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Carter BG, Harcourt E, Harris A, Zampetti M, Duke T, Tingay D. Making respiratory care safe for neonatal and paediatric intensive care unit staff: mitigation strategies and use of filters. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2024; 60:13-27. [PMID: 38384335 PMCID: PMC10881236 DOI: 10.29390/001c.91262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Background Many medical devices in pediatric and newborn intensive care units can potentially expose healthcare workers (HCWs) and others to transmission of respiratory and other viruses and bacteria. Such fomites include ventilators, nebulizers, and monitoring equipment. Approach We report the general, novel approach we have taken to identify and mitigate these risks and to protect HCWs, visitors and patients from exposure while maintaining the optimal performance of such respiratory equipment. Findings The approach combined a high level of personal protective equipment (PPE), strict hand hygiene, air filtration and air conditioning and other relevant viral risk mitigation guidelines. This report describes the experiences from the SARS-CoV-2 pandemic to provide a reference framework that can be applied generally. The steps we took consisted of auditing our equipment and processes to identify risk through sources of potentially contaminated gas that may contain aerosolized virus, seeking advice and liaising with suppliers/manufacturers, devising mitigation strategies using indirect and direct approaches (largely filtering), performing tests on equipment to verify proper function and the absence of negative impacts and the development and implementation of relevant procedures and practices. We had a multidisciplinary team to guide the process. We monitored daily for hospital-acquired infections among staff caring for SARS-CoV-2 patients. Conclusion Our approach was successful as we have continued to offer optimal intensive care to our patients, and we did not find any healthcare worker who was infected through the course of caring for patients at the bedside. The lessons learnt will be of benefit to future local outbreaks or pandemics.
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Affiliation(s)
- Bradley G Carter
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | - Edward Harcourt
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | | | - Michael Zampetti
- Neonatal and Paediatric Intensive Care UnitsThe Royal Children’s Hospital Melbourne
| | - Trevor Duke
- Paediatric Intensive Care UnitThe Royal Children’s Hospital
- Department of PediatricsThe University of Melbourne
| | - David Tingay
- Department of PediatricsUniversity of Melbourne
- Neonatal ResearchMurdoch Children’s Research Institute
- Department of NeonatologyThe Royal Children’s Hospital
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Abstract
In this chapter, we will discuss the infection history and epidemiology, the viral structure of COVID 19 or SARS-CoV-2, mode of transmission, virulence, and pathogenesis of disease, and we also discuss how it was started and its relation to other coronaviruses. Then we will mention the relation to pregnancy, how it can affect pregnant female, sequelae on pregnancy course and labor, and effect on fetus and neonates.
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3
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Investigation on the mental health status of pregnant women in China during the Pandemic of COVID-19. Arch Gynecol Obstet 2020; 303:463-469. [PMID: 33009997 PMCID: PMC7532741 DOI: 10.1007/s00404-020-05805-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/16/2020] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate the anxiety and depression in pregnant women in China, and its influencing factors during the corona virus disease 2019 (COVID-19) pandemic. Methods From February 22 to February 27, a questionnaire survey was conducted on 156 pregnant women, including demographic characteristics, a self-rating anxiety scale (SAS), and a self-depression rating scale (SDS). Results A total of 13 non-homologous end-joining (8.3%, 13/156) patients were anxious, 79 patients (50.6%, 79/156) were depressed, and 13 patients (8.3%, 13/156) suffered from both anxiety and depression. The SAS score of pregnant women was 40.55 ± 6.09, and the SDS score was 50.42 ± 11.64. For the SAS score, only 8.3% of all patients (13/156) were in a light anxiety state. For the SDS score, 46.79% (73/156) of patients was normal, 23.72% of patients (37/156) showed mild depression, 22.44% (35/156) showed moderate depression, and 4.49% (7/156) showed severe depression. No significant changes were observed in SAS and SDS scores between patients from different regions within China, health state, gestational week, educational background, and living condition (P > 0.05). Moreover, no significant differences were observed between diagnosed/suspected patients and the normal control group (P > 0.05), and between pregnant women in Wuhan compared to other regions (P > 0.05). Conclusion During the COVID-19 epidemic, the anxiety level of pregnant women was the same as that before the epidemic, while the level of depression was significantly higher. Pregnant women who lived in Wuhan, the epicenter of the epidemic, were not more anxious or depressed compared to pregnant women in other regions during the COVID-19 epidemic. Furthermore, the mental health status of pregnant women with COVID-19 was not more severe. Electronic supplementary material The online version of this article (10.1007/s00404-020-05805-x) contains supplementary material, which is available to authorized users.
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Luo F, DU LZ. [Possibility of mother-to-child vertical transmission of coronavirus infection from the perspectives of severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1043-1046. [PMID: 32933641 PMCID: PMC7499447 DOI: 10.7499/j.issn.1008-8830.2004237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
This article evaluates the potential influence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women on the development of coronavirus disease 2019 in neonates and discusses the possibility of mother-to-child vertical transmission of SARS-CoV-2. With reference to related articles published up to now and the information on official websites, a retrospective review was performed for the clinical manifestations and laboratory examination results of the neonates born to the mothers with infection during pregnancy during the epidemics of severe acute respiratory syndrome and Middle East respiratory syndrome and after the outbreak of SARS-CoV-2 infection since December 2019. Based on the limited data, there is no conclusive evidence for mother-to-child vertical transmission of coronavirus disease 2019, and more cases need to be collected for further evaluation.
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Affiliation(s)
- Fang Luo
- National Clinical Research Center for Child Health/National Children's Regional Medical Center/Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
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5
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Melo GCD, Araújo KCGMD. COVID-19 infection in pregnant women, preterm delivery, birth weight, and vertical transmission: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2020; 36:e00087320. [PMID: 32696830 DOI: 10.1590/0102-311x00087320] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
In less than four months, the total of confirmed cases of COVID-19 was 1,684,833 worldwide. Outcomes among the public of pregnant women with COVID-19 are still unclear. We performed a systematic review and meta-analysis to analyze whether COVID-19 in pregnant women is related to premature birth and birth weight, and to summarize the diagnostic results of neonates born to mothers with COVID-19 for investigating the possibility of vertical transmission. Searches were performed in PubMed, Scopus, LILACS, Web of Science, Google Scholar, Preprints, bioRxiv, and medRxiv. We used the odds ratio (OR) and mean difference (MD) as measure of analysis. Summary estimates were calculated using random effects models. 38 studies were included; data from 279 women were analyzed; 60 patients were diagnosed with COVID-19. The meta-analysis showed no significant association between COVID-19 and preterm delivery (OR = 2.25; 95%CI: 0.96, 5.31; p = 0.06; I² = 0%). No significant relationship was found between birth weight and COVID-19 (MD = -124.16; 95%CI: -260.54, 12.22; p = 0.07; I² = 0%). Among 432 newborns, 10 were reported with positive results for early SARS-CoV-2. Due to the characteristics of the studies, the level of evidence of this meta-analysis was considered very low. COVID-19 in pregnant women may not be associated with the occurrence of preterm deliveries or the birth weight of the newborn children, however the evidence to date is very uncertain. A few reports suggest vertical transmission of SARS-CoV-2 to newborn is possible, but evidence is still uncertain.
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6
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Madar J, Roehr C, Ainsworth S, Ersdal H, Morley C, Rüdiger M, Skåre C, Szczapa T, te Pas A, Trevisanuto D, Urlesberger B, Wilkinson D, Wyllie J. Die Versorgung und Reanimation des Neugeborenen. Notf Rett Med 2020; 23:257-259. [PMID: 32536802 PMCID: PMC7284680 DOI: 10.1007/s10049-020-00722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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7
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Ma X, Zhu J, Du L. Neonatal Management During the Coronavirus Disease (COVID-19) Outbreak: The Chinese Experience. Neoreviews 2020; 21:e293-e297. [PMID: 32358142 DOI: 10.1542/neo.21-5-e293] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Xiaolu Ma
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jiajun Zhu
- Department of Neonatology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lizhong Du
- Department of Neonatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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8
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Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J 2020. [PMID: 32310621 DOI: 10.1097/inf.0000000000002660)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Coronaviruses (CoVs) are a large family of enveloped, single-stranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The 2019 novel coronavirus (SARS-CoV-2) is currently causing a severe outbreak of disease (termed COVID-19) in China and multiple other countries, threatening to cause a global pandemic. In humans, CoVs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. SARS-CoV, MERS-CoV and SARS-CoV-2 seem to less commonly affect children and to cause fewer symptoms and less severe disease in this age group compared with adults, and are associated with much lower case-fatality rates. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. However, the importance of children in transmitting the virus remains uncertain. Children more often have gastrointestinal symptoms compared with adults. Most children with SARS-CoV present with fever, but this is not the case for the other novel CoVs. Many children affected by MERS-CoV are asymptomatic. The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them. In contrast, adults more often have a nosocomial exposure. In this review, we summarize epidemiologic, clinical and diagnostic findings, as well as treatment and prevention options for common circulating and novel CoVs infections in humans with a focus on infections in children.
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9
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Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J 2020; 39:355-368. [PMID: 32310621 PMCID: PMC7158880 DOI: 10.1097/inf.0000000000002660] [Citation(s) in RCA: 662] [Impact Index Per Article: 165.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 02/06/2023]
Abstract
Coronaviruses (CoVs) are a large family of enveloped, single-stranded, zoonotic RNA viruses. Four CoVs commonly circulate among humans: HCoV2-229E, -HKU1, -NL63 and -OC43. However, CoVs can rapidly mutate and recombine leading to novel CoVs that can spread from animals to humans. The novel CoVs severe acute respiratory syndrome coronavirus (SARS-CoV) emerged in 2002 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The 2019 novel coronavirus (SARS-CoV-2) is currently causing a severe outbreak of disease (termed COVID-19) in China and multiple other countries, threatening to cause a global pandemic. In humans, CoVs mostly cause respiratory and gastrointestinal symptoms. Clinical manifestations range from a common cold to more severe disease such as bronchitis, pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. SARS-CoV, MERS-CoV and SARS-CoV-2 seem to less commonly affect children and to cause fewer symptoms and less severe disease in this age group compared with adults, and are associated with much lower case-fatality rates. Preliminary evidence suggests children are just as likely as adults to become infected with SARS-CoV-2 but are less likely to be symptomatic or develop severe symptoms. However, the importance of children in transmitting the virus remains uncertain. Children more often have gastrointestinal symptoms compared with adults. Most children with SARS-CoV present with fever, but this is not the case for the other novel CoVs. Many children affected by MERS-CoV are asymptomatic. The majority of children infected by novel CoVs have a documented household contact, often showing symptoms before them. In contrast, adults more often have a nosocomial exposure. In this review, we summarize epidemiologic, clinical and diagnostic findings, as well as treatment and prevention options for common circulating and novel CoVs infections in humans with a focus on infections in children.
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Affiliation(s)
- Petra Zimmermann
- From the Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases Research Group, Murdoch Children’s Research Institute
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases Research Group, Murdoch Children’s Research Institute
- Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
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10
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Trevisanuto D, Moschino L, Doglioni N, Roehr CC, Gervasi MT, Baraldi E. Neonatal Resuscitation Where the Mother Has a Suspected or Confirmed Novel Coronavirus (SARS-CoV-2) Infection: Suggestion for a Pragmatic Action Plan. Neonatology 2020; 117:133-140. [PMID: 32335559 PMCID: PMC7251577 DOI: 10.1159/000507935] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 12/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by the novel SARS-CoV-2 virus, is rapidly spreading across the world. As the number of infections increases, those of infected pregnant women and children will rise as well. Controversy exists whether COVID-19 can be transmitted in utero and lead to disease in the newborn. As this chance cannot be ruled out, strict instructions for the management of mothers and newborn infants are mandatory. This perspective aims to be a practical support tool for the planning of delivery and neonatal resuscitation of infants born by mothers with suspected or confirmed COVID-19 infection.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy,
| | - Laura Moschino
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
| | - Nicoletta Doglioni
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
| | - Charles Christoph Roehr
- Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Maria Teresa Gervasi
- Obstetrics and Gynecology Unit, Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eugenio Baraldi
- Department of Woman and Child's Health, University Hospital of Padova, Padua, Italy
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11
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Muldoon KM, Fowler KB, Pesch MH, Schleiss MR. SARS-CoV-2: Is it the newest spark in the TORCH? J Clin Virol 2020; 127:104372. [PMID: 32335336 PMCID: PMC7195345 DOI: 10.1016/j.jcv.2020.104372] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/11/2020] [Indexed: 02/07/2023]
Abstract
The SARS-CoV-2 pandemic poses under-appreciated risks during pregnancy, and perinatal infections endanger newborn outcomes. SARS-CoV-2 virus is transmitted in utero, although the clinical manifestations of neonatal infection are not understood. While the route of infection is uncertain, infection control measures should be developed to protect the newborn infant. Breast milk acquisition of COVID-19 is not described, and breast-feeding remains the preferred source of infant nutrition. The study of SARS-CoV-2 vaccines should target not only protection of the pregnant patient, but also the newborn infant.
Amid the rapidly evolving global coronavirus disease 2019 (COVID-19) pandemic that has already had profound effects on public health and medical infrastructure globally, many questions remain about its impact on child health. The unique needs of neonates and children, and their role in the spread of the virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) should be included in preparedness and response plans. Fetuses and newborn infants may be uniquely vulnerable to the damaging consequences of congenitally- or perinatally-acquired SARS-CoV-2 infection, but data are limited about outcomes of COVID-19 disease during pregnancy. Therefore, information on illnesses associated with other highly pathogenic coronaviruses (i.e., severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome [MERS]), as well as comparisons to common congenital infections, such as cytomegalovirus (CMV), are warranted. Research regarding the potential routes of acquisition of SARS-CoV-2 infection in the prenatal and perinatal setting is of a high public health priority. Vaccines targeting women of reproductive age, and in particular pregnant patients, should be evaluated in clinical trials and should include the endpoints of neonatal infection and disease.
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Affiliation(s)
- Kathleen M Muldoon
- Department of Anatomy, College of Graduate Studies and Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, 85308, USA; National CMV Foundation, Tampa, FL, 33679, USA
| | - Karen B Fowler
- Department of Pediatrics, University of Alabama at Birmingham Medical School, Pediatric Division of Infectious Diseases, Birmingham, AL, 35233, USA; National CMV Foundation, Tampa, FL, 33679, USA
| | - Megan H Pesch
- Department of Pediatrics, University of Michigan Medical School, Division of Developmental and Behavioral Pediatrics, Ann Arbor, MI, 48109, USA; National CMV Foundation, Tampa, FL, 33679, USA
| | - Mark R Schleiss
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN, 55455, USA; National CMV Foundation, Tampa, FL, 33679, USA.
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12
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Chen Z, DU LZ, Fu JF, Shu Q, Chen ZM, Shi LP, Wang W, Chen SH, Ma XL, Ye S, Sun W, Chen MY, Zhu HH, Huang GL, Luo FX. [Emergency plan for inter-hospital transfer of newborns with SARS-CoV-2 infection]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:226-230. [PMID: 32204758 PMCID: PMC7389604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 08/01/2024]
Abstract
Since December 2019, the outbreak of coronavirus disease (COVID-19) has become the most serious public health issue. As the special population with immature immune function, newborns with COVID-19 have been reported. Newborns with suspected or confirmed COVID-19 should be transferred to designated hospitals for isolation treatment. An emergency transfer response plan for newborns with COVID-19 has been worked out. This plan puts forward the indications for neonatal COVID-19 transfer, organization management, protection strategies for medical staff, work procedures, and disinfection methods for transfer equipment, in order to provide guidance and suggestions for the inter-hospital transfer of suspected or confirmed neonatal COVID-19.
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Affiliation(s)
- Zheng Chen
- National Clinical Research Center for Child Health/National Children's Regional Medical Center/Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
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13
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Chen Z, DU LZ, Fu JF, Shu Q, Chen ZM, Shi LP, Wang W, Chen SH, Ma XL, Ye S, Sun W, Chen MY, Zhu HH, Huang GL, Luo FX. [Emergency plan for inter-hospital transfer of newborns with SARS-CoV-2 infection]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:226-230. [PMID: 32204758 PMCID: PMC7389604 DOI: 10.7499/j.issn.1008-8830.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
Since December 2019, the outbreak of coronavirus disease (COVID-19) has become the most serious public health issue. As the special population with immature immune function, newborns with COVID-19 have been reported. Newborns with suspected or confirmed COVID-19 should be transferred to designated hospitals for isolation treatment. An emergency transfer response plan for newborns with COVID-19 has been worked out. This plan puts forward the indications for neonatal COVID-19 transfer, organization management, protection strategies for medical staff, work procedures, and disinfection methods for transfer equipment, in order to provide guidance and suggestions for the inter-hospital transfer of suspected or confirmed neonatal COVID-19.
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Affiliation(s)
- Zheng Chen
- National Clinical Research Center for Child Health/National Children's Regional Medical Center/Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
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14
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Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020; 12:v12020194. [PMID: 32050635 PMCID: PMC7077337 DOI: 10.3390/v12020194] [Citation(s) in RCA: 579] [Impact Index Per Article: 144.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/09/2020] [Accepted: 02/09/2020] [Indexed: 12/16/2022] Open
Abstract
In early December 2019 a cluster of cases of pneumonia of unknown cause was identified in Wuhan, a city of 11 million persons in the People’s Republic of China. Further investigation revealed these cases to result from infection with a newly identified coronavirus, initially termed 2019-nCoV and subsequently SARS-CoV-2. The infection moved rapidly through China, spread to Thailand and Japan, extended into adjacent countries through infected persons travelling by air, eventually reaching multiple countries and continents. Similar to such other coronaviruses as those causing the Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS), the new coronavirus was reported to spread via natural aerosols from human-to-human. In the early stages of this epidemic the case fatality rate is estimated to be approximately 2%, with the majority of deaths occurring in special populations. Unfortunately, there is limited experience with coronavirus infections during pregnancy, and it now appears certain that pregnant women have become infected during the present 2019-nCoV epidemic. In order to assess the potential of the Wuhan 2019-nCoV to cause maternal, fetal and neonatal morbidity and other poor obstetrical outcomes, this communication reviews the published data addressing the epidemiological and clinical effects of SARS, MERS, and other coronavirus infections on pregnant women and their infants. Recommendations are also made for the consideration of pregnant women in the design, clinical trials, and implementation of future 2019-nCoV vaccines.
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Affiliation(s)
- David A. Schwartz
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Ashley L. Graham
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA;
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15
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Ng PC. Infection Control Measures for COVID-19 in the Labour Suite and Neonatal Unit. Neonatology 2020; 117:141-143. [PMID: 32348989 PMCID: PMC7251568 DOI: 10.1159/000508002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/19/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Pak Cheung Ng
- Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China,
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16
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Wang Y, Wang Y, Han X, Ye J, Li R. Potential Effect of COVID-19 on Maternal and Infant Outcome: Lesson From SARS. Front Pediatr 2020; 8:511. [PMID: 32850564 PMCID: PMC7426626 DOI: 10.3389/fped.2020.00511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/20/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, is highly infectious and its ongoing outbreak has been declared a global pandemic by the WHO. Pregnant women are susceptible to respiratory pathogens and the development of severe pneumonia, suggesting the urgent need to assess the potential maternal and infant outcome of pregnancy with COVID-19. The intrauterine vertical transmission potential of SARS-CoV-2 also remains controversial. Herein, we discuss the potential effect of COVID-19 on maternal and infant outcomes based on current studies, including those published in Chinese, in a total of 80 mothers with COVID-19 and 80 infants. We also comprehensively explored the mother-to-child transmission routes of SARS-CoV-2, in particular the route of intrauterine vertical transmission. Given SARS-CoV-2 is a sister to SARS-CoV, of the SARS-related coronavirus species, we made a comprehensive comparison between them to learn from experiences with SARS. Although there is no evidence supporting the intrauterine vertical transmission of SARS-CoV-2, our comprehensive analysis suggests that the adverse maternal and infant outcomes caused by COVID-19 cannot be underestimated. Further, we speculated that the inconsistency between nucleic acids and serological characteristics IgM to SARS-CoV-2 of infants' specimens may be caused by the disruption of the amniotic barrier by the inflammatory factors induced by SARS-CoV-2 infection. Our review is beneficial to understand the effect of SARS-CoV-2 on maternal and infant outcomes.
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Affiliation(s)
- Yun Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiliang Wang
- Guangzhou Jinan Biomedicine Research and Development Center, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Xiaoxue Han
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiazhuo Ye
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ruiman Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Chan SSC, Leung D, Chui H, Tiwari AFY, Wong EMY, Wong DCN, Barnsteiner JH, Lau YL. Parental response to child's isolation during the SARS outbreak. ACTA ACUST UNITED AC 2007; 7:401-4. [PMID: 17870650 PMCID: PMC7106272 DOI: 10.1016/j.ambp.2007.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 05/12/2007] [Accepted: 06/04/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine the needs, uncertainties, and experiences of parents during their child's hospitalization with highly suspected severe acute respiratory syndrome (HSS), and to identify ways to improve their psychological preparedness and communication with health care professionals and their isolated children during future infectious disease outbreaks. METHODS Qualitative, semistructured interviews were conducted in July 2003 with parents of HSS pediatric patients. Seventeen HSS patients were hospitalized in a pediatric outpatient clinic of a major academic medical center in Hong Kong, between March 20 and May 28, 2003, during severe acute respiratory syndrome (SARS). Seven parents (41%) consented to participate in the study. RESULTS Four major themes were identified from the interviews: 1) fear of immediate isolation and infection control procedures, 2) sources of anxiety, 3) coping, and 4) communication with children and health care professionals. CONCLUSIONS Findings indicate a need to improve the psychological preparedness of the parents regarding the child's immediate isolation during hospitalization. Ample preparation and appropriate communication among parents, health care workers, and children might minimize fear and anxiety, sustain trust, and facilitate mutual understanding during an infectious disease outbreak.
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Affiliation(s)
- Sophia S C Chan
- Department of Nursing Studies, The University of Hong Kong, Hong Kong SAR, China.
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Jamieson DJ, Ellis JE, Jernigan DB, Treadwell TA. Emerging infectious disease outbreaks: old lessons and new challenges for obstetrician-gynecologists. Am J Obstet Gynecol 2006; 194:1546-55. [PMID: 16731070 PMCID: PMC7093849 DOI: 10.1016/j.ajog.2005.06.062] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Revised: 05/13/2005] [Accepted: 06/14/2005] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to summarize 3 recent high-profile infectious disease threats that have affected the United States: severe acute respiratory syndrome, West Nile virus, and anthrax. STUDY DESIGN A systematic review was conducted with the use of Medline searches, searches of the Centers for Disease Control and Prevention website, and review by experts at the Centers for Disease Control and Prevention. RESULTS The 3 emerging infectious diseases pose very different threats: Severe acute respiratory syndrome is a newly identified pathogen that caused an international pandemic; the West Nile virus investigation involved an old pathogen that was identified in a new location; and the anthrax attacks involved the intentional introduction of a pathogen. CONCLUSION All 3 outbreaks highlight the importance of obstetrician-gynecologists keeping current with new information as it emerges. In this global environment, it is likely that novel disease threats will continue to emerge in the United States.
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Affiliation(s)
- Denise J Jamieson
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Abstract
Influenza has historically been an uncommon illness in the newborn period, although epidemic outbreaks in neonatal intensive care units have been described. There is currently significant concern about the possibility of a new pandemic of influenza in the near future. During a pandemic neonates are likely to be exposed, with significant illness more likely in pre-term newborns due to reduced levels of passively transferred protective maternal antibodies. While newer therapies have been shown to be effective in reducing the severity of illness in adults and children, such therapies are untried in neonates. Supportive care and measures to contain and prevent spread of infection may well be the most important measures in the event of a neonate acquiring influenza, including the avian variety.
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Affiliation(s)
- D J Wilkinson
- Neonatal Unit, Mercy Hospital for Women, Melbourne, Australia.
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Lam HS, Chan MH, Ng PC, Wong W, Cheung RC, So AK, Fok TF, Lam CW. Are your hands clean enough for point-of-care electrolyte analysis? Pathology 2005; 37:299-304. [PMID: 16194829 PMCID: PMC7131148 DOI: 10.1080/00313020500169156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIM To investigate clinically significant analytical interference in point-of-care electrolyte analysis caused by contamination of blood specimens with hand disinfectant. METHODS Six different hand hygiene products were added separately to heparinised blood samples in varying amounts as contaminant. The contaminated samples were analysed by three different blood gas and electrolyte analysers for assessing interference on measured whole blood sodium and potassium concentrations. RESULTS There were significant analytical interferences caused by hand hygiene product contamination that varied depending on the combination of disinfectant and analyser. Small amounts of Microshield Antibacterial Hand Gel contamination caused large increases in measured sodium concentration. Such effect was much greater compared with the other five products tested, and started to occur at much lower levels of contamination. There was a trend towards lower sodium results in blood samples contaminated with Hexol Antiseptic Lotion (Hexol), the hand hygiene product that we used initially. Apart from AiE Hand Sanitizer, all the other hand disinfectants, especially Hexol, significantly elevated the measured potassium concentration, particularly when a direct ion-selective electrode method was used for measurement. CONCLUSIONS Hand disinfectant products can significantly interfere with blood electrolyte analysis. Proper precautions must be taken against contamination since the resultant errors can adversely affect the clinical management of patients.
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Affiliation(s)
- Hugh S. Lam
- Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Michael H.M. Chan
- Departments of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Pak C. Ng
- Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - William Wong
- Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Robert C.K. Cheung
- Departments of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Alan K.W. So
- Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Tai F. Fok
- Departments of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
| | - Christopher W.K. Lam
- Departments of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
- Address for correspondence: Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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Abstract
Severe acute respiratory syndrome (SARS) runs a more benign course in children during the acute phase. Infants born to mothers with the disease did not acquire the infection through vertical transmission. The treatment strategy for children with SARS has not been standardised and is based on adult experience. Thus far, no deaths have been reported in the paediatric age group. Exercise impairment and residual radiological abnormalities were present six months after diagnosis. It is important to assess these patients on a regular basis to detect and provide appropriate management for any persistent or emerging long term sequelae in the physical, psychological, and social domains. This review describes the current understanding of SARS coronavirus infection in newborns and children.
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Affiliation(s)
- A M Li
- Level 6, Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, ROC
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22
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Abstract
Severe acute respiratory syndrome (SARS) is an emerging infection that causes a potentially fatal respiratory disease. Although the SARS outbreak lasted less than 1 year, it resulted in significant morbidity and mortality and impacted nursing practices. A literature review was conducted. Only English language research articles in peer-reviewed journals, national organization publications, and book chapters were utilized. Data from 37 relevant articles were extracted, analyzed, and summarized. SARS' clinical description is presented, including its common signs/symptoms, diagnosis, and treatment. Recommended isolation practices for labor and delivery and proper procedures for donning, using, and doffing personal protective equipment are provided. Potential maternal outcomes include spontaneous miscarriage during the first trimester, preterm birth, emergency cesarean section, renal failure, secondary bacterial pneumonia, sepsis, adult respiratory distress syndrome, disseminated intravascular coagulation, surgical site infection, and maternal death. There have been no documented cases of vertical transmission; passive immunity is suspected on the basis of the presence of antibodies in some maternal body fluids. Potential neonatal outcomes include complications related to premature birth, intrauterine growth restriction, respiratory distress syndrome, and severe gastrointestinal manifestations. It is not known if or when SARS will reemerge, but perinatal and neonatal nurses should become familiar with its clinical description and proper infection control procedures to halt potential outbreaks.
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Affiliation(s)
- Terri Rebmann
- School of Nursing, and Institute for Biosecurity, School of Public Health, Saint Louis University, St Louis, MO 63104, USA.
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Abstract
The recent severe acute respiratory syndrome (SARS) outbreak has almost mandated a re-evaluation of infection control practices in hospitals, clinics, schools and domestic environments, especially for patients with respiratory tract symptoms. Triage, early case detection followed by prompt isolation and quarantine are major preventive measures. Respiratory tract infections are the most common childhood illnesses and paediatric SARS poses special problems in diagnosis because of its non-specific presentation. The main lessons learnt from the outbreak were: (1) despite well established guidelines on infection control precautions, poor understanding of underlying principles and deficiencies in compliance are common among healthcare professionals, especially during emergencies; (2) even a slight lapse can be fatal; and (3) over-protection can be counterproductive. Hence it is important to: (1) be protected to protect others; (2) be vigilant and prepared for emerging infections; (3) be proficient and scrupulous in infection control measures; (4) be apposite and practical on personal protective equipments to ensure sustainability; and (5) be dutiful and prompt in informing of potential threats and work closely with others.
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Affiliation(s)
- C B Chow
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Lai King Hiu Road, Kowloon, Hong Kong.
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Leung TF, Ng PC, Cheng FWT, Lyon DJ, So KW, Hon EKL, Li AM, Li CK, Wong GWK, Nelson EAS, Hui J, Sung RYT, Yam MC, Fok TF. Infection control for SARS in a tertiary paediatric centre in Hong Kong. J Hosp Infect 2004; 56:215-22. [PMID: 15003670 PMCID: PMC7124203 DOI: 10.1016/j.jhin.2003.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2003] [Accepted: 11/25/2003] [Indexed: 02/04/2023]
Abstract
Severe acute respiratory syndrome (SARS) is an emerging infectious disease. After the appearance of an index patient in Hong Kong in February 2003, SARS outbreaks occurred rapidly in hospitals and spread to the community. The aim of this retrospective study is to evaluate the effectiveness of a triage policy and risk-stratified infection control measures in preventing nosocomial SARS infection among paediatric healthcare workers (HCWs) at the Prince of Wales Hospital, a general hospital to which children with SARS are referred in Hong Kong. The acute paediatric wards were stratified into three areas: (1) ultra high-risk area, (2) high-risk area and (3) moderate-risk area according to different risk levels of nosocomial SARS transmission. The implementation of different levels of infection control precautions was guided by this risk stratification strategy. Between 13 March and 23 June, 38 patients with probable and suspected SARS, 90 patients with non-SARS pneumonia, and 510 patients without pneumonia were admitted into our unit. All probable SARS cases were isolated in negative-pressure rooms. Twenty-six HCWs worked in the ultra high-risk area caring for SARS patients and 88 HCWs managed non-SARS patients in other ward areas. None of the HCWs developed clinical features suggestive of SARS. In addition, there was no nosocomial spread of SARS-associated coronavirus to other patients or visitors during this period. In conclusion, stringent infection control precautions, appropriate triage and prompt isolation of potential SARS patients may have contributed to a lack of nosocomial spread and HCW acquisition of SARS in our unit.
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Affiliation(s)
- T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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Robertson CA, Lowther SA, Birch T, Tan C, Sorhage F, Stockman L, McDonald C, Lingappa JR, Bresnitz E. SARS and pregnancy: a case report. Emerg Infect Dis 2004; 10:345-8. [PMID: 15030710 PMCID: PMC3322896 DOI: 10.3201/eid1002.030736] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We report a laboratory-confirmed case of severe acute respiratory syndrome (SARS) in a pregnant woman. Although the patient had respiratory failure, a healthy infant was subsequently delivered, and the mother is now well. There was no evidence of viral shedding at delivery. Antibodies to SARS virus were detected in cord blood and breast milk.
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