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Rustogi D, Saxena G, Chopra SS, Soraisham A. Potential Neurologic Manifestations of COVID-19 Infection in Neonates. Neoreviews 2024; 25:e71-e77. [PMID: 38296786 DOI: 10.1542/neo.25-2-e71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
In contrast to adults, neonates and infants with coronavirus disease 2019 (COVID-19) infection have milder symptoms and are less likely to require hospitalization. However, some neonates with COVID-19 can present with significant symptoms. Recent evidence suggests that neurologic manifestations of neonatal COVID-19 infection may be higher than initially thought. In this comprehensive review of the current literature, we summarize the clinical, laboratory, and radiologic findings, as well as potential management strategies for COVID-19-related neurologic illness in neonates. Although the growing brain may be affected by neurologic disease associated with COVID-19 infection, the few published studies on the long-term outcomes after COVID-19 infection in neonates and infants provide conflicting results. Larger collaborative clinical studies are needed to determine whether COVID-19 infection in neonates has long-term neurodevelopmental outcomes.
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Affiliation(s)
- Deepika Rustogi
- Department of Neonatology and Pediatrics, Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad, UP, India
| | - Garima Saxena
- Department of Neonatology and Pediatrics, Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad, UP, India
| | - Saurabh S Chopra
- Department of Neonatology and Pediatrics, Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad, UP, India
- Department of Pediatric Neurology, Max Super Speciality Hospitals, Delhi-NCR, India
| | - Amuchou Soraisham
- Department of Pediatrics and Neonatology, Foothills Medical Centre, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Alves de Araujo Junior D, Motta F, Fernandes GM, Castro MECD, Sasaki LMP, Luna LP, Rodrigues TS, Kurizky PS, Soares AADSM, Nobrega ODT, Espindola LS, Zaconeta AM, Gomes CM, Martins-Filho OA, de Albuquerque CP, da Mota LMH. Neuroimaging assessment of pediatric cerebral changes associated with SARS-CoV-2 infection during pregnancy. Front Pediatr 2023; 11:1194114. [PMID: 37292371 PMCID: PMC10244818 DOI: 10.3389/fped.2023.1194114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
Background SARS-CoV-2 infection and perinatal neurologic outcomes are still not fully understood. However, there is recent evidence of white matter disease and impaired neurodevelopment in newborns following maternal SARS-CoV-2 infection. These appear to occur as a consequence of both direct viral effects and a systemic inflammatory response, with glial cell/myelin involvement and regional hypoxia/microvascular dysfunction. We sought to characterize the consequences of maternal and fetal inflammatory states in the central nervous system of newborns following maternal SARS-CoV-2 infection. Methods We conducted a longitudinal prospective cohort study from June 2020 to December 2021, with follow-up of newborns born to mothers exposed or not exposed to SARS-CoV-2 infection during pregnancy. Brain analysis included data from cranial ultrasound scans (CUS) with grayscale, Doppler studies (color and spectral), and ultrasound-based brain elastography (shear-wave mode) in specific regions of interest (ROIs): deep white matter, superficial white matter, corpus callosum, basal ganglia, and cortical gray matter. Brain elastography was used to estimate brain parenchymal stiffness, which is an indirect quantifier of cerebral myelin tissue content. Results A total of 219 single-pregnancy children were enrolled, including 201 born to mothers exposed to SARS-CoV-2 infection and 18 from unexposed controls. A neuroimaging evaluation was performed at 6 months of adjusted chronological age and revealed 18 grayscale and 21 Doppler abnormalities. Predominant findings were hyperechogenicity of deep brain white matter and basal ganglia (caudate nuclei/thalamus) and a reduction in the resistance and pulsatility indices of intracranial arterial flow. The anterior brain circulation (middle cerebral and pericallosal arteries) displayed a wider range of flow variation than the posterior circulation (basilar artery). Shear-wave US elastography analysis showed a reduction in stiffness values in the SARS-CoV-2 exposed group in all analyzed regions of interest, especially in the deep white matter elasticity coefficients (3.98 ± 0.62) compared to the control group (7.76 ± 0.77); p-value < 0.001. Conclusion This study further characterizes pediatric structural encephalic changes associated with SARS-CoV-2 infection during pregnancy. The maternal infection has been shown to be related to cerebral deep white matter predominant involvement, with regional hyperechogenicity and reduction of elasticity coefficients, suggesting zonal impairment of myelin content. Morphologic findings may be subtle, and functional studies such as Doppler and elastography may be valuable tools to more accurately identify infants at risk of neurologic damage.
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Affiliation(s)
- David Alves de Araujo Junior
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, VIC, Australia
| | - Felipe Motta
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
| | - Geraldo Magela Fernandes
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
| | - Maria Eduarda Canellas De Castro
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
| | - Lizandra Moura Paravidine Sasaki
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
| | - Licia Pacheco Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Patricia Shu Kurizky
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
| | | | | | | | | | - Ciro Martins Gomes
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
| | | | - Cleandro Pires de Albuquerque
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
| | - Licia Maria Henrique da Mota
- Department of Medicine, University of Brasilia (UnB), Brasilia, Brazil
- Hospital Universitario de Brasília (HUB), Brasilia, Brazil
- Medical Sciences, University of Brasilia, Brasilia, Brazil
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Carvajal J, Casanello P, Toso A, Farías M, Carrasco-Negue K, Araujo K, Valero P, Fuenzalida J, Solari C, Sobrevia L. Functional consequences of SARS-CoV-2 infection in pregnant women, fetoplacental unit, and neonate. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166582. [PMID: 36273675 PMCID: PMC9581789 DOI: 10.1016/j.bbadis.2022.166582] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/04/2022]
Abstract
The SARS-CoV-2 infection causes COVID-19 disease, characterized by acute respiratory distress syndrome, bilateral pneumonia, and organ failure. The consequences of maternal SARS-CoV-2 infection for the pregnant woman, fetus, and neonate are controversial. Thus, it is required to determine whether there is viral and non-viral vertical transmission in COVID-19. The disease caused by SARS-CoV-2 leads to functional alterations in asymptomatic and symptomatic pregnant women, the fetoplacental unit and the neonate. Several diseases of pregnancy, including COVID-19, affect the fetoplacental function, which causes in utero programming for young and adult diseases. A generalized inflammatory state and a higher risk of infection are seen in pregnant women with COVID-19. Obesity, diabetes mellitus, and hypertension may increase the vulnerability of pregnant women to infection by SARS-CoV-2. Alpha, Delta, and Omicron variants of SARS-CoV-2 show specific mutations that seem to increase the capacity of the virus to infect the pregnant woman, likely due to increasing its interaction via the virus S protein and angiotensin-converting enzyme 2 receptors. This review shows the literature addressing to what extent COVID-19 in pregnancy affects the pregnant woman, fetoplacental unit, and neonate. Prospective studies that are key in managing SARS-CoV-2 infection in pregnancy are discussed.
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Affiliation(s)
- Jorge Carvajal
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
| | - Paola Casanello
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands
| | - Alberto Toso
- Department of Neonatology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Marcelo Farías
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Karina Carrasco-Negue
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Kenny Araujo
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Paola Valero
- Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile,Faculty of Health Sciences, Universidad de Talca, Talca 3460000, Chile
| | - Javiera Fuenzalida
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Caterina Solari
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile
| | - Luis Sobrevia
- Department of Obstetrics, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), Sao Paulo State University (UNESP), Brazil; Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville E-41012, Spain; University of Queensland, Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston 4029, Queensland, Australia; Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ, Groningen, the Netherlands; Tecnologico de Monterrey, Eutra, The Institute for Obesity Research (IOR), School of Medicine and Health Sciences, Monterrey, Nuevo León, Mexico.
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