First Neonates with Vertical Transmission of SARS-CoV-2 Infection in Late Pregnancy in West Part of Romania: Case Series

Abstract

The Coronavirus disease 2019 (COVID-19) pandemic has exposed the vulnerable neonatal population to unknown risks. Given that herd immunity is has not been reached, the entire population is susceptible to Severe Acute Respiratory Syndrome Coronavirus 2 Virus(SARS-CoV-2) infection. The arising concern about the vertical transmission of neonatal complications caused by the novel coronavirus is a continuous challenge for managing newborns, considering the rare cases and unclear guidelines. Therefore, a retrospective study was conducted in a tertiary unit from Timisoara, Romania. Of the 283 newborns born during the study period, only 3 neonates were diagnosed with SARS-CoV-2 infection in the first 24 h of life (DOL-0). The present study plans to identify the findings, including clinical features, laboratory characteristics, and outcomes of newborns with vertical transmission of SARS-CoV-2. All infected neonates were confirmed with COVID-19 by Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) from nasal aspirates and were isolated in the neonatology department. They were the first and the only neonate infected at birth from the West part of Romania. The clinical findings were unremarkable except for one neonate who developed mild respiratory distress syndrome. Elevated IgG-specific anti-SARS-CoV-2 serum levels were found in one newborn. Swab samples in DOL-0 strengthened the awareness of vertical transmission, although peripartum SARS-CoV-2 infection does not seem responsible for severe symptoms. We conclude that vertical transmission is rare in late pregnancy. Even if the studied newborns showed mild forms of COVID-19, it is essential to note that newborns represent a particular category of patients. More studies are needed to complete the observations of this study.

Clinical, Laboratory, and Imaging Findings of Pregnant Women with Possible Vertical Transmission of SARS-CoV-2—Case Series

“…Both newborns had positive RT-PCR SARS-CoV-2 from NP swabs. This work complements our previous study, where the characteristics of newborns are described in more detail [ 28 ]. Since Patient 1 had a vaginal delivery, and we have no samples from the amniotic fluid or placenta to sustain intrapartum transmission, and we appreciate that it could be an intrapartum transmission.…”

COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

“…Low levels of iron have been reported in Romanian patients early on, accordingly to international data [ 56 , 72 , 88 ]; however, there have been cases of normal values reported [ 54 , 86 , 89 , 90 ], while others have reported high levels of FER, including in children [ 14 , 21 , 23 , 24 , 25 , 26 , 29 , 30 , 31 , 35 , 36 , 41 , 43 , 48 , 62 , 74 , 79 ], with a few rare cases of vertical transmission describing increased FER levels, as observed in Iacob et al’s study [ 64 ].…”

“…CRP levels were also associated with new neurological manifestations in elder patients [ 62 ] and children with pediatric inflammatory multisystem syndrome (PIMS) [ 41 , 63 ]. In the rare cases of vertical transmission, such as the one identified by Iacob and his team, CRP was elevated in the newborns with positive SARS-CoV-2 PCR testing [ 64 ].…”

“…Elevated LDH levels were observed in many studies of Romanian patients [ 21 , 26 , 33 , 34 , 79 ], with one study focusing on how these values could be related to thrombotic microangiopathy by presenting a case report of a patient with a complement gene variant (complement factor I) [ 80 ] and another focusing on a pediatric case, signaling the risk for a systemic inflammatory syndrome associated with COVID-19 in some children [ 23 ]. Neonatal vertical infection is rare; however, in those cases, LDH was elevated [ 64 ].…”

“…The study by Davidescu et al observed a statistically significant difference between elders and non-elders in regard to AST [ 62 ]. Other cases were reported with elevated levels as well, with a tendency towards elevated AST rather than a modified ALT [ 23 , 24 , 25 , 26 , 30 , 34 , 35 , 36 , 37 , 59 , 64 , 79 , 97 ].…”