Background The exclusion of pregnant women from COVID-19 mRNA vaccine trials raised hesitancy regarding the benefit of vaccination of pregnant women, hence little is known about the vaccine's efficacy in this population. Objective To determine the maternal-neonatal transplacental transfer of SARS CoV-2 antibodies among vaccinated parturient women. A control group of COVID 19 recovered patients was included in order to compare IgG levels between vaccinated and recovered patients. Study Design A prospective cohort study in a single tertiary medical center in Israel between February and March 2021; parturient women who had been vaccinated with BNT162B2 mRNA vaccine during pregnancy were included and compared to COVID-19 recovered parturient women. SARS CoV-2 IgG antibodies were measured in maternal and cord sera, dried blood spot samples taken from newborns, and breast-milk samples. The primary outcome was to determine whether neonatal cord and dried blood spot samples were positive for SARS CoV-2 antibodies and to evaluate transfer ratio defined as cord blood IgG divided by maternal IgG levels. Results The study included 64 vaccinated parturient women and 11 parturient women who had COVID-19 disease during pregnancy. All maternal blood sera samples and 98.3% of cord blood sera samples were positive for SARS Cov-2 IgG with median concentrations of 26.1 (IQR 22.0;39.7) and 20.2 (IQR 12.7;29.0) respectively. Similarly, 96.4% of neonatal blood spot samples and all breast milk samples were positive for SARS CoV-2 IgG with median concentrations of 11.0 (IQR 7.2;12.8) and 4.9 (IQR 3.8;6.0), respectively. There was a significant positive correlation between maternal serum levels of SARS Cov-2 IgG and cord blood (R=0.483, p=0.0001), neonatal blood spot (R=0.515, p=0.004), and breast milk levels (R=0.396, p=0.005) of SARS CoV-2 IgG. The median placental transfer ratio of SARS-COV-2 IgG was 0.77. Comparison of vaccinated with recovered COVID-19 patients revealed significantly higher SARS CoV-2 IgG levels in maternal serum and cord blood among vaccinated women (p<0.0001). Conclusion(s) Our study demonstrated efficient transfer of SARS CoV-2 IgG across the placenta from women vaccinated with BNT162b2 mRNA vaccine during pregnancy to their neonates with positive correlation between maternal serum and cord blood antibody concentrations. In addition to maternal protection against COVID-19, the vaccine may also provide neonatal humoral immunity.

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Intractable hypotension due to septic shock is associated with high mortality rates in critically ill children worldwide. The use of terlipressin (triglycyl-lysine-vasopressin), an analog of vasopressin with a longer duration of action, recently emerged as a treatment of hypotension not responsive to vasopressors and inotropes. This was a retrospective study set in an 18-bed pediatric critical care department in a tertiary care children's hospital. We reviewed the files of all children with septic shock who were treated with terlipressin between January 2003 and February 2004. Fourteen children (mean age, 5.6 years; range, 4 days to 17.7 years) were treated with terlipressin in 16 septic shock episodes. Significant improvements in respiratory and hemodynamic indices were noted shortly after treatment. Mean arterial blood pressure increased significantly from 54 +/- 3 to 72 +/- 5 mmHg 10 min after terlipressin administration (P = 0.001). Heart rate decreased from 153.0 +/- 6.5 beats/min to 138.0 +/- 7.5 beats/min 12 h after treatment onset (P = 0.003). Epinephrine infusion was decreased or stopped in eight patients after terlipressin administration. Urine output increased from 1.6 +/- 0.5 mL/kg/h to 4.3 +/- 1.2 mL/kg/h 1 h after treatment onset (P = 0.011). PaO2 increased from 95.1 +/- 12.3 mmHg to 110.1 +/- 20.5 mmHg, and the oxygenation index decreased from 10.2 +/- 2.2 to 9.2 +/- 1.7. Terlipressin treatment of hypotension due to septic shock was successful in eight out of 16 episodes. Six of the 14 patients with poor prognosis for survival recovered. We conclude that terlipressin improves hemodynamic indices and renal function in critically ill children. Terlipressin should be considered as a rescue therapy in intractable shock not responsive to catecholamines in children.