key: cord-351736-4x5u4qsy
authors: Fernandez-Garcia, Cristina; Montaner-Ramon, Alicia; Hernandez-Perez, Susana; Camba-Longueira, Fatima; Ribes-Bautista, Carmen; Frick, Marie Antoinette; Castillo-Salinas, Felix
title: Severe COVID-19 During Pregnancy and the Subsequent Premature Delivery
date: 2020-09-19
journal: Pediatr Neonatol
DOI: 10.1016/j.pedneo.2020.09.005
sha: 
doc_id: 351736
cord_uid: 4x5u4qsy

nan

Coronavirus disease 2019 (COVID-19), which is caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic in January 2020. Although most of the cases in pregnant women are mild, there are reports of increasing severe infection in pregnancy. Only a few case of SARS-CoV-2 infection in preterm neonates delivered by mothers with COVID-19 have been reported till date.

The possibility of in utero transmission of SARS-CoV-2 is highly controversial. 1,2

While SARS-CoV-2 has been detected in several neonates by reverse transcriptionpolymerase chain reaction (RT-PCR ) of nasopharyngeal swabs collected in the early hours or days of life, 3,4 the reliability of these swabs is under scrutiny, as there is a chance of contamination by coronavirus-infected maternal body fluids.

We report the cases of three premature babies delivered by two mothers with severe COVID-19 pneumonia, whose condition deteriorated to the point that necessitated the use of mechanical ventilation on the mothers as well as accelerated child delivery of the mothers. All the babies were admitted to level III neonatal intensive care unit at Vall d'Hebron University Hospital in Barcelona, Spain in March 2020. Clinical management was based on national guidelines and hospital protocols. The babies were separated from their mother and placed on strict isolation as soon as they were born. They had no contact with their close family members unless they were asymptomatic and tested negative to SARS-CoV-2. Figure   1 ).

There have been very few reports of preterm delivery in mothers with COVID-19 and most babies have tested negative to SARS-CoV-2. 3, 4 In the few reported neonates who tested positive to SARS-CoV-2 via PCR, there is no evidence of in utero transmission, since infection in the immediate neonatal period could not be completely excluded. 5, 6 Preterm delivery was required in the three cases described in this report, since the mothers developed severe COVID-19 pneumonia. There was no evidence of in utero transmission, such that all the babies (3) tested negative to SARS-CoV-2 immediately after birth and at 24 hours, 5, and 14 days of life. Apart from requiring mechanical J o u r n a l P r e -p r o o f ventilation due to maternal sedation, the babies had an uneventful course and showed no signs or symptoms of COVID-19.

Knowledge of how COVID-19 affects newborns and pregnant women is limited. Until multicenter studies are conducted, it is essential to share experiences of case reports and series in order to improve our understanding of the effects of this emerging disease on newborns and their mothers, in the interim.

Perinatal aspects on the covid-19 pandemic: a practical resource for perinatal-neonatal specialists

Delivery Room Preparedness and Early Neonatal Outcomes During COVID19 Pandemic

Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan

Association of COVID-19 with pregnancy outcomes in health-care workers and general women

Severe COVID-19 during Pregnancy and Possible In utero Transmission

COVID-19 in a 26-week preterm neonate