & Gynecology https://www.sciencedirect.com/science/article/pii/S0002937820305494?via%3Dihub | 5-13-20 | US | Case report Pregnant woman | Case report of pregnant woman at 28 4/7 weeks presenting with respiratory symptoms and known COVID-19 -Presented to ED and admitted for pneumonia -Required intubation and initiation of pressors -On HOD4, worsening metabolic acidosis, prompting to deliver due to maternal condition -C-section performed (29 1/7 weeks) -APGAR scores 3, 5, 6 at 1, 5, 10 minutes -Mother started on remdesivir post-delivery and gradually improved; discharged home on POD 10 -Neonatal SARS-CoV-2 testing negative on DOL 2 and 3 -No details of neonatal course presented -Study focused on placental pathology with reported visualization of single virion invading a syncytiotrophoblast and a single virion visualized in a microvillus, with several others seen at higher magnification |
Acute kidney injury in pregnant women following SARS-CoV-2 infection: A case report from Iran Taghizadieh et al. Respiratory Medicine Case Reports https://www.sciencedirect.com/science/article/pii/S2213007120302306?via%3Dihub | 5-13-20 | Iran | Case report Pregnant woman | To be completed |
Application of pulmonary ultrasound in the diagnosis of COVID-19 pneumonia in neonates Feng et al. Chinese Journal of Pediatrics | 5-13-20 | China | Case series Neonates | To be completed |
Placental pathology in COVID-19 positive mothers: Preliminary findings Baergen et al. Pediatric and Developmental Pathology https://journals.sagepub.com/doi/pdf/10.1177/1093526620925569 | 5-12-20 | US | Case series Pregnant women | Case series focused on placental pathology of pregnant women with confirmed COVID-19 who delivered -All women were in the third trimester of pregnancy and most were term -20 women delivered 21 neonates -Study states that all neonates had APGAR scores of 8 and 9 and were admitted to the well nursery - seems unlikely given stated gestational ages of women, which included a 32 week and 33 week preterm delivery -All neonates reported to test negative -No mothers required ICU admission or mechanical ventilation -Study primarily focused on placental pathology, notable for fetal vascular malperfusion in 9 (45%) |
Neonatal early-onset infection with SARS-CoV-2 in a newborn presenting with encephalitic symptoms Lorenz et al. | 5-12-20 | Germany | Case report Neonate | To be completed |
Report of a series of healthy term newborns from convalescent mothers with COVID-19 Perrone et al. Acta Biomedica https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/9743 | 5-11-20 | Italy | Case series Neonates | To be completed |
The immunologic status of newborns born to SARS-CoV-2-infected mothers in Wuhan, China Liu et al. Journal of Allergy and Clinical Immunology https://www.sciencedirect.com/science/article/pii/S0091674920306400?via%3Dihub | 5-11-20 | China | To be completed | |
COVID-19 in neonates and infants: Progression and recovery Ng et al. The Pediatric Infectious Disease Journal | 5-9-20 | Case series Neonates Infants | To be completed | |
Detection of severe acute respiratory syndrome coronavirus 2 in placental and fetal membrane samples Penfield et al. AJOG MFM | 5-8-20 | US | To be completed | |
Clinical course of severe and critical COVID-19 in hospitalized pregnancies: a US cohort study Pierce-Williams et al. AJOG MFM https://www.sciencedirect.com/science/article/pii/S258993332030077X?via%3Dihub | 5-8-20 | US | Cohort study Pregnant women | To be completed |
Acute respiratory distress syndrome in a preterm pregnant patient with coronavirus disease 2019 (COVID-19) Blauvelt et al. Obstetrics & Gynecology | 5-8-20 | US | Case report Pregnant woman Neonate | Case report of pregnant woman with confirmed COVID-19 at 28 4/7 weeks gestation -PMH notable for asthma, gestational DM, obesity, 3 prior C_sections -Initially started on hydroxychloroquine, azithromycin, and ceftriaxone -Developed fever and respiratory distress on hospital day 2 -Initially on nonrebreather mask, then high flow nasal cannula, and ultimately intubated for respiratory failure -Started on remdesivir, hydroxychloroquine discontinued due to prolonged QTc, antibiotics discontinued -Deep sedation/neuromuscular blockade without significant improvement -Decision made to proceed with C-section - received course of betamethasone, magnesium, and insulin -Uncomplicated C-section under general anesthesia -Birth weight 1880g, APGAR scores 4 and 8 -Neonate required intubation in DR -Placental pathology with evidence of acute chorioamnionitis -Maternal post-delivery course complicated by E. coli UTI; extubated on POD 10 (illness day 17) and discharged home on POD 15 -Neonate admitted to NICU, required surfactant administration for RDS -Neonatal labs notable for leukopenia, neutropenia, lymphopenia, mild acidosis, and negative SARS-CoV-2 testing (NP, OP, rectal PCR, IgM, IgG) -Neonate extubated to CPAP shortly after admission -Neonate admitted in NICU on DOL 16 but has been weaned to HFNC 3L, tolerating full gavage feeds, and reassuring neurologic exam |
COVID-19 in a 26-week preterm neonate Piersigilli et al. Lancet Child and Adolescent Health https://www.sciencedirect.com/science/article/pii/S2352464220301401?via%3Dihub | 5-7-20 | Belgium | Case report Neonate | To be completed |
Intensive care unit admissions for pregnant and non-pregnant women with COVID-19 Blitz et al. American Journal of Obstetrics & Gynecology https://www.sciencedirect.com/science/article/pii/S0002937820305287?via%3Dihub | 5-6-20 | US | Pregnant women | Multi-hospital data on prevalence of ICU admission among pregnant women with COVID-19 (compared with non-pregnant women with COVID-19) -7 hospitals within the same health system -From March 4 until April 9, 2020, there were 1168 symptomatic patients diagnosed with COVID-19, among whom 332 were non-pregnant women and 82 were pregnant women -9.8% of pregnant women with COVID-19 and 15.1% of non-pregnant women with COVID-19 required ICU admission -No details regarding outcomes of pregnant women or any neonates delivered were provided |
Critically ill pregnant patient with COVID-19 and neonatal death within two hours of birth Li et al. International Journal of Gynecology & Obstetrics https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.13189 | 5-5-20 | China | Case report Pregnant woman Neonate | To be completed (overlap with Zhang 3-31-20) |
Coronavirus disease 2019 among pregnant Chinese women: case series data on the safety of vaginal birth and breastfeeding Wu et al. BJOG https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.16276 | 5-5-20 | China | Case series | To be completed |
Early neonatal SARS-CoV-2 infection manifesting with hypoxemia requiring respiratory support SInelli et al. Pediatrics https://pediatrics.aappublications.org/content/early/2020/04/30/peds.2020-1121 | 5-4-20 | Case report Neonate | To be completed | |
Neonatal late onset infection with Severe Acute Respiratory Syndrome Coronavirus 2 Buonsenso et al. American Journal of Perinatology https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1710541 | 5-2-20 | Italy | Case series Neonates | Case series of 2 neonates born to mothers with COVID-19 - these are the 2 neonates delivered in the case series of pregnant women previously reported by Buonsenso et al. (see below) -Case 1: 38 3/7 week term infant, BW 3390, APGAR scores 9-10, asymptomatic and quarantined from mother in pediatric unit. Placental tissue and amniotic fluid negative. Breast milk neg Nasal swab PCR testing negative DOL 1 and 5. Discharged home. |
Multidisciplinary team management and cesarean delivery for a Jordanian woman infected with SARS-CoV-2: A case report AlZaghal et al. Case Reports in Women’s Health https://www.sciencedirect.com/science/article/pii/S2214911220300424?via%3Dihub | 5-1-20 | Jordan | Case report Pregnant woman | Case report of 30-year-old pregnant woman with confirmed COVID-19 -Presented at 36 weeks with cough, rhinorrhea, chills, and headache -Treated with hydroxychloroquine -Obstetric history notable for prior placental abruption at 35 weeks as well as vaginal stillbirth complicated by severe postpartum hemorrhage -C-section performed on hospital day 3 due to obstetric history -Birth weight 2.5 kg, APGAR scores 8,9 -Neonate immediately separated from mother and bottle fed by staff -Neonatal NP swab PCR negative x 3 -Neonate discharged home on day of life 4 -Mother discharged on hospital day 11 after negative NP swab -Breast milk testing subsequently negative and neonate breastfed thereafter |
Evidence of mother-to-newborn infection with COVID-19 Sun et al. British Journal of Anaesthesia https://www.sciencedirect.com/science/article/pii/S0007091220302816?via%3Dihub | 4-28-20 | China | To be completed | |
Vaginal delivery in SARS-CoV-2 infected pregnant women in Northern Italy: a retrospective analysis Ferrazzi et al. BJOG https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/1471-0528.16278 | 4-27-20 | Italy | Retrospective cohort study Pregnant women Neonates | Retrospective cohort study of 42 pregnant women with COVID-19 in Lombardy, Italy; these are likely the cases identified in prior publication by this group re OB Task Force (see below) -All women had confirmed diagnosis of COVID-19 (throat swab SARS-CoV-2 PCR) prior to or within 36 hours of delivery; 10 diagnosed prior to admission, 27 diagnosed after admission but prior to delivery, and 5 diagnosed postpartum while still admitted -Most common pregnancy complication was GDM (n=6, 14%) -Fever was most common symptom (n=26); cough seen in 18, dyspnea in 8, myalgia in 7, diarrhea in 2 -Leukocytosis in 16, lymphopenia in 6, elevated CRP in 17, elevated ast in 5 -19 (45%) diagnosed with pneumonia -7 required oxygen support (NC or CPAP) -4 required ICU admission -Vaginal delivery in 24 (57%); 3 of these with IOL for obstetric indication -Elective C-section in 18 (43%); 8 for indications unrelated to COVID, 10 for worsening dyspnea or other COVID-related symptoms -30 (71%) delivered at term; 4 delivered at </= 34 weeks -Birth weight range 840-4040g -NICU admission in 3 (prematurity or respiratory distress) -Breastfeeding permitted if mother asymptomatic or with mild symptoms; mothers wore surgical masks and used hand hygiene to reduce risk to baby -10 women permitted to breastfeed; 2 additional women had been breastfeeding when diagnosed after delivery - no mask worn, both neonates tested positive for SARS-CoV-2 (100%) - likely postnatal acquisition, though one neonate tested positive on day 1 (the other on day 3) -One neonate immediately separated from mother at delivery (due to maternal postpartum hemorrhage); not breastfed; neonate developed GI symptoms 3h after delivery and respiratory symptoms after 3d -> NICU admission, mechanical ventilation x 1d; initial SARS-CoV-2 OP swab PCR at few hours of life equivocal, but positive 3d later -No other neonates tested positive; none of the positive neonates were delivered to the women who had a C-section for worsening COVID-related symptoms -Women and babies followed until discharge or March 25th, whichever came first; no detailed reporting of clinical course of length of stay -No reported maternal deaths |
Clinical role of lung ultrasound for the diagnosis and monitoring Buonsenso et al. | 4-26-20 | Italy | Case series Pregnant women Neonates | Case series of 4 pregnant women with COVID-19, focused on radiographic findings -Gestational ages 17, 24, 35, and 28 weeks, all with unremarkable PMH -Clinical presentation included cough (4), fever (3), ageusia/anosmia (1), shortness of breath (1) -All women had lymphopenia and elevated LDH; CRP was high in 1 and “slightly elevated” in 3 -Lung US abnormal in all; 3 had resolution of lung pathology on US 4d after admission -One woman required ICU admission for non-invasive ventilation (CPAP); others did not require respiratory support -All women treated with hydroxychloroquine and lopinavir/ritonavir; woman admitted to ICU additionally received tolicizumab -Two women remain pregnant -One delivery at 40 weeks via scheduled C-section -One delivery at 36 weeks via urgent C-section for fetal bradycardia -Both neonates had negative SARS-CoV-2 PCR testing from cord blood and swabs (site not specified) on day of life 1 and 4; both discharged in good condition -Authors emphasize utility of lung US in pregnant women to avoid radiation |
Successful treatment of preterm labor in association with acute COVID-19 infection Browne et al. American Journal of Perinatology https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1709993 | 4-24-20 | United States | Case report Pregnant woman | Case report of pregnant woman with COVID-19 treated for preterm labor -33-year-old woman with PMH significant for asthma and migraines, pregnant at 23 weeks gestation with dichorionic-diamniotic pregnancy and presenting with fever, cough, and myalgias in the setting of contact with multiple family members and church members with COVID-19 -Negative for influenza and group A strep, COVID test obtained in the ED -Sent home for 14d of self-quarantine and prescribed azithromycin and prednisone taper for suspected bronchitis, tylenol prn fever -Returned 9d later to OB with contractions and increased vaginal discharge; URI symptoms improving and fever resolved 7-8d prior; COVID test still pending -Admitted for tocolysis, antenatal steroids (betamethasone, 2 doses 24 hours apart), GBS prophylaxis (ampicillin) - GBS later negative -Reassuring fetal monitoring -Contractions improved with IV fluids and magnesium -Initial COVID test returned positive on hospital day 3 (11 days after specimen obtained) -Magnesium discontinued on hospital day 3 -Discharged home to continue self-quarantine -COVID tests repeated 21 and 22 days after initial positive and both were negative -Remains pregnant at 27 weeks gestation |
Clinical analysis of ten pregnant women with COVID-19 in Wuhan, China: A retrospective study Cao et al. Journal of Infectious Diseases https://www.sciencedirect.com/science/article/pii/S1201971220302630?via%3Dihub | 4-23-20 | China | Retrospective cohort study Pregnant women Neonates | Retrospective cohort study of 10 pregnant women with mild COVID-19 -Singleton gestation in 9, twin gestation in 1 -Gestational age on admission were 33 6/7-40 5/7 -7 (70%) had fever - 2 antepartum, 5 postpartum -1 (10%) with cough and chest tightness -No sore throat, chills, myalgia, respiratory distress, or diarrhea -All women with laboratory confirmed COVID-19 by OP swab PCR, all with mild disease without progression to severe disease -1 (10%) with lymphopenia prior to delivery; 6 (60%) with post-delivery lymphopenia -6 (60%) had chest CT before delivery, 5 of which were abnormal; all women had abnormal chest CT after delivery -Pregnancy complications included PROM (4), gestational DM (1), preeclampsia (3), placental abruption (1), fetal distress (2? - 2 stated in text, 3 in table), hypothyroidism (1), anemia (1) -C-section in 8 (80%) - 2 due to fetal distress, vaginal delivery in 2 (20%); 3 preterm deliveries including twins -> 4 premature neonates -No maternal deaths -None of the neonates had clinical symptoms o -Neonates who were tested had negative throat swab SARS-CoV-2 PCR; unclear how many were tested (data collection section states 5 had test collected within 24 hours, results section states all 11 had negative testing, table lists 4 tests as negative) -No neonates developed fever, cough, or diarrhea through 14 days of follow-up -No neonatal deaths -Telephone follow-up performed until women fully recovered |
Late-onset neonatal sepsis in a patient with COVID-19 Coronado Munoz et al. New England Journal of Medicine https://www.nejm.org/doi/full/10.1056/NEJMc2010614?query=featured_home | 4-22-20 | United States | Case report Neonate | Case report of 3-week-old neonate presenting from home with symptoms of sepsis, confirmed to have COVID-19 -History of prematurity at 36 weeks, maternal GBS colonization (reported intrapartum antibiotic prophylaxis), history of sepsis evaluation in neonatal period due to fever and received 48 hours of empiric antibiotics; work-up negative and discharged home -Presented with 2 day history of congestion, tachypnea, reduced PO -One family member symptomatic, though none of the eight household contacts were tested -Hypothermic, tachycardic, and hypoxic on ED admission; CXR with bilateral linear opacities and RUL consolidation -Started on supplemental oxygen and empiric ampicillin and gentamicin -Transferred to pediatric hospital -On transfer, hypotensive, tachycardic, tachypneic, and hypothermic -Started on droplet and contact precautions, transferred to PICU negative pressure room -Intubated and placed on mechanical ventilation -Received crystalloid and started on vasopressors -NP swabs obtained (positive on day 7 for SARS-CoV-2) -Echocardiogram normal -Elevated inflammatory markers -Antibiotics switched to vancomycin, cefepime, and ampicillin; discontinued after cultures negative at 48 hours (blood, urine, CSF; also ETT though unclear when obtained) -Started on hydroxychloroquine and azithromycin for 5 day course -Respiratory viral panel positive for rhinovirus (from supplemental materials) -Course complicated by pneumothorax requiring chest tube placement -Extubated on day 5 and transferred out of PICU -Discharged on day 9, no supplemental oxygen needed on discharge |
COVID-19 pneumonia in an Iraqi pregnant woman with preterm delivery Asian Pacific Journal of Reproduction Al-kuraishy et al. | 4-21-20 | Iraq | Case report Pregnant woman Neonate | Case report of a 25-year-old pregnant woman at 28 weeks gestation who presented with COVID symptoms and decreased fetal movement -Mother with classic radiographic findings -Confirmed as SARS-CoV-2 PCR positive -Treated with chloroquine -Testing negative after 8 days -Developed preterm labor ~2 weeks after admission and vaginally delivered at 30 weeks -Birth weight 2.2 kg, APGAR scores 8,0 -Neonate admitted to NICU, subsequent negative testing -Mother discharged home; states that she started breastfeeding though may mean expressed breast milk given neonate’s gestational age |
Second-trimester miscarriage in a pregnant woman with SARS-CoV-2 infection JAMA Baud et al. | 4-20-20 | Switzerland | Case report Pregnant woman | Case report of a pregnant woman with confirmed COVID-19 who had a second trimester miscarriage -Presented at 19 weeks with fever, myalgias, fatigue, sore throat, cough, and diarrhea; NP swab positive for SARS-CoV-2 -Two days after initial presentation, developed contractions and had persistent fever - bulging membranes, cervical dilation; labor progressed and had miscarriage -Samples obtained for SARS-CoV-2 testing from mother and fetus notable for negative maternal vaginal swab, urine, and blood, negative cord blood, amniotic fluid, negative fetal samples from mouth, liver, thymus, and anus; placental samples positive from submembrane and cotyledon -Placental pathology notable for funisitis and mixed inflammatory infiltrates |
Severe COVID-19 during pregnancy and possible vertical transmission Alzamora et al. American Journal of Perinatology https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1710050 | 4-18-20 | Peru | Case report Pregnant woman Neonate | Case report of pregnant woman with severe COVID requiring mechanical ventilation and neonate with positive postnatal COVID testing -41-year-old G3P2 woman with history of DM presented at 33 weeks gestation with 4 day history of malaise, low-grade fever, and worsening shortness of breath -Partner and 2 other children also symptomatic -Initially admitted at outside hospital -Given course of steroids for fetal lung maturity -Transferred to another hospital -On admission, labs notable for metabolic acidosis, pancytopenia, elevated CRP, elevated ferritin, and slightly elevated D-dimer and glucose -NP swab positive for COVID-19; serologies negative (partner also tested positive); negative for other common respiratory viruses -Respiratory failure on day 5 after symptom onset necessitated mechanical ventilation -Started on azithromycin, hydroxychloroquine, meropenem, vancomycin, oseltamivir -C-section performed due to maternal respiratory status -Birth weight 2970g, APGAR scores 6 and 8 at 1 and 5 minutes -Neonate separated from mother and immediately isolated without delayed cord clamping or skin-to-skin -Neonate required intubation in the delivery room, thought to be due to effect of maternal sedative medications -Admitted to NICU -Initial CXR normal -No breastfeeding due to maternal status and medications -Neonate extubated after 12 hours and placed on CPAP; not treated with antibiotics -Neonate eventually transitioned to NC -Imaging and labs reported as normal -Neonatal NP swab 16 hours after delivery positive (PCR); IgM and IgG were negative on day of birth, day 4 and day 5; repeat NP PCR positive on day 2 -Maternal IgM and IgG negative on postpartum day 1, positive postpartum day 4 (day 9 after symptom onset) and again positive day 5 -Length of stay and disposition not reported for mother or neonate |
Pronóstico perinatal y de la paciente embarazada con infección por COVID-19 Gonzalez Romero et al. Revista Clinica Espanola | 4-17-20 | Spain | Case report Pregnant woman | (Translated via Google Translate) Case report of a pregnant woman with COVID-19 -44-year-old woman presented at 29 2/7 wga with 12 day history of painful swallowing and cough and several days of fever -SARS-CoV-2 PCR positive (unspecified site) -Labs notable for leukocytosis and lymphopenia -Required supplemental oxygen via NC -Abnormal CXR with bilateral multilobar infiltrates and pleural effusion -Treated with liponavir/ritonavir, chloroquine, ceftriaxone, azithromycin -Worsening tachycpnea 48h later, requiring intubation and mechanical ventilation -Given betamethasone course -C-section performed due to worsening respiratory status, with subsequent improvement in respiratory status -Maternal LOS and disposition not described -No description of neonatal course but would presume NICU admission given gestational age |
Sequential analysis of viral load in a neonate and her mother infected with SARS-CoV-2 Han et al. Clinical Infectious Diseases https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa447/5820869?searchresult=1 | 4-16-20 | South Korea | Case report Adult woman Neonate | Case report of 27-day-old neonate and her mother, both with community-onset COVID-19 -Birth history: Term at 38 6/7 weeks, vaginal delivery, birth weight 3730g -Past medical history: None, breastfed infant -Known exposure to symptomatic family members in the home (grandparents) who had productive cough; mother became symptomatic 2 days later with productive cough, sore throat, chills, myalgias -Neonate developed nasal congestion 1 day after onset of mother’s symptoms; father became symptomatic with chills and sore throat same day and was confirmed to have COVID-19 2 days later → all family members tested and all symptomatic tested positive; two siblings in home tested negative -Neonate admitted given age and mother admitted in same isolation room to care for her -Neonate with elevated temperature on admission (37.6 Celsius), nasal congestion, tachypnea; noted to be jaundiced which was presumed to be breast milk jaundice and resolved in 2-3 days -Over course of admission, neonate became febrile (Tmax 38.4), tachycardic, vomiting, cough -CXR normal, labs unremarkable -Did not require supplemental oxygen -Blood culture negative, urinalysis normal -Neonate not treated with antiviral or antibacterial agents -Fed well, continued to gain weight -Mother remained afebrile, continued to have sore throat and productive cough -Both neonate and mother discharged hospital day 19 after both had two consecutive NP swabs collected >/= 24 hours apart that were negative -Summary of neonatal PCR testing: PCR testing positive from NP, OP, plasma, urine, stool, and saliva; highest viral load at early stage of infection was NP followed by OP; viral load in respiratory specimens decreased over time and undetectable 17 days after onset of symptoms; stool viral load remained high until 18 days after onset; low level viral excretion in urine for more than 10 days -Maternal testing: viral load significantly lower in maternal respiratory and stool specimens than the neonate’s on 10th day; plasma and urine negative; breast milk negative |
Pregnant versus non-pregnant SARS-CoV-2 and COVID-19 hospital admissions: The first 4 weeks in New York Tekbali et al. American Journal of Obstetrics and Gynecology https://www.sciencedirect.com/science/article/pii/S0002937820304373?via%3Dihub | 4-15-20 | United States | Pregnant women | Review of first 4 weeks of data of SARS-CoV-2 positive cases by pregnancy status and weeks -SARS-CoV-2 infection status for pregnant and postpartum patients increased from 0.14% of all hospital admission in week 1 to 5.65% of all hospital admissions in week 4, whereas SARS-CoV-2 infection status for non-pregnant patients rose from 1.21% to 56.79% over the same time period -No detailed data on pregnancy or neonatal outcomes presented |
COVID-19 vaginal delivery - a case report Lowe et al. The Australian & New Zealand Journal of Obstetrics & Gynecology https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/ajo.13173 | 4-15-20 | Australia | Case report Pregnant woman Neonate | Case report of pregnant woman with confirmed COVID-19 infection -Presented at 40 2/7 weeks with upper respiratory symptoms; no fever or hypoxia -Contact with family member with recent travel and confirmed COVID-19 -Admitted for observation -Spontaneous vaginal delivery at 40 3/7 in isolation room -Artificial ROM and augmented with pitocin -Epidural anesthesia -Intrapartum fever thought to be due to COVID-19 but also covered with gentamicin, metronidazole, and cefazolin for possible chorioamnionitis -APGAR scores 9 and 9, no resuscitation required, reassuring cord gases -No maternal-neonatal separation, baby remained with parents in room -Both parents confirmed COVID-19 positive (site not described) -Precautions included strict hand hygiene and wearing surgical masks around baby -Neonate breastfed -Neonatal COVID-19 testing at 24 hours negative (site not described) -Mother and baby discharged home day 4 (unclear whether maternal hospital day 4 or post-delivery day 4) -Family advised to isolate at home and continue precautions until clearance criteria met - provided with box of surgical masks on discharge -Both mother and baby remained well with complete resolution of maternal symptoms and discharge from fever clinical at 10 days after symptom onset |
Clinical characteristics of 19 neonates born to mothers with COVID-19 Liu et al. Frontiers of Medicine https://link.springer.com/content/pdf/10.1007/s11684-020-0772-y.pdf | 4-13-20 | China | Case series Pregnant women Neonates | Case series of 19 neonates delivered to 10 women with confirmed COVID-19 infection and 9 women with clinically diagnosed COVID-19 infection -10 women with confirmed infection had positive throat swab PCR -9 women with clinical diagnosis met the following criteria: (1) fever and/or respiratory symptom; (2) radiographic evidence of typical viral pneumonia (bilateral ground-glass opacities); (3) low or normal WBC count or low lymphocyte count; (4) no improvement in symptoms after antimicrobial treatment for 3 days, ruling out common virus infections like influenza -All women healthy with uncomplicated pregnancy prior to COVID diagnosis -Maternal symptoms included fever (11/19), cough or dyspnea (5/19), diarrhea or other GI symptom (2/19) -6 women treated with anti-viral umifenovir for 5 days prior to delivery -18 women delivered via C-section, 1 vaginally, all in isolation room -3 with prolonged ROM -Median time between symptom onset and delivery was 4 days -All neonates immediately separated from mothers and transferred to another facility with a NICU for isolation for at least 14 days -Gestational age 38.6 +/- 1.5 weeks -Birth weight 3293 +/- 425 grams -All cord blood and amniotic fluid testing negative -None of the neonates developed clinical symptoms of COVID -All neonates had CXR; 17 were normal, 2 showed increased lung markings -All 19 neonates had PCR testing from throat and gastric fluid right after birth as well as urine and feces; all testing negative except 1 neonate with positive throat sample - retesting on same sample was negative and this was thought to be a false positive |
Universal screening for SARS-CoV-2 in women admitted for delivery Sutton et al. New England Journal of Medicine | 4-13-20 | United States | (Letter to the editor) Pregnant women | Universal testing of 215 pregnant women who delivered infants at New York-Presbyterian Allen Hospital and Columbia Irving Medical Center between 3/22/20 and 4/4/20 -Symptomatic screening: 4 (1.9%) had fever or other symptoms on admission; all tested positive -211 women without symptoms, all afebrile on admission; 210 (99.5%) were tested; of these 29 *13.7%) were positive -29 of 33 (87.9%) admitted women who were positive were asymptomatic on admission -Of 29 asymptomatic positive women, 3 (10%) developed fever before discharge; 2 of these women were treated with antibiotics for presumed endomyometritis -1 patient with negative swab on admission became symptomatic postpartum and then tested positive -No detailed description of maternal outcomes -No description of neonatal outcomes or management |
Clinical features and outcomes of pregnant women suspected of Coronavirus Disease 2019 Yang et al. Journal of Infection https://www.sciencedirect.com/science/article/pii/S0163445320302127?via%3Dihub | 4-12-20 | China | Case-control Pregnant women | Report of 55 pregnant women with suspected COVID-19, 13 of women had confirmed COVID-19 by throat swab PCR -> case-control design with 13 confirmed women serving as cases and 42 suspected women with negative testing serving as controls -Among 13 confirmed women, 2 had antepartum fever and 8 postpartum fever; 2 had cough -Chest CT was performed in all 13; 6/13 had ground glass opacity, 5/13 patch-like shadows, 3/13 fiber shadow, 5/13 pleural effusion, 1/13 pleural thickening -No statistically significant difference between cases and controls in WBC count, neutrophils, lymphocytes, neutrophil: lymphocyte ratio, CRP -Among confirmed group, 9 delivered via C-section and 4 delivered vaginally -All neonates admitted to isolation suite of NICU -57 neonates delivered to 55 women -20 neonates (from both groups) were tested with throat swab 24 hours after birth; no case tested positive -3 neonates with respiratory distress syndrome (2 were preterm <35 weeks, 1 was term with chromosomal anomaly) -After hospital discharge, telephone follow-up performed; 1 neonate born to confirmed mother had temperature of 37.7 degrees Celsius |
Unlikely SARS-CoV-2 vertical transmission from mother to child: A case report Peng et al. Journal of Infection and Public Health https://www.sciencedirect.com/science/article/pii/S1876034120304391 | 4-11-20 | China | Case report Pregnant woman Neonate | Case report of late preterm neonate born to mother with COVID -Mother admitted with fever, fatigue, shortness of breath -Chest CT with classic findings -Throat swab positive for COVID on day 6 of symptoms -Mother isolated and treated with interferon nebs, lopinavir, antibiotics, and supplemental oxygen -Given dexamethasone for fetal lung development -C-section performed under droplet, contact, and airborne precautions at 35 3/7 weeks, 7 days after symptom onset -Mother and neonate separated immediately -Neonate transported to NICU in closed isolette -Neonate required CPAP and was given surfactant in the setting of abnormal CXR with reduced lung volumes -Started on empiric ampicillin and gentamicin -Labs notable for leukocytosis and elevated procalcitonin -Antibiotics stopped at 48 hours as blood and sputum cultures negative -Weaned off CPAP on day 5 -After delivery, testing of amniotic fluid, vaginal secretions, placenta, cord blood, serum (neonate or mother?), and breast milk negative -Neonatal throat, anal, serum, and urine testing negative at 2 hours, 1 day, 2 days, 3 days, 7 days, and 14 days; sputum negative at 1 day and 7 days -Neonate discharged home at 14 days |
Mortality of a pregnant patient diagnosed with COVID-19: A case report with clinical, radiological, and histopathological findings Karami et al. Travel Medicine and Infectious Disease https://www.sciencedirect.com/science/article/pii/S1477893920301332?via%3Dihub | 4-11-20 | Iran | Case report Pregnant woman | Case of pregnant woman with COVID-19 infection -Presented at 30 3/7 weeks with fever, myalgia, and cough -No past medical history, no known contact with COVID-19 infected person, worked as housekeeper, no recent travel -Previously uncomplicated pregnancy -Transferred to maternity hospital, had already received oseltamivir, azithromycin, and ceftriaxone prior to arrival -No evidence of rupture of membranes -Admitted to ICU due to tachypnea -Labs notable for leukopenia, lymphopenia, increased creatinine, elevated CRP and LDH -CXR and chest CT abnormal -Required intubation due to respiratory distress, with evidence of metabolic alkalosis on non-invasive ventilation -Mechanical ventilation with SIMV -Suspected COVID-19, started on oseltamivir, lopinavir/ritonavir, hydroxychloroquine, meropenem, and vancomycin; azithromycin and ceftriaxone discontinued -Echo notable for severe RV and RA enlargement, severe R systolic dysfunction, tricuspid regurgitation, EF 50% -Hypotensive requiring epi drip -Sedated -On the day after admission, spontaneous contractions noted followed by spontaneous vaginal delivery -APGAR scores 0 at 1 and 5 minutes, no response to CPR - not specifically described as stillbirth versus neonatal death -Worsening maternal respiratory status following delivery with worsening chest CT and new pleural effusion -Likely ARDS, team suspected acute collagen vascular autoimmune disease and patient started on methylprednisolone and plasmapheresis -Again hypotensive despite increased epi drip -Maternal death due to multi-organ failure, described as ARDS, acute kidney injury, and septic shock -PCR testing positive for COVID-19 (appears to have been collected after death based on writing) -Autopsy of lungs: alveolar spaces with focal hyaline membrane, pneumocyte proliferation, metaplastic changes, viral cytopathic effect with multinucleation and nuclear atypia, lymphocyte and macrophage predominance |
Clinical characteristics and risk assessment of newborns born to mothers with COVID-19 Yang et al. Journal of Clinical Virology https://www.sciencedirect.com/science/article/pii/S1386653220300986?via%3Dihub | 4-10-20 | China | Case series Pregnant women Neonates | Case series of 7 neonates born to mothers with confirmed COVID-19 in Wuhan over a 10 day period in January 2020 -6/7 women with abnormal chest with findings consistent with viral pneumonia -All delivered via C-section (0-6 days after symptom onset): 4 routine to prevent transmission, 2 emergent due to severe preeclampsia, 1 due to severely elevated aminotransferase -Gestational age range 36 weeks - 38 2/7 weeks -Birth weight 1880-3800 grams -APGAR scores all 8 and above -5 of the neonates were immediately separated and transferred to negative pressure rooms in the NICU -2 of the neonates were immediately separated and cared for by healthy family members -1 neonate had hypoglycemia and vomiting, 1 described as having “moan, spit”, 1 described as having “moan” -2 neonates (both late preterm with “moan”) required CPAP -Not all neonates had CXR -All neonates had normal CBC -Some neonates with elevated myoglobin, CK-MB, and D-dimer -Testing in all tested amniotic fluid, cord blood, and neonatal throat swab were negative, though not all neonates had all testing: 5/7 had amniotic fluid testing, 5/7 cord blood testing; 5/7 throat swab at delivery, 5/7 throat swab at 2-5 days; 1 neonate only had the throat swab at 2-5 days but no other testing -Publication references another neonate born at this center to mother with suspected COVID who had hematochezia |
Vaginal delivery report of a healthy neonate born to a convalescent mother with COVID-19 Xiong et al. Journal of Medical Virology | 4-10-20 | China | Case report Pregnant woman Neonate | Case report of pregnant woman with confirmed COVID-19 infection and description of pregnancy and delivery course after recovery from infection -25-year-old woman presented at 33 1/7 weeks with fever and cough 9 days after travel from Wuhan and admitted to ward for isolation -CXR abnormal -Throat swab PCR of COVID-19 returned positive on hospital day 2 -Transferred to another hospital and treated with antiviral, “anti-infection”, and steroid therapies; recovered following treatment -IgM and IgG positive, normal chest CT -2 follow-up PCR tests negative (days of collection not described) -Discharged hospital day 7 -Delivered approximately 1 month following hospital discharge -Spontaneous vaginal delivery at 38 4/7 weeks following PROM -Birth weight 3070g -APGAR scores 9, 10, 10 at 1, 5, 10 minutes -At delivery, amniotic fluid, neonatal throat swab, and rectal swab collected, all negative for COVID by PCR -Neonatal IgM and IgG negative -Placenta negative for N protein of SARS-CoV-2 -Mother and neonate discharged 3 days after delivery |
COVID-19 infection among asymptomatic and symptomatic pregnant women: Two weeks of confirmed presentations to an affiliated pair of New York City hospitals Breslin et al. American Journal of Obstetrics and Gynecology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144599/pdf/main.pdf | 4-9-20 | United States | Case series Pregnant women | Case series of 43 pregnant women with confirmed COVID-19 presenting to 2 NYC hospitals over 2 week period in March 2020 -7 women were identified prior to implementation of universal testing and 36 were identified after -Median gestational age at presentation was 37 0/7 weeks -18 (41.9%) had comorbidities, including asthma, DM, chronic hypertension -Among the 43 women, 3 (7%) were admitted for COVID-19 symptoms, 18 (41.9%) admitted for obstetric reasons, 22 (51.2%) were managed exclusively outpatient; 1 previously symptomatic patients readmitted PPD 6 for supplemental oxygen (same patient as described above) -Among 18 women admitted for OB reasons, 1 was for preterm labor, 1 for scheduled term C-section, 7 term labor, and 9 term labor inductions -37 (86%) of women had mild disease, 4 (9.3%) had severe disease, 2 had critical disease (4.7%) -Among 29 symptomatic women, 25 (86.2%) were discharged home for outpatient management; 4 of these represented within a week requiring admission for worsening fever or increased work of breathing (3 were antepartum, 1 postpartum) -Among 4 symptomatic admitted patients, 1 was treated with hydroxychloroquine and ceftriaxone (presumed superimposed bacterial pneumonia), 1 received IV fluids only (co-infection with parainfluenza), 1 received ceftriaxone, azithromycin, and IV fluids, and the fourth (postpartum) patient required initially nonrebreather face mask oxygen and then supplemental oxygen via NC (CXR with bilateral multifocal pneumonia), also treated with hydroxychloroquine (final patient still admitted) -Among asymptomatic women, 2 initially admitted for OB indicated induction of labor and developed COVID-19 symptoms (1 intrapartum and 1 postpartum) and required ICU admission (these were previously described in this group’s prior publication); the other 12 were identified as part of universal testing -Among 12 asymptomatic women identified via universal testing, 4 (33%) remained asymptomatic, 8 (66.7%) developed fever (5 intrapartum, 3 postpartum) - the 5 with intrapartum fever were treated with ampicillin and gentamicin for presumed intraamniotic infection, 2 of postpartum fevers were treated with antibiotics for presumed endometritis; none developed respiratory symptoms; 13 discharged home to date - 6 (46.2%) developed cough, myalgia, chest pain, anosmia, and/or dysgeusia within first 7 days days after positive test results -Among the 18 women who have delivered, 8 (44.4%) were via C-section for NRFHTs (3), repeat (2), arrest of descent (1), arrest of dilation (1), failed IOL (1); 10 (55.5%) had uncomplicated vaginal deliveries -All had neuraxial anesthesia; 1 required conversion to general anesthesia due to intraoperative hemorrhage (described in prior publication) -All 18 neonates had APGAR scores of >/=7 at 1 minute and >/=9 at 5 minutes -No confirmed neonatal COVID-19 - all tested ;15 tested negative on DOL 0, 2 had unclear results and had repeat negative DOL 1-2; 1 had indeterminate test (clinically managed as presumed negative but may represent low level infection) -3 neonates required NICU admission - 1 for prematurity at 34 6/7 weeks, 1 at 39 5/7 weeks for congenital multicystic dysplastic kidneys, 1 at 37 weeks for respiratory distress with concern for sepsis -No IgM or IgG testing performed in neonates -Healthy neonates either roomed in with mothers in isolettes when possible and otherwise were in an isolated nursery -Mothers asked to perform hand hygiene and wear surgical masks; if rooming in, asked to keep 6 foot distance from baby -Breastfeeding encouraged with use of hand hygiene and maternal masking -All neonates have been discharged home |
Association of COVID-19 with pregnancy outcomes in health-care workers and general women Khan et al. Clinical Microbiology and Infection https://www.sciencedirect.com/science/article/pii/S1198743X20301804?via%3Dihub | 4-8-20 | China | ||
COVID-19 Obstetric Task Force, Lombardy, Italy: executive summary and short report of outcome (Pre-proof publication) Ferrazzi et al. International Journal of Gynecology & Obstetrics https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.13162 | 4-8-20 | Italy | ?Case series (not explicitly stated); interim data analysis Pregnant women | Description of obstetric task force in Lombardy, Italy, and interim data analysis for period of 3/1-3/20/20 -Details of task force not described here, limited review of described maternal data -42 pregnant women with confirmed COVID-19 infection delivered during this time period, representing approximately 0.6% of expected 7000 deliveries in the same region over same time period (true denominator not described/known) -20 (48%) of infected women presented with interstitial pneumonia; 7 (35%) of these required CPAP or were admitted to the ICU -18 (43%) were delivered via C-section -2 women with spontaneous preterm delivery -No details of neonatal outcomes included -Task force describes policy regarding breastfeeding and separation of mother and baby as follows: breastfeeding with mother wearing mask if mother has mild or no symptoms; symptomatic mothers are separated from newborns and women use pumps to express breast milk |
COVID-19 infection in a paucisymptomatic infant: Raising the index of suspicion in epidemic settings Canarutto et al. Pediatric Pulmonology | 4-6-20 | Italy | Case report Infant <2 months | Case report of 32-day-old infant with community-onset COVID-19 -Presented to ED with low grade fever, rhinitis, cough -History of uncomplicated term delivery, no past medical history -Father with URI and conjunctivitis -Neonate with neutropenia, monocytosis -Urine dipstick and blood culture negative -Pharyngeal swab positive for COVID-19 -Admitted for observation -CXR normal -Able to breastfeed well throughout admission, required no supportive therapy -Continued to be febrile in hospital for 3 days -Discharged home after 5 days -Quarantined for 14 days |
Lung ultrasound and computed tomographic findings in pregnant woman with COVID-19 (Pre-proof publication) Kalafat et al. Ultrasound in Obstetrics & Gynecology https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.22034 | 4-6-20 | Turkey | Case report Pregnant woman | Case report of pregnant woman presenting with cough and shortness of breath, with initial negative COVID-19 testing but concerning imaging findings -32-year-old G1 woman developed cough and shortness of breath at 35 3/7 weeks -Medical history notable for thalassemia trait -Family contacts with respiratory symptoms and nausea -No recent travel or known COVID-19 contact -NP and throat swabs obtained 1 day after initial symptoms from mother, her husband, and her father - all negative -Mother presented 2 days later for persistent symptoms; afebrile and not hypoxic at presentation -POC lung ultrasound with thick B-lines bilaterally in basal posterior segments -Referred to COVID-19 clinic; mother declined repeat testing and went home against medical advice -2 days later, presented to outpatient OB clinic with worsening shortness of breath, reduced fetal movement, and swollen left leg -Mother afebrile but tachycardic and mild hypoxia -Lung ultrasound repeated with persistent findings concerning for viral pneumonia -SARS-CoV-2 PCR positive from NP and OP swabs -Chest CT obtained, ruled out PE, otherwise consistent with US findings -Required initiation of NC 2L, admitted to ICU -Decision made to proceed with C-section given worsening respiratory status -C-section under spinal anesthesia uneventful -Neonate with birth weight 2790g, APGAR at 5 min 9 -Placenta and cord blood negative for COVID by PCR; amniotic fluid sample discarded due to blood contamination -Mother admitted to ICU post-operatively on NC 6L -Maternal labs notable for lymphopenia and acidosis -Mother treated with azithromycin, hydroxychloroquine, and oseltamivir -Mother initially transferred to general ward on hospital day 3 but required readmission to ICU on hospital day 4 due to worsening respiratory status prompting intubation -Labs notable for increasing procalcitonin with suspected cytokine storm -Favipiravir and steroids added -Remains in ICU at time of publication -Neonate did not require respiratory support and had negative throat and nasal swabs for COVID-19 by PCR -Maternal breast milk tested negative by PCR and expressed breast milk was given |
COVID-19 in pregnancy with comorbidities: More liberal testing strategies are needed Gidlof et al. Acta Obstetricia et Gynecologica Scandinavica https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/aogs.13862 | 4-6-20 | Sweden | Letter to the editor/case report Pregnant woman Neonates | Case report of 34-year-old primigravid woman with dichorionic twin pregnancy admitted at 36 2/7 weeks gestation due to hypertension and proteinuria; pregnancy otherwise complicated by gestational DM -Presenting symptoms otherwise included mild headache, hoarseness, malaise -Febrile to 38.0 degrees Celsius on admission -Labs notable for elevated uric acid -NP COVID-19 PCR test obtained (positive 3 hours after delivery) -Admitted to isolation room, appropriate PPE used by staff -Treated with paracetamol, labetalol, and nifedipine -Persistent hypertension with associated severe headache -Started on magnesium -Emergency C-section under spinal anesthesia performed -POD 3: mother with desaturations treated with supplemental oxygen via NC; CT chest with typical findings -POD 4: elevated CRP -POD 5: supplemental O2 discontinued -Neonates in good condition at delivery, assessed by pediatrician and then roomed in with mother, mixed breast and formula feeding -Twin A: Birth weight 2680g, APGAR scores 9, 10, 10; 22 minutes after delivery, developed breathing problems and was started on CPAP for 40 minutes (not described whether neonate continued to room in during this time); on second day, cyanotic episode during feed, thought to be due to reflux -Twin B: Birth weight 2160g, APGAR scores 9, 10, 10 -Both twins with negative COVID NP PCR testing at 34 hours and 4.5 days of life -Breast milk and maternal vaginal secretions on POD 5 were negative |
Two cases of coronavirus 2019–related cardiomyopathy in pregnancy Juusela et al. American Journal of Obstetrics & Gynecology MFM https://www.sciencedirect.com/science/article/pii/S2589933320300434 | 4-3-20 | United States | Case series Pregnant women | Case series of 2 pregnant women with COVID-19 associated cardiomyopathy Case 1: -45-year-old woman at 39 2/7 weeks presented with contractions and emesis; history notable for GDM and obesity -No known COVID-19 contacts -Maternal and fetal tachycardia -Admitted for IV fluids and prolonged monitoring -Febrile shortly after admission -Abnormal CXR with pulmonary edema and ground glass opacities -Subsequently developed severe range HTN and tachypnea -Diagnosed with preeclampsia and started on magnesium -Worsening tachypnea, hypoxic, prompting C-section 7.5 hours after presentation -Post-delivery ABG notable for metabolic acidosis, CXR with bilateral opacities -Concern for CHF, magnesium stopped and started on IV furosemide -Cardiology consulted; Echo showed moderately reduced LV ejection fraction → diagnosis of acute heart failure -COVID-19 PCR (unspecified site ) - positive -Troponin normal, mildly elevated BNP and procalcitonin -POD 4: worsening CXR and hypoxia; EKG with nonspecific T wave abnormalities -Started on methylprednisolone and hydroxychloroquine -Continued to have hypoxia on 6L NC with respiratory acidosis -> transitioned to nonrebreather -Intubated due to worsening respiratory status and wanting to avoid non-invasive ventilation in COVID patient, no improvement -Became bradycardic and developed PEA -> CPR and ROSC achieved after 5 minutes -Elevated troponin after arrest, BNP 323 -Started on norepi drip, given tocilizumab -Currently POD 7, remains intubated and ventilated in ICU; arousable, moving all extremities, not hypoxic on current support, continued on norepi and methylpred, on hydroxychloroquine -Improved troponin, now markedly elevated procalcitonin Case 2: -26-year-old woman at 33 6/7 weeks presented with shortness of breath and decreased fetal movement; history significant for PCOS -Husband diagnosed with COVID-19 -Tachycardic on presentation, ABG notable for metabolic acidosis, CXR with bilateral infiltrates -Respiratory viral panel negative; elevated CRP, normal troponin -SARS-CoV-2 testing positive (unspecified site) -Treated with fluid restriction, supplemental oxygen via NC, ceftriaxone, azithromycin -Echo obtained (primarily due prior experience with case 1), notable for moderately reduced LV EF with global hypokinesis -Started on metoprolol -C-section delivery on hospital day 6 at 34 4/7 weeks due to COVID, recovered on telemetry -Remains admitted (POD 1, hospital day 7) and now on room air; developed SVT, prompting increase in metoprolol -Afebrile throughout admission -No presentation of neonatal course for either case |
SARS-CoV-2 is not detectable in the vaginal fluid of women with severe COVID-19 infection Qiu et al. Clinical Infectious Diseases https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa375/5815295?searchresult=1 | 4-2-20 | China | Case series Women | Case series of 10 postmenopausal women with confirmed COVID-19 infection -Study conducted in postmenopausal women but included here due to evaluation of vaginal fluid, which may have implications on pregnant women with COVID-19 -All women had severe pneumonia requiring ICU admission -Vaginal swab negative for COVID-19 by PCR in all women |
First case of neonate infected with novel coronavirus pneumonia in China (in Chinese) Zeng et al. Chinese Journal of Pediatrics | 4-2-20? | China | Case report Neonate | (Translated via Google Translate) Case report of 17-day-old full term neonate who presented from home in the setting of known household contact with COVID-19 -First symptoms included sneezing, intermittently associated with “spitting milk” -Laboratory studies unremarkable including normal WBC count and inflammatory markers, respiratory viral testing negative for influenza, parainfluenza, RSV, and adenovirus -Head CT obtained (unclear reason) -Abdominal ultrasound and Echo unremarkable -Chest CT and CXR abnormal - improved over course of admission -NP swab on hospital day 3 positive for COVID-19, NP and anal swab positive on hospital day 4, NP swab negative and anal swab positive on hospital day 5 -Symptoms throughout hospital course included temperature of 37.8 degrees Celsius, vomiting, and diarrhea -Supportive treatment included IV fluids and vitamin K (reason not described) -Symptoms resolved by hospital day 7 -Admission duration not described |
An uncomplicated delivery in a patient with COVID-19 in the United States Iqbal et al. New England Journal of Medicine | 4-1-20 | United States | Case report Pregnant woman | Case report of pregnant woman presenting to L&D at 39 weeks with 3 day history of fever, chills, dry cough, and myalgia with decreased fetal movement for 1 day; husband with similar symptoms; no recent travel -Mother placed on droplet and contact precautions -Transferred to ED due to no immediate OB intervention needed -Initial ED exam notable for diminished breath sounds -CXR with reticular interstitial opacities -Labs notable for lymphopenia -NST reactive, US normal -NP and OP swabs obtained for COVID-19, influenza, and other respiratory viral infections; COVID positive -Hospital day 2: onset of painful, irregular contractions; labor augmented -Hospital day 3: uncomplicated spontaneous vaginal delivery -APGAR scores 8 and 9 -No delayed cord clamping, no skin-to-skin contact -Neonate moved to a separate room until discharge, fed with formula and expressed breast milk -No neonatal testing reported -Mother discharged home with neonate on hospital day 6 -Telephone follow-up after delivery: no signs of neonatal infection |
First case of neonatal infection due to SARS-CoV-2 in Spain (in Spanish) Alonso Diaz et al. Anales de Pediatria https://www.sciencedirect.com/science/article/pii/S1695403320301302?via%3Dihub | 4-1-20 | Spain | Case report Neonate | (Translated via Google Translate) Case report of post-delivery COVID diagnosis in mother and neonate -Mother underwent urgent C-section for severe preeclampsia at 38 4/7 weeks; IVF pregnancy, maternal history of hypothyroidism -Neonate was SGA -APGAR scores 7 and 9 -Neonate required oropharyngeal suctioning in the DR -Started on CPAP 21% and admitted to the neonatal unit; CPAP discontinued by 2 hours of life and physical exam normal by 9 hours - course initially interpreted as delayed transitioning -Neonate moved to maternity ward with mother -On day 3 of admission, mother developed low-grade fever -Common viral infections were ruled out and PCR for COVID-19 was positive; her partner also tested positive (presented with GI symptoms) -Neonate had been asymptomatic and feeding breast milk and formula -Neonate separated from mother (isolated in maternity ward) and COVID-19 testing was performed and was negative on day of life 6; repeat testing on day of life 8 from NP was positive -Neonate transferred to neonatal unit and developed intermittent tachypnea with mild retractions and brief desaturations with sleep and feeding -Mild respiratory acidosis, CXR with slight opacity of right perihilar region -Neonate asymptomatic again after about 24 hours and remains admitted -Mother is in intensive care requiring mechanical ventilation -Suspected horizontal transmission |
Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis: a case report Kamali Aghdam et al. Infectious Diseases https://www.tandfonline.com/doi/full/10.1080/23744235.2020.1747634 | 4-1-20 | Iran | Case report Neonate | Case report of 15-day-old neonate who presented from home with clinical signs of sepsis and was diagnosed with COVID-19 -Unremarkable birth history, C-section delivery -Initial presentation with fever, lethargy, mottling, and respiratory symptoms -Parents with recent fever and cough; mother also with diaphoresis, weakness, and malaise -Neonate admitted to neonatal ward; required transfer to NICU due to respiratory distress, where he was isolated -Required IV fluids, supplemental oxygen, antibiotics (vancomycin and amikacin), and antiviral (oseltamivir) -Neonate PCR testing (pharynx) positive for COVID-19, negative for influenza -Otherwise unremarkable laboratory testing with normal WBC count and CRP not elevated -Blood, stool, and urine cultures negative -Normal CXR -Neonate gradually improved and discharged on hospital day 6 -No parental testing performed since neither parent required hospitalization (Iranian Ministry of Health guidelines) |
Emergency cesarean section on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed patient (Pre-proof publication) Lee et al. Korean Journal of Anesthesiology | 3-31-20 | South Korea | Case report Pregnant woman | Case report of pregnant woman with confirmed COVID-19 infection -28-year-old G1P0 woman recommended for C-section due to cephalopelvic disproportion -Recent contact with confirmed COVID-19 patient and began self-isolation -Symptomatic 11 days after starting self-isolation with fever, sore throat, and cough; tested positive for COVID-19 -Initially planned to delay delivery until completely recovered from symptoms but required emergency C-section 10 days after symptom onset due to obstructed labor -Admitted to negative pressure room -Abnormal CXR and chest CT -Emergency C-section performed under spinal anesthesia -Nausea and hypotension following spinal, required colloid and phenylephrine -C-section otherwise uneventful -Repeat COVID-19 PCR testing on day of delivery and 2 days later were negative; mother moved to general ward on POD 4 and discharged home POD 5 -Neonate with birth weight 3130g, APGAR scores 9 and 10 -Neonate admitted to separate, private room in the NICU -Neonatal testing negative from NP swab PCR x 2 -Placenta, amniotic fluid, cord blood testing negative -Neonate did well and was discharged with mother on day of life 5 |
Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study Li et al. Clinical Infectious Diseases https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa352/5813589 Pre-publication version available 3-13-20: https://www.medrxiv.org/content/10.1101/2020.03.10.20033605v1 | 3-30-20 | China | Case-control study Pregnant women in labor during third trimester Neonatal outcomes | 16 pregnant women with confirmed COVID-19 pneumonia; none with known exposure history 18 suspected cases 121 women as controls, admitted during same time period 121 women as historical control, admitted in 2019 32 delivered via C-section, 2 via vaginal delivery (hospital used COVID-19 as indication for C-section since Jan 24 2020) Low rates of preterm delivery though study only included women in third trimester 17 neonates delivered to 16 confirmed COVID-19 mothers 19 neonates delivered to 18 suspected mothers No neonates with confirmed COVID-19 infection No severe neonatal complications Neonates were isolated from mothers after delivery and cared for by other family members |
Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia Chen at al. Journal of Medical Virology (Accepted, pre-print) | 3-28-20 | China | Case series Pregnant women Neonates | Case series of 5 pregnant women admitted to single center in Hubei Province in China between 1/20 and 2/10/20 who developed symptomatic COVID-19 infection after delivery -All term, range 38-41 wga -2 (40%) with gestational DM and 1 (20%) with preeclampsia -All admitted for regular delivery without symptoms of COVID-19 -Length of admission prior to delivery varied from 0-1 days; length of admission prior to diagnosis varied from 0-4 days -No antepartum fever, all developed low-grade fever (temperatures included 37.4-38.5 degrees Celsius) within 24 hours after delivery -None had shortness of breath or hypoxia -1 (20%) woman did have cough 1 day before delivery, 1 (20%) had cough and rhinorrhea 10 days before delivery -All women with normal liver and renal function -4 (80%) with elevated CRP -All with hypoalbuminemia -1 (20%) with mildly elevated CK -All with abnormal chest CT with ground glass opacities -Testing for common respiratory pathogens positive in 2 (40%) for mycoplasma pneumoniae, otherwise negative -All positive for COVID-19 by PCR testing; date of diagnosis varied from day of delivery (20%) to day after delivery (60%) and 3 days after delivery (20%) -1 (20%) emergent C-section for fetal tachycardia, 1 (20%) elevative C-section due to GDM, 3 (60%) vaginal delivery -Birth weight range 3235-4050 grams; APGAR scores reported as 10 and 10 at 1 and 5 minutes for all neonates -No neonatal complications -All neonatal PCR testing negative for COVID-19 (testing site and timing not described) -No cord blood testing or amniotic testing performed (lack of reagent cited) -All mothers asked to stop breastfeeding and treated with oseltamivir and azithromycin |
COVID-19 in pregnancy: early lessons Breslin et al. American Journal of Obstetrics & Gynecology https://www.sciencedirect.com/science/article/pii/S2589933320300410 | 3-27-20 | United States | Case series Pregnant women | Case series of 7 pregnant women presenting to tertiary care center with confirmed COVID-19 infections -5 presented with clinical symptoms such as cough, myalgia, fever, chest pain, headache; 4 of the 5 were admitted; 2 required IV fluids -2 initially asymptomatic and admitted for induction of labor; both became symptomatic post-partum and required ICU admission -Case 1: induction of labor for poorly controlled type 2 DM and intrahepatic cholestasis of pregnancy; febrile intrapartum, initially suspected chorioamnionitis; C-section for arrest of descent complicated by uterine atony with postpartum hemorrhage, required intubation, complicated by severe bronchospasm; CXR abnormal and COVID-19 testing positive; admitted to SICU and treated with hydroxychloroquine; extubated after 8 hours and discharged postpartum day 4 -Case 2: induction of labor at 37 wga for worsening chronic hypertension, also with history of mild intermittent asthma and type 2 DM; delivered via C-section after failed induction; new onset cough 25 hours after delivery (60 hours after admission), progressed to respiratory distress, fever, diaphoresis; CXR with mild pulmonary edema; COVID-19 PCR testing positive; treated with hydroxychloroquine, azithromycin, ceftriaxone; temporary respiratory improvement but developed severe hypertension requiring nicardipine drip and admitted to ICU; remains hospitalized with supplemental oxygen requirement and AKI -Both neonates placed in isolation; neonatal PCR testing negative -Both cases involved significant HCW exposure without PPE prior to diagnosis |
Can SARS-CoV-2 infection be acquired in utero? More definitive evidence is needed Kimberlin et al. JAMA https://jamanetwork.com/journals/jama/fullarticle/2763851?resultClick=1 | 3-26-20 | N/A | Editorial to accompany Zeng and Dong articles described below | Editorial response to two separate articles published in JAMA (Zeng et al., Dong et al., see below) describing elevated IgM in 3 total infants and suggesting possibility of vertical transmission -None of these neonates had positive PCR testing -IgM antibodies too large to cross placenta and elevation could represent fetal production following in utero infection -Congenital infections usually not diagnosed based on IgM detection because IgM assays can be associated with false-positive and false-negative results, as well as cross-reactivity and testing issues -Examples provided include CMV (low overall sensitivity of original IM assay), rubella (false-positive IgM due to presence of rheumatoid factor or incomplete removal of IgG, maternal in origin), toxoplasmosis (sensitivity of IgM alone 54-76%), Zika (false-positives due to nonspecific reactivity or cross-reactivity with other flaviviruses) -Described decline of IgM values in Dong et al study unusual - very rapid decrease, whereas usual IgM decline (for example congenital rubella) takes months -Cited sensitivity and specificity of assays used in Dong and Zeng studies inadequate for review by authors of editorial |
Antibodies to infants born to mothers with COVID-19 pneumonia Zeng et al. JAMA https://jamanetwork.com/journals/jama/fullarticle/2763854?resultClick=1 | 3-26-20 | China | Case series Pregnant women Neonates | Case series of 6 pregnant women with COVID infection who delivered 6 neonates -IgG/IgM testing for SARS-CoV-2 became available in February 2020 -China’s National Health Commission released 7th edition of New Coronavirus Pneumonia Prevention and Control Protocol on March 4, 2020; added serologic diagnostic criteria -New criteria applied to 6 pregnant women with COVID-19 and their infants -All women had mild clinical symptoms and were delivered via C-section in third trimester in negative pressure rooms; mothers and neonates separated immediately -All neonates had APGAR scores 8-9 at 1 minute and 9-10 at 5 minutes -Maternal blood samples collected at delivery -Neonatal blood and throat swab samples at birth -Neonatal testing included PCR from blood and throat, inflammatory cytokines, and serum IgM and IgG testing -Maternal testing included serum IgM and IgG -All neonatal PCR testing was negative -2 (33%) neonates had elevated IgM and IgG levels -3 (50%) neonates had normal IgM but elevated IgG levels -IL-6 elevated in all infants -None of the neonates had any symptoms (follow-up likely not complete for most recent delivery given provided dates); incomplete data on neonatal outcomes is acknowledged by authors -No testing of cord blood, amniotic fluid, or breast milk |
Possible vertical transmission of SARS-CoV-2 from an infected mother to her newborn Dong et al. JAMA https://jamanetwork.com/journals/jama/fullarticle/2763853?resultClick=1 | 3-26-20 | China | Case report Neonate | Case report of 1 neonate born to COVID-19 infected mother -29-year-old P0 mother presented at 34 2/7 wga with exposure to COVID, fever, congestion, and respiratory distress; chest CT 3d later with patchy ground glass opacities bilaterally; NP swab positive -Mother admitted 5d after initial presentation and treated with antiviral, antibiotic, corticosteroid, and oxygen -Multiple repeat NP swabs positive -Antibody levels to SARS-CoV-2 obtained day prior to delivery - IgG 107.89 AU/ml and IgM 279.72 -Vaginal secretions negative by PCR day prior to delivery -Neonate delivered via C-section in negative pressure room with immediate separation -Birth weight 3120 grams, APGAR scores 9 and 10 -Neonate asymptomatic, quarantined in NICU -Antibody titers sent from neonate at 2 hours of age; IgG 140.32 and IgM 45.83 -IL-6, IL-10 elevated; authors describe WBC count as elevated though reference range used is not neonatal reference range -Mildly elevated ast, elevated LDH -Chest CT normal -Neonate transferred to Children’s Hospital -NP swab x 5 from DOL 0 to DOL 16 all negative -Antibody titers continued to be elevated -Discharged home DOL 25 -Authors state that elevated neonatal IgM is indicative of neonatal infection as IgM not transferred via placenta |
Neonatal early-onset infection with SARS-CoV-2 in 33 neonates born to mothers with COVID-19 in Wuhan, China Zeng et al. JAMA Pediatrics https://jamanetwork.com/journals/jamapediatrics/fullarticle/2763787?resultClick=1 | 3-26-20 | China | Prospective cohort study Neonates | Cohort of 33 neonates born to mothers with COVID-19 recruited at Wuhan Children’s Hospital -C-section delivery and immediate separation of mother and baby -Most common symptom was shortness of breath (4/33) -3 of 33 (9.1%) tested positive for COVID-19 -Case 1: maternal COVID-19 pneumonia meconium-stained amniotic fluid, C-section delivery at 40 wga; on DOL 2, infant presented with lethargy and fever and was transferred to the ICU; CXR notable for pneumonia, elevated procalcitonin, NP and anal swabs positive for COVID-19 on DOL 2 and 4, negative on DOL 6 -Case 2: maternal COVID-19 pneumonia, C-section delivery at 40 4/7 wga; neonate presented with lethargy, vomiting, fever; labs notable for leukocytosis, lymphopenia, elevated CK-MB; CXR consistent with pneumonia; NP and anal swabs positive on DOL 2 and 4, negative on DOL 6 -Case 3: maternal COVID-19 pneumonia, PROM, C-section at 31 2/7 wga due to fetal distress and maternal pneumonia; APGARs 3, 4, 5, required resuscitation; CXR on admission with RDS and pneumonia, supported with noninvasive ventilation, caffeine, and antibiotics, resolved by DOL 14; suspected sepsis with Enterobacter agglomerates-positive blood culture, leukocytosis, thrombocytopenia, and coagulopathy, improved with antibiotics; NP and anal swabs positive on DOL 2 and 4, negative on DOL 7 -None required mechanical ventilation and there were no neonatal deaths -Authors acknowledge that clinical presentation of these 3 positive neonates may be due to other causes, including sepsis, RDS, etc. -No description of outcomes for neonates without positive testing |
Experience of clinical management for pregnant women and newborns with novel coronavirus pneumonia in Tongji Hospital, China Wang et al. Current Medical Science | 3-26-20 | China | Comment | Description of clinical management of pregnant women with COVID-19 and their neonates, using combination of “New Diagnosis and Treatment Scheme for Novel Coronavirus Infected Pneumonia (Trial Edition 5)” and site’s own clinical treatment experience -No patient data presented |
A pregnant woman with COVID-19 in Central America Zambrano et al. Travel Medicine and Infectious Disease https://www.sciencedirect.com/science/article/pii/S1477893920301071?via%3Dihub | 3-25-20 | Honduras | Case report Pregnant woman | Case report of a pregnant woman with recent travel to Spain who presented with clinical symptoms and had positive testing for COVID-19 -41-year-old woman at 31 weeks gestation with history of gestational hypertension and hypothyroidism; fetal US notable for unilateral dysplastic and multicystic kidney -Presented with fever, cough, headache and myalgias with onset a few days after return from Spain -NP aspirate PCR positive for COVID-19 -Mother admitted for observation -Preterm delivery via spontaneous vaginal delivery 10 days after admission at 32 weeks gestation -Birth weight 1500 grams -NP and blood negative for COVID-19 by PCR -No details of neonatal course |
SARS-CoV-2 infection with gastrointestinal symptoms as the first manifestation in a neonate Wang et al. Chinese Journal of Contemporary Pediatrics | 3-25-20 (date added to PubMed) | China | Case report Neonate | Abstract only, article in Chinese -Neonate presented with emesis and refusal of PO -Admitted to Wuhan Children’s Hospital (presumably from home) -Two weeks of treatment -Gradual improvement and discharged home |
Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study Yu et al. Lancet Infectious Diseases https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30176-6/fulltext | 3-24-20 | China | Case series Pregnant women Neonates | Case series of 7 pregnant women admitted from 1/1-2/8/20 to single center in Wuhan, China -Maternal history notable for hypothyroidism (1) and PCOS (1) -Maternal clinical presentation included fever (86%), cough (14%), shortness of breath (14%), diarrhea (14%) -Maternal diagnosis by throat swab PCR -Labs notable for lymphopenia (71%), thrombocytopenia (29%), elevated D-dimer (100%), elevated transaminases (29%), elevated procalcitonin and/or ESR (57%), elevated CRP (100%), elevated IL-6 (100% of 4 tested) -Co-infections with H1N1 (29%), Legionella (14%) -Chest CT abnormal in all with bilateral involvement in 86% -All mothers required supplemental oxygen and received oseltamivir, ganciclovir, inhaled interferon, antibiotics, and arbidol, as well as traditional Chinese medicine -None required ICU admission, no maternal deaths -C-section delivery in all within 3 days of presentation; 6 with combined spinal/epidural, 1 with general anesthesia -Average gestational age 39 2/7 -4 neonates taken home and were not tested -3 neonates were admitted for observation and tested; 1 (33%) was positive at 36 hours after birth -Neonate with positive testing transferred to Children’s Hospital, mild shortness of breath with abnormal CXR, resolved quickly; discharged home after 2 weeks following negative testing x 2 -All neonates well on follow-up call at 28 days |
Pregnancy and perinatal outcomes of women with Coronavirus Disease (COVID-19) pneumonia: A preliminary analysis Liu et al. American Journal of Roentgenology https://www.ajronline.org/doi/10.2214/AJR.20.23072 Follow-up publication: Follow-up information about the four pregnant patients with Coronavirus Disease (COVID-19) pneumonia who were still in the hospital at the end of our study Li et al. | 3-19-20 4-16-20 | China | Case series Pregnant women Neonates Case series Pregnant women | Case series of 15 pregnant women with confirmed COVID-19 infection with pneumonia -11 women delivered - 10 C-sections, 1 vaginal -4 women still pregnant (3 second trimester, 1 third trimester) at end of study period -In pregnant women, most common presenting symptoms were fever (13/15) and cough (9/15); most common early chest CT finding was ground glass opacity, progressing to “crazy paving pattern” and consolidation; most common lab findings was lymphopenia (12/15), 10/15 had elevated CRP -14/15 required oxygen, 11/15 treated with antivirals, all treated with antibiotics -No worsening of pneumonia on chest CT post-delivery Follow-up publication: -Letter describing outcomes in the 4 women who were still pregnant (patients 12-15) -All patients had been discharged from hospital by March 30 with negative results of 2 consecutive PCR tests at least 24 hours apart; all had normalized labs and vital signs and none had preterm delivery or spontaneous abortion -Patient 12 had repeat chest CT that was imprvoed |
An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission Schwartz Archives of Pathology & Laboratory Medicine (early online release) https://www.ncbi.nlm.nih.gov/research/coronavirus/publication/32180426 | 3-18-20 | China | Review Pregnant women Neonates | Review of previously published case series of a cumulative 38 pregnant women with COVID-19 in China, giving birth to 39 neonates First case series (Chen et al.) - primary manuscript reviewed elsewhere in this document Second case series (Liu et al.) - primary manuscript reviewed elsewhere in this document Third case series (Zhu et al.) - primary manuscript reviewed elsewhere in this document Fourth report (Zhang et al.) - primary manuscript in Chinese, summary here: -16 pregnant women with COVID-19 compared with 45 uninfected pregnant women -16 women with COVID-19: GA at delivery 35 5/7-41 wga; 3 had gestational diabetes, 3 with PROM, 3 with preterm deliveries; 1 women had severe preeclampsia, meconium-stained fluid, fetal distress, and fetal asphyxia -All women with COVID-19 delivered via C-section -No significant differences between infected and uninfected women in occurrence of: severe preeclampsia, gestational diabetes, preterm delivery, neonatal asphyxia -Among neonates delivered to infected women, 10 were tested and all were negative; of these 10, 9 were term and 1 was delivered at 36 2/7 wga -Three neonates had “bacterial pneumonia” based on symptoms, laboratory testing, sputum culture, and imaging results, all recovered with treatment - specific data not available in this review -All neonates were well at follow-up after hospital discharge |
Coronavirus disease 2019 (COVID-19) in Italy Livingston et al. JAMA | 3-17-20 | Italy | Population-level data (infographic only) | Summarizes data out of Italy through 3-15-20 Out of 22512 cases, only 1.2% were in pediatric patients; no specific breakdown given whether any neonatal cases No pediatric deaths No data on pregnant women |
Perinatal transmission of COVID-19 associated SARS-CoV-2: Should we worry? Fan et al. Clinical Infectious Diseases https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa226/5809260?searchresult=1 | 3-17-20 | China | Case series Pregnant women Neonates | 2 cases of COVID-19 in pregnant women (both physicians) during third trimester First case: -34-year-old woman at 37 weeks gestation, initially presented with congestion and ultimately febrile, developed rash, and was confirmed as COVID-19 with nasopharyngeal swab on day 8 of illness -Admitted on day 10 of illness -Treated with azithromycin, oseltamivir, and lianhua qingwen -Initial chest CT negative but patchy infiltrates noted on repeat CT on hospital day 4 -> given methylprednisolone 20 mg IV daily x 2 -Delivered via C-section on hospital day 6 -Birth weight 3400 grams, Apgars 9 and 10 -Mother and baby separated immediately -Negative testing from newborn NP swab, maternal serum, placental tissue, cord blood, amniotic fluid, vaginal swab, and breast milk -Neonate developed “low-grade fever” and abdominal distention; labs notable for lymphopenia on day 3; CXR with diffuse haziness bilateral lung fields day 4 -Neonate treated with antibiotics and discharged on day of life 8 -Mother treated with cefotiam, ornidazole, and methylprednisolone after delivery -Mother with decreasing viral load and gradual normalization of WBC and lymphocyte counts -Mother with negative NP swab x 2 on hospital days 17 and 20 but again positive on hospital day 24 Second case: -29-year-old women at 36 weeks gestation, initially presented with fever, chills, congestion, and sore throat (on same day as discharged from hospital after admission for vaginal bleeding) -Husband with known exposure to COVID-19 patient -Initially treated with diclofenac, admitted due to persistent fever on day 3 of illness -Initial labs notable for lymphopenia, NP swab positive -Treated with ceftazidime, oseltamivir, and linhua qingwen -Chest CT with patchy infiltrates -> methylprednisolone 20 mg IV daily added -C-section performed at 36 5/7 weeks on day 8 of illness/hospital day 6 -Birth weight 2890g, Apgars 9 and 10 -Negative testing of products of conception and neonate -Neonate developed mild pneumonia and lymphopenia -Treated with antibiotics with good response within 2 days -Mother discharged on hospital day 26 after negative chest CT and negative NP swab x 2 Notes: -Breastfeeding was discouraged in these cases despite negative samples -Authors state low risk of vertical transmission but offer no explanation of neonates’ symptoms |
Coronavirus in pregnancy and delivery: Rapid review and expert consensus Mullins et al. Ultrasound in Obstetrics & Gynecology https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1002/uog.22014 Pre-publication version available: https://www.medrxiv.org/content/10.1101/2020.03.06.20032144v1 | 3-8-20 | Review Pregnant women Neonatal outcomes | Combined data from 18 case reports and case series - unclear which countries included 19 pregnant women with confirmed COVID infection 16 (84%) women symptomatic, majority with CXR/CT changes 3 (16%) women asymptomatic 1 (5%) woman required ICU admission No maternal deaths 20 neonates delivered to 19 women (all within 13 days of symptom onset) 17 (89%) delivered via C-section; indication not included in all 8 (42%) preterm deliveries No placental pathology available 1 neonatal death - 34 weeks at delivery, respiratory distress at 30 minutes of life, developed shock, DIC, and multi-organ failure; died at 8 days of life 15 tested neonates, no evidence of vertical transmission | |
A 55-day-old female infant with COVID-19: presenting with pneumonia, liver injury, and heart damage Cui et al. The Journal of Infectious Diseases (accepted, pre-publication release) https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa113/5807961?searchresult=1 | 3-17-20 | China | Case report Infant <2 months | 55-day-old female infant initially presenting with rhinorrhea and dry cough Parents diagnosed with COVID-19 on child’s day 4 of illness after contact with ill family members (~1 week prior) Admitted on day 6 of illness; nasopharyngeal swab positive Initial exam notable for pharyngeal hyperemia; chest CT with classic findings Abnormal hepatic function and myocardial zymogram Elevated lymphocyte count, platelet count, CD8+ T lymphocyte count, serum IgM Treated empirically with inhaled interferon alpha-1b, amox-clav, reduced glutathione, ursodeoxycholic acid, and traditional Chinese medicine (lotus qingwen) Worsening illness hospital days 2-6 (days 7-11 of illness) with productive cough, intermittent tachycardia, hypoxemia, elevated lactic acid -> supplemental oxygen, ambroxol Chest CT on hospital day 4 with progressive pneumonia Elevated troponin on hospital day 4 -> added IV sodium creatine phosphate Stool viral PCR positive on day 11 of illness Gradual improvement hospital days 7-12 (days 12-17 of illness) -> oxygen discontinued Hepatic function and myocardial zymogram normalized by hospital day 10 Chest CT improved by hospital day 11 Repeat pharyngeal swabs x 3 hospitals day 10-13 were negative Amox-clav discontinued hospital day 11 Interferon alpha-1b discontinued hospital day 12 Continued to have detectable virus on stool samples hospital days 11 and 13 -> decision made to keep inpatient; transferred to another facility for continued isolation and observation despite otherwise asymptomatic. Stool sample eventually negative. Maternal breast milk tested x 3 and negative |
Infants born to mothers with a new coronavirus (COVID-19) Chen at al. Frontiers in Pediatrics https://www.frontiersin.org/articles/10.3389/fped.2020.00104/full | 3-16-20 | China | Case series Neonates | Case series of 4 full-term neonates born to mothers with confirmed COVID-19 infections -Mothers presented with fever (75%), cough (50%), myalgia/fatigue (50%), headache (50%), dyspnea (25%) -1 with decreased fetal movement -All mothers with lymphopenia and elevated CRP, 1 with thrombocytopenia -All women positive on throat swab PCR for COVID-19, all with abnormal chest CT -1 pregnancy complicated by cholecystitis, another by placenta previa -3 delivered via C-section, 1 vaginally -All neonates separated from mothers immediately after birth, no breast milk given -3 mothers discharged 3-5 days after delivery; 1 mother with severe dyspnea after delivery and required respiratory support but did survive -2 of 4 neonates healthy; the other 2 developed rashes -1 neonate with diffuse maculopapular rash and one forehead ulceration; rash disappeared and skin desquamation noted the next day; this infant also with edema of lateral thigh on day 3, low albumin level; discharged from NICU 6 days after birth; this neonate not tested for COVID-19 (no parental consent) -1 neonate with forehead rash, “diffuse small miliary red papules” noted on day 2, disappeared on day 10; also had TTN and required CPAP; respiratory status improved within 2 days; discharged from NICU on day 7 -3 of 4 neonates were tested, all were negative -No neonatal deaths |
Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients Chen et al. Canadian Journal of Anaesthesiology https://link.springer.com/content/pdf/10.1007/s12630-020-01630-7.pdf | 3-16-20 | China | Case series Pregnant women Neonates | Case series of 17 pregnant women infected with COVID-19 -All singleton pregnancies delivered via C-section in negative pressure rooms under airborne precautions; manuscript includes diagrams of OR setup -14/17 epidural anesthesia; 12/14 had intraoperative hypotension -3/17 general anesthesia due to emergent delivery -All neonates admitted to NICU -3 neonates born prematurely (all >2500g birth weight), no neonatal deaths or neonatal asphyxia -All neonatal testing (NP swab) negative |
Epidemiology of COVID-19 among children in China Dong et al. Pediatrics (accepted, pre-publication release) https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0702.full.pdf Accompanying comment piece by Pediatrics associate editors: https://pediatrics.aappublications.org/content/pediatrics/early/2020/03/16/peds.2020-0834.full.pdf | 3-16-20 | China | Case series Children | Nationwide case series of 2143 pediatric patients with COVID-19 reported to Chinese CDC from 1/6/20 to 2/8/20; 731 with laboratory-confirmed disease and 1412 with suspected disease -Over 90% asymptomatic, mild, or moderate -379 cases in infants <1 year of age; 86 confirmed and 293 suspected -Among infants, 1.8% asymptomatic, 54.1% mild, 33.5% moderate, 8.7% severe, and 1.8% critical; infants more likely to have severe or critical illness than other pediatric patients -More severe and critical cases among suspected versus confirmed cases; may indicate underlying etiology was different respiratory virus/other illness -No available information on any neonates among group of infants |
Characteristics of pediatric SARS-CoV-2 infections and potential evidence for persistent fecal viral shedding Xu et al. Nature Medicine | China | Case series Children | Case series of 10 pediatric patients, including a 2-month-old infant - infant case only reviewed here -2-month-old infant presenting with cough and sore throat, part of family cluster outbreak -Abnormal chest CT, elevated transaminases and LDH -NP swab positive -Multiple rectal swabs negative (8/10 pediatric patients had positive rectal swabs) -No patients required respiratory support or ICU care -All patients treated with interferon oral spray | |
A case report of neonatal COVID-19 infection in China Wang et al. Clinical Infectious Diseases https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa225/5803274 | 3-12-20 | China | Case report Neonate | Case report of neonate positive for COVID-19 at 36 hours of life -Mother presented with fever at 40 weeks and had CT findings concerning for viral pneumonia, also with lymphopenia and elevated CRP -Emergency C-section performed under airborne precautions (indication for emergency not described); mother wore N95 during case -Meconium-stained fluid noted intra-operatively -Birth weight 3205g, Apgars 8 and 9 -No delayed cord clamping, early bath performed -Mother and baby immediately separated; baby placed in isolation room in nursery -Mother received treatment with recombinant human interferon alpha-1b inhalation, ganciclovir, abipenem, moxifloxicin, and methylprednisolone -Mother’s pharyngeal swab positive for COVID-19 after delivery -Neonate with emesis at 30 minutes of life but able to subsequently feed -Labs notable for lymphopenia, abnormal LFTs, and elevated CK -Started on PCN G and given IV dose of vitamin K 1 mg daily (unclear duration) -Neonatal pharyngeal swab collected after mother’s returned as positive, at approximately 36 hours of life and was positive -Breast milk sample sent (negative) and infant formula fed -Cord blood and placenta negative for COVID -Neonatal work-up for pediatric viral infections otherwise negative -Neonatal CXR with “thickened lung texture” -Neonate transferred to Children’s Hospital -Neonatal chest CT obtained x 3 and notable for patchy opacities, gradually improved -Neonate did not require respiratory support and was afebrile; no specific treatment provided -Subsequent neonatal pharyngeal and anal swab on DOL 15 negative -Neonate discharged on DOL 16 |
Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records Chen et al. Lancet https://www.sciencedirect.com/science/article/pii/S0140673620303603?via%3Dihub | 3-7-20 (published online 2-12-20) | China | Retrospective chart review Pregnant women Neonates | 9 pregnant women with confirmed COVID-19 infection 7 of 9 presented with fever; other symptoms included cough, myalgia, sore throat, and malaise Clinical characteristics in pregnant women similar to non-pregnant adults with COVID-19 Lymphopenia and elevated aminotransferase seen One woman noted to have influenza on admission → influenza and coronavirus co-infection All delivered by C-section in third trimester Fetal distress in 2 patients, PROM in 2 patients Gestational age 36-39 weeks 6 of 9 cases were assessed for vertical transmission through collection of amniotic fluid, cord blood, and neonatal throat swabs immediately after delivery in OR; all testing negative 3 untested cases: 1 woman diagnosed after delivery, 2 emergency nighttime deliveries |
Lack of vertical transmission of severe acute respiratory syndrome coronavirus 2, China Li et al Emerging Infectious Diseases https://www.ncbi.nlm.nih.gov/research/coronavirus/publication/32134381 | 3-6-20 | China | Case report Pregnant woman Neonate | Case report of a pregnant woman at 35 wga presenting with cough, confirmed COVID-19 infection by sputum sample -Abnormal CXR -Treated with lopinavir, ritonavir, methylprednisolone -Cough resolved on day 2 of hospitalization -Persistent positive sputum on hospital day 2, abnormal FHR (110 beats/min) -Delivered via emergency C-section in negative pressure room -Antibiotic ppx with cefoperazone/sulbactam -Increased methylprednisolone dose -Neonate was well appearing -Neonatal OP swab obtained immediately after delivery negative -Maternal testing on day of delivery negative from serum, urine, stool, amniotic fluid, cord blood, placenta, and breast milk -Neonate placed in negative pressure room -Subsequent neonatal testing over next 2 days was negative (OP, blood, stool, urine) -Mother discharged hospital day 14 -Infant discharged day of life 16 (length of stay not justified, no complications described) |
Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy Liu et al. Journal of Infection | 3-5-20 | China | Case series Pregnant women Neonates | Case series of 13 pregnant women hospitalized with confirmed COVID-19 in hospitals outside of Wuhan -Gestational age at illness onset ranged from 25 weeks to 38 3/7 weeks; 2 women in 2nd trimester, 11 in 3rd trimester -None with underlying medical conditions -10 (77%) presented with fever, 3 (23%) with shortness of breath, 1 asymptomatic (tested due to contact with positive family member) -12 (92%) with clear epidemiologic link - affected family members or linkage to Wuhan -3 (23%) improved after hospitalization and were discharged with uncomplicated ongoing pregnancy -1 (8%) required ICU admission with ARDS and multi-organ dysfunction including hepatic and renal failure, septic shock; required intubation, mechanical ventilation, and ECMO - still on ECMO at time of publication -6 (46%) with preterm labor at 32-36 weeks -10 (77%) underwent C-section; 5 of these (50%) with emergent C-section due to pregnancy complications (3 fetal distress, 1 premature ROM, 1 stillbirth) -9 neonates who were delivered liveborn had a 1 minute APGAR reported as 10 -Neonatal testing negative - details not described |
Coronavirus disease (COVID-19) and neonate: What neonatologist need to know Lu et al. Journal of Medical Virology | 3-1-20 | China | Review Neonates | Three neonatal cases reported to date - mostly “family cluster cases” -17 day old neonate with fever, cough, vomiting; preceding positive cases in household (Lingkong Z, Xuwei T, Wenhao Y, Wang J, Liu X, Liu Z. First case of neonate infected with novel coronavirus pneumonia in China. Chin J Pediatr. 2020;58:E009 - reviewed separately below) -5 day old with fever; mother with confirmed infection (referenced article not indexed in PubMed; unable to find via Google Scholar or other search engines) -Asymptomatic neonate diagnosed 30 hours after birth; mother was infected 6 neonates delivered to women with confirmed COVID-19 infection: all amniotic fluid, cord blood, neonatal throat swab, and breast milk samples negative (Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID‐19 infection in nine pregnant women: a retrospective review of medical records. The Lancet. 2020.) |
Pregnant women with new coronavirus infection: a clinical characteristics and placental pathological analysis of three cases (Article in Chinese) Chen et al. Zhonghua Bing Li Xue Za Zhi | 3-1-20 | China | Case series Pregnant women | (Translated via Google Translate) Case series of 3 pregnant women with confirmed COVID-19 infection in third trimester -Women admitted for C-section in setting of COVID infection with mild symptoms -Gestational age at admission: 37 3/7, 38 6/7, 35 wga -Pregnancy complications included complete placenta previa (2), acute cholecystitis (1), placental abruption (1) -All women febrile (1 antepartum, 2 postpartum); 1 with chest tightness -All had elevated CRP; no lymphopenia; normal transaminases -Chest CT abnormal in all women with ground glass opacities -All delivered by C-section, 2 on day of presentation and 1 3 days after presentation -Placental pathology notable for choriohemangioma (n=1), multifocal infarction (n=1); fibrin deposition in/around villi (n=3); no villitis or chorioamnionitis noted -Placental testing negative for COVID-19 -Two women discharged home, one transferred to another hospital for continued isolation -Two term neonates (37 3/7 and 39 2/7 wga) had APGAR scores of 8 and 9 and were healthy but isolated from mother -Preterm neonate (35 wga) had APGAR scores of 7 and 8 and was admitted to the neonatal ward -All neonates negative for COVID-19 by NP swab PCR -All neonates did well |
A case of 2019 novel coronavirus in a pregnant woman with preterm delivery Wang et al. Clinical Infectious Diseases https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa200/5771323 | 2-28-20 | China | Case report Pregnant woman Preterm neonate | Case report of 28-year-old woman who presented with fever x 1 week at 30 weeks gestation -Initial throat swab negative, second swab positive -Chest CT with left-sided subpleural patchy consolidation and right-sided ground glass opacities -Labs notable for lymphopenia and hypoalbuminemia -Required 5 L/min O2 via Venturi mask -Mother treated with arbidol, lopinavir, ritonavir, cefoperazone/sulbactam, albumin, dexamethasone, and magnesium -Repeat chest CT on hospital day 3 with worsening pneumonia -Absent fetal movement and no FHR variability -No maternal improvement on ventilator -Emergency C-section with spinal-epidural anesthesia performed -Birth weight 1830g, APGARs 9 and 10 -Neonate admitted to NICU, formula fed only -Amniotic fluid, placenta, umbilical cord, gastric aspirate (neonate), and OP (neonate) testing all negative -Gradual improvement of maternal pneumonia (repeat chest CT x 3) -Mother and neonate with “uneventful postpartum and neonatal course” |
Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia Translational Pediatrics Zhu et al. | February 2020 | China | Case series Neonates | Case series of 10 neonates delivered to 9 women with suspected or confirmed COVID-19 infection at 5 hospitals from 1/20-2/5/20 -Onset of maternal symptoms variable - before, on day of, or after delivery -9 women with positive testing; 1 mother classified as COVID-19 after exclusion of other causes (mother of twins) -4 full-term neonates, 7 preterm (range 31-39 weeks) -2 SGA, 1 LGA -Fetal distress in 6, PROM in 3, abnormal amniotic fluid in 2, abnormal umbilical cord in 2, and placenta previa in 1 -Only one neonate described as having no symptoms -Neonate 1: term SGA with emesis and abdominal distention; abnormal CXR with ground glass opacities -Neonate 2: 33w with shortness of breath; CXR with “crude and blurred markings in both lungs” -Neonate 3: 34w with shortness of breath -Neonate 4: 34w with tachycardia, refractory shock, GI bleed, DIC, multi-organ failure; died -Neonate 5: term with diffuse rash, edema -Neonate 6: LGA term infant, asymptomatic; CXR with “slightly blurred markings in right lung”; remains admitted -Neonate 7: 34w with shortness of breath, fever, GI bleed, DIC; CXR with granular and scattered patchy opacities in lower lungs -Neonate 8: 31w twin with shortness of breath and cyanosis; described as RDS; remains admitted -Neonate 9: 31w twin with shortness of breath and cyanosis; described as RDS; remains admitted -Neonate 10: term SGA with shortness of breath, cyanosis, fever, and poor PO intake; confirmed to have pneumothorax; remains admitted -9 of 10 neonates had pharyngeal swabs obtained during admission (variable timing), all were negative -Authors cite no evidence for vertical transmission based on negative neonatal testing but do not adequately describe pathophysiology of neonatal presentation |
Novel coronavirus infection in hospitalized infants under 1 year of age in China Wei et al. JAMA | 2-14-20 | China | Case series Infants | Case series of 9 infants admitted for COVID infection 1 infant aged 1 mo 26 d who presented with rhinorrhea and cough, otherwise all 3mo+ All had infected family members None of the included infants required ICU admission or mechanical ventilation and none had severe complications |
Source: Preprints | ||||
Title/Source | Date | Country | Study Type and Population | Summary |
Coronavirus disease 2019 (COVID-19) during pregnancy: A case series Liu et al. Pre-peer review manuscript | 2-25-20 | China | Case series Pregnant women | -3 pregnant women admitted between 2/2 and 2/5/20 -Case 1: Woman with hypothyroidism, presented with fever, positive from OP swab and stool, chest CT with bilateral infiltrates. Testing negative from breast milk, vaginal mucous, and placenta. Delivery complicated by “chronic fetal distress”, chorioamnionitis, meconium-stained fluids. Infant with good APGAR scores, negative testing from whole blood, serum, cord blood, and OP swab. Mother treated with oxygen, inhaled interferon, ganciclovir, antibiotics, and glucocorticoids. Neonatal labs notable for elevated ast. -Case 2: Presented with fever at 37wga, abnormal chest CT, OP swab positive. Delivered via C-section at 38 4/7 wga with good APGAR scores. Neonate with slightly decreased tone and responsiveness that improved by DOL 1. Testing from whole blood, serum, OP swab, urine, and stool negative. Mother treated with oxygen, arbidol, antibiotics, and glucocorticoids.. -Case 3: Woman with gestational hypertension during prior pregnancy. Presented with cough at 37wga, chest CT abnormal, OP swab positive. Maternal anal swab, vaginal mucous, and breast milk negative. Delivered vaginally at 39 5/7 wga with good APGAR scores. Two sets of testing on successive days were negative (whole blood, plasma, OP swabs, urine, and stool). Mother treated with oxygen and arbidol. Neonatal labs notable for elevated ast. |
Source: medRxiv | ||||
Title/Source | Date | Country | Study Type and Population | Summary |
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection during pregnancy in China: A retrospective cohort study Yin et al. Pre-peer review manuscript https://www.medrxiv.org/content/10.1101/2020.04.07.20053744v1.full.pdf | 4-7-20 | China | Retrospective cohort study Pregnant women Non-pregnant women Neonates | Retrospective cohort study (case-control?) of 31 pregnant women and 35 non-pregnant women with COVID-19 -Pregnant women less likely to have fever but had a higher proportion of severe or critical disease (32.3% versus 11.4% of non-pregnant women) -Review focused on pregnant women in this study -Among 31 pregnant women, 5 (16.1%) asymptomatic, 1 (3.2%) had diarrhea -All had normal prenatal ultrasound -4 (12.9%) were in first trimester, 5 (16.1%) in second trimester, and 22 (71%) in third trimester -Among 4 patients in first trimester, 3 underwent uterine curettage by their choice and 1 chose fetal monitoring; all patients in second and 5 in third trimester chose fetal monitoring; 17 of third trimester patients delivered -Among 17 delivered in third trimester, 13 chose C-section and 4 chose vaginal delivery -17 live births -5 were premature but all beyond 35 weeks -1 with low birth 2450g (at 35 weeks) and APGAR scores of 7 and 8; all other neonates had APGAR scores of 8 and 9 -All neonates stable, no neonatal deaths -All amniotic fluid (2), placenta (2), neonatal throat (17), neonatal anal (5), and breast milk (14) testing negative for SARS-CoV-2 |
Clinical features and the maternal and neonatal outcomes of pregnant women with coronavirus disease 2019 Nie et al. https://www.medrxiv.org/content/10.1101/2020.03.22.20041061v1.full.pdf | 3-27-20 | China | Case series Pregnant women Neonates | Retrospective chart review from 5 Chinese hospitals describing 33 pregnant women with COVID-19 and 28 neonates -8 (24.2%) of pregnant women were healthcare workers -32 (97%) had known COVID-19 exposure -3 women in second trimester (17 weeks, 20 weeks, 26 weeks) -Remaining 30 were in third trimester -15 (45.5%) with chronic health problems (broad category) -Clinical symptoms included fever (63.6%), cough (39.4%), fatigue (21.2%), and shortness of breath (21.2%); 12.1% had no obvious symptoms -Chest CT abnormal in most -87.9% required supplemental oxygen via NC, 3% required non-invasive mechanical ventilation -None of the women required ICU admission; symptom severity classified as mild (39.4%), moderate (57.6%), and severe (3%) based on National Health Commission of China classification system -87.9% treated with antibiotics, 33.3% with steroids, 36.4% with traditional Chinese medicine -Obstetric complications in 22.2%: PPROM (3), hypertensive disease of pregnancy (2), GDM (2), preterm labor (1); fetal distress in 4 -Among the 27 women who delivered, 81.5% had a C-section and 18.5% had a vaginal delivery -5 women remained pregnant and 1 woman had a termination -9 (27.3%) discharged, others continue to be hospitalized -No maternal deaths Neonatal outcomes: -28 neonates born to 27 women -10 (35.7%) delivered preterm -APGAR scores at 1 minute 8-10, at 5 minutes 9-10 -5 (17.9%) with low birth weight -All neonates separated after birth and fed formula -1 34 week preterm neonate described as developing ARDS (RDS?) and requiring NICU admission; recovered and discharged home -26 neonates tested via throat swab PCR; 1 neonate tested positive -The neonate who tested positive at ~36 hours of life had a mother who presented with fever and appropriate precautions were taken during delivery and mother and baby were immediately separated; maternal testing resulted 36 hours after delivery -This neonate’s CXR at 53 hours of life was “consistent with pulmonary infection” -Cord blood and placental testing negative -Neonate was asymptomatic -Repeat neonatal testing was negative by throat swab PCR on days 4, 8, and 15 -Repeat CXR with resolution -Discharged 16 days after birth -Perinatal transmission rate 3.6% |
Source: CDC | ||||
Title/Source | Date | Country | Population | Summary |
Information for Healthcare Providers: COVID-19 and Pregnant Women https://www.cdc.gov/coronavirus/2019-ncov/hcp/pregnant-women-faq.html | Page last reviewed 3-16-20 | US | Pregnant women Neonates | Webpage organized in FAQ format, largely summarizing lack of available evidence -No evidence to support increased susceptibility of pregnant women to infection or increased risk of severe disease in pregnant women -Healthcare facilities may want to consider limiting exposure of pregnant healthcare workers to suspected or confirmed COVID-19 patients, especially during higher risk procedures (aerosolizing procedures) -No confirmed vertical transmission to date -Adverse infant outcomes in infants born to COVID-19 positive mothers have been reported in case reports; unclear whether related to maternal COVID-19 status -No evidence of transmission via breast milk |
Inpatient Obstetric Healthcare Guidance https://www.cdc.gov/coronavirus/2019-ncov/hcp/inpatient-obstetric-healthcare-guidance.html | Page last reviewed 2-18-20 | US | Pregnant women Neonates | -Infants born to mothers with confirmed COVID-19 should be considered PUIs; as such, infants should be isolated according to CDC Infection Prevention and Control Guidance for PUIs -Facilities should consider temporarily separating the mother who has confirmed COVID-19 or is a PUI from her baby until mother’s transmission-based precautions are discontinued -A separate isolation room should be available for the infant while they remain a PUI -Healthcare facilities should consider limiting visitors, with the exception of a healthy parent or caregiver -Visitors should wear appropriate PPE -Decision to discontinue temporary separation of mother and baby should be made on case-by-case basis in consultation with clinicians, IPC specialists, and public health officials -If colocation/rooming in is performed (mother’s wishes or facility limitations), reduce exposure to newborn by using a physical barrier (curtain between mother and baby) and keeping newborn 6 feet or more from ill mother; if no other healthy adult present, mother should put on face mask and practice hand hygiene before each feeding and other close contact with newborn -During temporary separation, mothers should be encouraged to express breast milk. A dedicated pump should be provided. All parts to come into contact with breast milk should be thoroughly washed and entire pump should be appropriately disinfected after each pumping session. Expressed breast milk should be fed to newborn by a healthy caregiver. -If rooming in and mother wishes to breastfeed, mother should put on face mask and practice hand hygiene before each feeding |
Interim Considerations for DIsposition of Hospitalized Patients with COVID-19 https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html | Page last reviewed 3-14-20; revisions made 3-10-20 | US | All | -Discontinuation of transmission-based precautions should include: 1. Resolution of fever without use of anti-pyretic medication 2. Improvement in illness signs and symptoms 3. Negative results of COVID-19 test from at least two consecutive sets of paired NP and throat swabs greater than or equal to 24 hours apart -Patients can be discharged whenever clinically indicated; isolation should be maintained at home if patient returns home before decision is made to discontinue transmission-based precautions |
Source: WHO | ||||
Title/Source | Date | Country | Population | Summary |
Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance | 3-13-20 | N/A | All; sections for pregnant women, infants, and mothers included | Caring for pregnant women with COVID-19: -Limited data on clinical presentation and perinatal outcomes -No evidence that pregnant women have different signs/symptoms or are at higher risk of severe illness -No evidence on mother-to-child transmission -Evidence of increased severe maternal or neonatal outcomes is uncertain and limited to infection in third trimester, with some cases of PROM, fetal distress, and preterm birth reported WHO recommendations: -Considering asymptomatic transmission may be possible in pregnant or recently pregnant women, all women with epidemiologic history of contact should be carefully monitored -Pregnant women with suspected or confirmed COVID-19 should have access to appropriate care; C-section should only be undertaken if otherwise medically indicated Caring for infants and mothers with COVID-19: IPC and breastfeeding -Breast milk samples tested to date have been negative WHO recommendations: -Infants born to mothers with suspected or confirmed infection should be fed according to standard infant feeding guidelines while applying necessary precautions for IPC -Symptomatic mothers who are breastfeeding or practicing skin-to-skin or kangaroo mother care should practice respiratory hygiene, including during feeding (medical mask when near child, hand hygiene before or after contact with child, routine cleaning and disinfection of surfaces mother comes in contact with) -If mother severely ill or unable to care for child, mother should be encouraged to express breast milk if able -Mother and infant should be enabled to remain together and practice skin-to-skin, kangaroo mother care, and room in together throughout day and night, especially immediately after birth, whether they or there infants have suspected or confirmed COVID-19 infection |
Source: AAP | ||||
Initial Guidance: Management of Infants born to Mothers with COVID-19 Puopolo, Hudak, Kimberlin, Cummings AAP Committee on Fetus and Newborn, Section on Neonatal Perinatal Medicine, and Committee on Infectious Diseases https://downloads.aap.org/AAP/PDF/COVID%2019%20Initial%20Newborn%20Guidance.pdf | 4-2-20 | United States | Neonates | Initial guidance document issued by AAP, builds on expert consensus previously issued by Puopolo and Kimberlin -Current evidence is consistent with low rates of peripartum transmission, inconclusive about in utero transmission -Risk of postnatal acquisition from mother -Use airborne, contact, and droplet to attend all COVID-19 deliveries -When physical environment allows, neonates should be separated from mothers at birth -Well appearing term/near term neonates can be admitted in a physically separate area on contact and droplet precautions until newborn testing negative; if cohorting needed, infants should be at least 6 feet apart and/or placed in isolette -Neonates requiring CPAP or mechanical ventilation should be placed in negative pressure room on airborne, droplet, and contact precautions -Bathe neonate as soon as possible -Use of expressed breast milk should be permitted -Testing recommended in neonates at 24 and 48 hours - some reports of initial negative test followed by positive test -Throat and NP swab recommended - can use single swab for both (first throat then NP) -May consider rectal swab if testing available, especially in those requiring prolonged hospitalization -If positive, recommend repeat testing every 48-72 hours until two negative tests -Telephone, telemedicine, in-person assessments through 14 days after discharge recommended in neonates who are infected or who remain at risk -After discharge, mother with COVID-19 advised to maintain distance of at least 6 feet from newborn and when in closer proximity, use a mask and hand hygiene for newborn care until afebrile for 72 hours without antipyretics and at least 7 days since symptoms first appeared |
Source: ACOG | ||||
Practice Advisory: Novel Coronavirus 2019 (COVID-19) | 3-13-20 | US | Pregnant women | Algorithm for assessing and managing pregnant women with suspected or confirmed COVID-19 included Document otherwise references other CDC documents as described above |
Source: International Society of Ultrasound in Obstetrics & Gynecology | ||||
ISUOG* Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals Poon et al. Ultrasound in Obstetrics & Gynecology https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/uog.22013 *International Society of Ultrasound in Obstetrics & Gynecology | 3-11-20 | International organization Data from China and Italy reviewed | Review Pregnancy, L&D, postpartum/ neonatal | 1. Pregnant women with confirmed COVID-19 infection should be managed by designated tertiary hospitals, and they should be informed of the risk of adverse pregnancy outcome.
2. Negative-pressure isolation rooms should be set up for safe labor and delivery and neonatal care. 3. During the COVID-19 epidemic period, a detailed history regarding recent travel, occupation, significant contact and cluster (i.e. TOCC) and clinical manifestations should be acquired routinely from all pregnant women attending for routine care. 4. Chest imaging, especially CT scan, should be included in the work-up of pregnant women with suspected, probable or confirmed COVID-19 infection. 5. Suspected/probable cases should be treated in isolation and confirmed cases should be managed in a negative-pressure isolation room. A woman with confirmed infection who is critically ill should be admitted to a negative-pressure isolation room in the ICU. 6. Antenatal examination and delivery of pregnant women infected with COVID-19 should be carried out in a negative-pressure isolation room on the labor ward. Human traffic around this room should be limited when it is occupied by an infected patient. 7. All medical staff involved in management of infected women should don PPE as required. 8. Management of COVID-19-infected pregnant women should be undertaken by a multidisciplinary team (obstetricians, maternal–fetal-medicine subspecialists, intensivists, obstetric anesthetists, midwives, virologists, microbiologists, neonatologists, infectious-disease specialists). 9. Timing and mode of delivery should be individualized, dependent mainly on the clinical status of the patient, gestational age and fetal condition. 10. Both regional anesthesia and general anesthesia can be considered, depending on the clinical condition of the patient and after consultation with the obstetric anesthetist. 11. At present, limited data suggest that there is no evidence of vertical mother-to-baby transmission in women who develop COVID-19 infection in late pregnancy. 12. There is currently insufficient evidence regarding the safety of breastfeeding and the need for mother/baby separation. If the mother is severely or critically ill, separation appears the best option, with attempts to express breastmilk in order to maintain milk production. If the patient is asymptomatic or mildly affected, breastfeeding and colocation (also called rooming-in) can be considered by the mother in coordination with healthcare providers. 13. Healthcare professionals engaged in obstetric care and those who perform obstetric ultrasound examinations should be trained and fitted appropriately for respirators and/or PAPR. 14. Following an ultrasound scan of a suspected, probable or confirmed COVID-19-infected pregnant patient, surfaces of transducers should be cleaned and disinfected according to manufacturer specifications, taking note of the recommended ‘wet time’ for wiping transducers and other surfaces with disinfection agents. |
Source: Expert Opinion | ||||
Title/Source | Date | Country | Population | Summary |
(Draft) Guidelines for Management of Infant Born to Mother with COVID-19 Shared via AAP Section on Neonatal-Perinatal Medicine listserv, clarified by follow-up email that this is a draft guidance document developed by Karen Puopolo and David Kimberlin and is not an official AAP guideline | 3-16-20 | US | Neonates | All infants: -Mother and baby separated immediately at birth -Designated, limited set of caregivers assigned to infant -Infant bathed as soon as possible -Testing to include 2 consecutive sets of NP, throat, and stool swabs collected at 24 hours apart, starting at 24 hours - newborn to be designated as uninfected if all 6 tests are negative DR: -Airborne precautions recommended Admission: -Well-appearing neonates should be cared for in a designated area separate from other neonates -Enhanced droplet precautions should be used -Infants who require NICU care due to illness or gestational age should be admitted to a single patient isolation room; if CPAP, HFNC, or mechanical ventilation required, airborne precautions should be used until infection status is determined Breastfeeding: -Mother may express breast milk Visitation: -No visitation until infant status determined, except by non-maternal parent or designated equivalent if they are asymptomatic; must use enhanced droplet precautions during visits -If newborn uninfected but requires prolonged hospitalization, mother will not be allowed to visit until off precautions per CDC recommendations Discharge: -Infected but asymptomatic may be discharged home with appropriate precautions and plan for outpatient follow-up on case-by-case basis -Ideally discharge to designated healthy caregiver; if not available, manage on case-by-case basis |
Source: News | ||||
Title/Source | Date | Country | Population | Summary |
Newborn baby dies in Baton Rouge after coronavirus-positive mom went into premature labor The Advocate | 4-6-20 | United States | Pregnant woman | Pregnant woman with confirmed COVID-19 who went into preterm labor at “just under 22” weeks gestation -Exact gestational age not stated -Described as newborn death but if gestational age under 22 weeks, would consider this pre-viable -Unclear whether this may have been a stillbirth though reference to coroner’s office counting this as 1 of 7 coronavirus deaths in Baton Rouge over that weekend -Mother described as critically ill and requiring mechanical ventilation |
Newborn baby confirmed 4 weeks after birth in Dongdaemun-gu, Seoul...The nation’s youngest possible (Article in Korean) Yonhap News Agency | 3-28-20 | South Korea | Neonate | (Translated via Google Translate) 4-week-old neonate with confirmed COVID-19 infection Known family members with COVID-19 infection Course and symptoms not described |
Premature baby in serious condition after coronavirus infection The Times of Israel https://www.timesofisrael.com/premature-baby-in-serious-condition-after-coronavirus-infection/ | 3-22-20 | Israel | Neonate | Premature baby admitted to the NICU at Shaare Zedek Medical Center in Jerusalem Tested positive after contact with healthcare worker who had contact with a COVID case and tested positive after working shift in the NICU Gestational age and postmenstrual age not provided but stated to be “severely underweight” and have had a complication of prematurity 2 months ago Baby in serious condition |
Newborn baby tests positive for coronavirus in London The Guardian (reported by multiple news outlets) https://www.theguardian.com/world/2020/mar/14/newborn-baby-tests-positive-for-coronavirus-in-london | 3-14-20 | UK | Neonate | North Middlesex University Hospital NHS Trust Mother presented with pneumonia and was confirmed as COVID-19 after delivery Neonate tested for COVID-19 immediately after birth and positive No specific information regarding testing or clinical course |
Birth of a neonate from infected mother COVID-19 in Babol city (Article in Farsi) Tasnim Agency | 3-3-20 | Iran | Pregnant woman Neonate | (Translated via Google Translate) References birth of two neonates to pregnant women with suspected COVID-19 Both neonates described in good health |
45-day-old baby infected with new coronavirus in S. Korea: authorities Yonhap News Agency | 3-1-20 | South Korea | Neonate | 45-day-old neonate tested positive; father, who attended church at center of rapid spread in South Korea, tested positive Mother and baby self-quarantined at home No report of symptoms or type of testing performed |
Source: Personal Communication | ||||
Title/Source | Date | Country | Population | Summary |
PICU webinar with Italian group on nationwide experience | 3-19-20 | Italy | Children | Among ~3000 Italian cases, only 121 children and 186 adolescents (age ranges unclear for categories) One neonate born to COVID positive mother required intubation at birth; no information on gestational age or clinical course No pediatric deaths in Italy to date |