key: cord-0252273-d65tji7y authors: Mohagheghi, Parisa; Hakimelahi, Javad; Khalajinia, Zohreh; Sadeghi Moghadam, Parvaneh title: COVID-19 Infection in Iranian Newborns and their Mothers: a Case Series date: 2021-02-03 journal: Tanaffos DOI: nan sha: 8f9ffc693352904920de62faa711062d8d963daf doc_id: 252273 cord_uid: d65tji7y BACKGROUND: The symptoms, severity, and prognosis of coronavirus disease 2019 (COVID-19) are surprisingly different in neonates versus adults or even children. Currently, there are few studies on neonatal and maternal COVID-19 with limited populations. CASE PRESENTATION: In this study, we present 13 Iranian symptomatic newborns with a positive nasopharyngeal COVID-19 test and their maternal data on COVID-19. All neonates were admitted to the hospital at the first day of life, mostly having symptoms at birth, except three cases that had symptoms at days 2, 11, and 22. Almost all cases had respiratory distress and were tachypneic, which needed respiratory support. Although most cases were discharged after recovery, two patients died at days 12 and 48. CONCLUSION: Neonatal COVID-19 cases mostly had respiratory symptoms and subsequent radiographic features of a viral pneumonia; thus, they had an effective response to oxygen therapy. The symptoms were by far less severe in newborns, although we lost two cases to this infection. This highlights the necessity for good COVID-19 prognosis in infants and neonates. .6%, 7.3%, 4.2%, 4.1%, and 3.0% for the age group of <1, 1-5, 6-10, 11-15, and ≥16 years, respectively, suggesting a higher risk in neonates (4) . Moreover, there is a need for maternal study in newborns with COVID-19 not only due to the low risk of intrauterine infection by vertical transmission of SARS-CoV-2 (5), but also because of growing concerns regarding the effects of COVID-19 on pregnancy and parturition. Besides, the physiological changes in pregnant women make them more susceptible to pulmonary infections with poor prognosis (6) . Finally, due to the limited knowledge about maternal and neonatal COVID-19, clinicians are predisposed to TANAFFOS make uninformed and risky decisions. Thus, in this study we reported 13 cases of newborns with COVID-19 and their maternal data. Medical records of all hospitalized neonates due to COVID-19 including, demographic information, clinical features of the disease, signs, symptoms, duration, blood tests, along with radiographic data (chest x-ray and spiral chest CT scan without contrast to review pulmonary infection) were collected. Also, brain sonography and echocardiography data were presented if available to detect other underlying abnormalities. Following the patients' progress, the outcome was also recorded. We retrospectively collected maternal data of COVID-19 confirmed newborns, including age, underlying medical conditions, blood group, symptoms, and laboratory and radiographic data (if available). Besides, parturition-related data were collected and the patients' outcomes were presented. Tables 1-4 amounts. Liver aminotransferases were mostly normal (8) . Sign and symptoms Retraction - Cough + - - - - - - - - - - - - Fever - - - - - - - - + - - - - Diarrhea - - - - - - - - - - - - - Intolerance to feeding - - - - - - - - + - - - - Lethargy + + - - - - - - + - - + - Agitation - - - - - - - - - - - - Skin rash - - - - - - - - - - - - - Respiratiry distress + + + + + + + + - + + + + + + + - + - + - + + + + Cyanosis + + - + - + + + - + + + + Grunting + + + + - + - + - + + - + Respiratory support by nasal O2 (days) -- Respiratory support by CPAP ventilation (days) Respiratory support by mechanical ventilation (days) - Discharge after recovery (hospitalized days) 9 26 The normal range for vital signs are as follows: heart rate (120-160 beats per minute), respiratory rate (30-60 breaths per minute) and axillary temperature (36.5-37.4 ºC). Rectal temperature is not checked in neonates due to the possibility of rectal damage. Respiratory distress syndrome (RDS) severity according to Downe score indicates: 0: no respiratory distress, 1-4: mild, 5-7: moderate and 8-10 severe respiratory distress. Table 5 ), and blood group (six O+, four A+, two B+, and one AB+). The pregnancy measures of interest presented in Table 9 were duration of symptoms before parturition, which varied from asymptomatic or 2 to 20 days before delivery, rupture of membrane (ROM) (in 3 cases) to parturition duration from 2 to 24 hours and clear or meconium-stained amniotic fluid. Symptoms Discharge after recovery ----- Table 7 . Maternal laboratory data if available. Laboratory data 1 2 3 4 5 6 7 8 9 10 11 12 13 WBC (102 per microliter) -----120 -72 60 100 76 124 114 Neutrophil percentage -------40 30 55 79 76 80 Lymphocyte percentage -----12 -60 68 45 23 14 Negative --2 negative Negative --3 ----4 Negative Negative --5 Negative Negative --6 Negative Negative Normal GGOs 7 Negative Negative --8 Positive Positive Normal -9 Negative Negative Normal -10 Positive Negative Mild infiltration -11 Negative ---12 Negative ---13 Positive Negative --Abbreviations are as follows: GGOs: Ground glass opacities. Symptoms duration before parturition (days) This study had some limitations. All our patients were symptomatic neonates and there was no asymptomatic case in our research; however, PCR test under 24 hours of age was positive in some asymptomatic newborns (20) . Also, we did not test intrauterine tissue in our study for symptomatic mothers. In conclusion, COVID-19 infection in neonates has different presentations considering mostly respiratory symptoms and subsequent radiographic features of a viral pneumonia and effective response to oxygen therapy. The symptoms were by far less severe in newborns, although we lost two cases to this infection. This highlights the necessity for good COVID-19 prognosis in infants and neonates. Public health, health systems and palliation planning for COVID-19 on an exponential timeline Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections Epidemiology of COVID-19 Among Children in China Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China Perinatal Transmission of 2019 Coronavirus Disease-Associated Severe Acute Respiratory Syndrome Coronavirus 2: Should We Worry? Respiratory disease in pregnancy Usefulness of Downe score as clinical assessment tool and bubble CPAP as primary respiratory support in neonatal respiratory distress syndrome Gomella's Neonatology. 8 th ed: Lange Medical Books/McGraw-Hill First case of neonate infected with novel coronavirus pneumonia in China Novel coronavirus infection in newborn babies aged <28 days in China COVID-19 and Neonatal Respiratory Care: Current Evidence and Practical Approach Androgen sensitivity gateway to COVID-19 disease severity COVID-19 infection in Iranian children: a case series of 9 patients Coronavirus disease (COVID-19) and neonate: What neonatologist need to know COVID-19 in newborns and in children: the state of the art Neonatal outcome in 29 pregnant women with COVID-19: A retrospective study in Wuhan, China Clinical characteristics of 19 neonates born to mothers with COVID-19 Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy; a Narrative Review SARS-CoV-2 Infection and the Newborn