There is no evidence of vertical intrauterine transmission of coronavirus disease 2019


NEW YORK (Reuters Health) – There has been no evidence of intrauterine transmission of the new coronavirus 2019 infection (SARS-CoV-2) from the mother to the fetus, according to a retrospective review.
Previous reports have found little evidence of vertical transmission of other coronaviruses associated with severe acute respiratory syndrome (SARS). It is not yet known whether SARS-CoV-2 disease (COVID-19) can be transferred from mother to child in the womb.

Dr. Wei Hou of Wuhan University, Wuhan, in China, and his colleagues describe the clinical features and potential for intrauterine vertical transmission of SARS-CoV-2 infection in their retrospective review of medical records of nine pregnant women with pneumonia by COVID-19 in a report. in The Lancet.
All nine women tested positive for SARS-CoV-2 by PCR in respiratory tract samples.

In contrast, PCR did not detect SARS-CoV-2 in amniotic fluid, umbilical cord blood, neonatal throat swab or breast milk samples collected from six patients.

Clinically, women had fever (none higher than 39 C) and symptoms of an upper respiratory tract infection, but none developed severe pneumonia or died of COVID-19 pneumonia.
The nine live births had an Apgar score of one minute of 8-9 and an Apgar score of five minutes of 9-10. There were no fetal deaths, neonatal deaths or neonatal asphyxiation.
"Based on our findings in these nine patients, there is currently no evidence to suggest that the development of COVID-19 pneumonia in the third trimester of pregnancy could lead to the occurrence of serious adverse outcomes in newborns and fetal infection that it could be caused by intrauterine administration. vertical transmission, "the authors conclude.

"Considering the importance of this ongoing global public health emergency, although our conclusions are limited by the small sample size, we believe that the findings reported here are important to understand the clinical characteristics and the potential for vertical transmission of infection by COVID-19 in pregnant women, "they add.
"Due to the small number of cases analyzed and the short duration of the study period, further follow-up studies should be conducted to further assess the safety and health of pregnant women and newborns who develop COVID-19 infection," Dr. Jie Qiao of the Third Hospital of Peking University in Beijing writes in a linked editorial.
He adds: "The National Health Commission of China released a new notice on February 8, 2020, which proposed strengthening health advice, screening and monitoring for pregnant women, reinforcing visiting time and procedures in Obstetric clinics and units with specialized infection monitor preparations and protective clothing, and emphasized that newborns of pregnant women with suspected or confirmed infection by COVID-19 should be isolated in a designated unit for at least 14 days after birth and not they should breastfeed, to avoid close contact with the mother while she has suspected or confirmed a COVID-19 infection. "
In an article in The Lancet Child & Adolescent Health, Dr. Yuan Shi and his colleagues, on behalf of the National Center for Clinical Research for Childhood Health and Disorders and the Pediatric Committee of the Army Medical Liberation Association Pueblo Chino, propose a contingency plan to address outbreaks of COVID-19 in neonatal intensive care units (NICU).

This plan recommends the admission of all probable or laboratory-confirmed infants with COVID-19 to NICUs, where they should receive general treatment that includes close monitoring of blood tests and chest X-ray, along with respiratory assistance when necessary .

Newborns who do not have a fever for at least three days and improve respiratory symptoms; resolution of any abnormal chest radiography findings; and two nasopharyngeal and nasal swabs negative for SARS-CoV-2 at least 48 hours apart could be discharged.

All other newborns newly admitted to the NICU must undergo a high-risk examination of COVID-19, and high-risk newborns who develop manifestations similar to COVID-19 should be isolated and referred to a hospital designated for such infections

Dr. David A. Schwartz, from the Georgia School of Medicine in Augusta, recently reviewed the possible maternal and infant outcomes of SARS-VOC-19 and has just returned from the 3rd International Conference on Zika virus and infections related to Aedes, where there was a special seminar on the novel coronavirus.

He told Reuters Health via email: "Previous experience with coronavirus infections such as SARS (severe acute respiratory syndrome) and MERS (Middle Eastern respiratory syndrome) indicates that they have a high risk for mothers when they occur during pregnancy. , as they have caused poor obstetric outcomes, including maternal death and miscarriage. However, there has never been a case of intrauterine transmission of viruses from a mother with SARS or MERS to the fetus. "

"Following communications with my colleagues in the US and China, until February 20, no incidents of maternal-fetal intrauterine transmission of the SARS-CoV-2 virus have been confirmed among pregnant women with COVID-19 and their unborn babies. "he said.

"Pregnant women with COVID-19 are high-risk patients and should be treated accordingly," added Dr. Schwartz, who was not involved in the new study. "It has been shown that SARS-CoV-2 causes severe disease of the lower respiratory tract, including acute respiratory distress syndrome (ARDS) and diffuse alveolar damage (DAD) in the lungs, which can endanger the life of pregnant and non-pregnant patients. If you are a newborn, babies should develop a lung infection as a result of SARS-CoV-2 infection, it could lead to a fatal outcome. "

Dr. Hou and co-author Dr. Huixia Yang did not respond to a request for comment.

SOURCE: and The Lancet, online February 12, 2020. The Lancet Child & Adolescent Health, online February 7, 2020.

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