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Aguilar-Caballero D, Capcha JMC, Caballero V, Young KC, Duara S, Borchetta M, Gonzalez I, Saad AG, Webster KA, Shehadeh LA, Bandstra ES, Schmidt AF. Case report: Fatal lung hyperinflammation in a preterm newborn with SARS-CoV-2 infection. Front Pediatr 2023; 11:1144230. [PMID: 37287630 PMCID: PMC10242137 DOI: 10.3389/fped.2023.1144230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Vertical transmission of SARS-CoV-2 from mother to fetus is widely accepted. Whereas most infected neonates present with mild symptoms or are asymptomatic, respiratory distress syndrome (RDS) and abnormal lung images are significantly more frequent in COVID-19 positive neonates than in non-infected newborns. Fatality is rare and discordant meta-analyses of case reports and series relating perinatal maternal COVID-19 status to neonatal disease severity complicate their extrapolation as prognostic indicators. A larger database of detailed case reports from more extreme cases will be required to establish therapeutic guidelines and allow informed decision making. Here we report an unusual case of a 28 weeks' gestation infant with perinatally acquired SARS-CoV-2, who developed severe protracted respiratory failure. Despite intensive care from birth with first line anti-viral and anti-inflammatory therapy, respiratory failure persisted, and death ensued at 5 months. Lung histopathology showed severe diffuse bronchopneumonia, and heart and lung immunohistochemistry confirmed macrophage infiltration, platelet activation and neutrophil extracellular trap formation consistent with late multisystem inflammation. To our knowledge, this is the first report of SARS CoV-2 pulmonary hyperinflammation in a preterm newborn with fatal outcome.
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Affiliation(s)
- Daniela Aguilar-Caballero
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Jose M. C. Capcha
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Veronica Caballero
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Karen C. Young
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Shahnaz Duara
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Michael Borchetta
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ivan Gonzalez
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ali G. Saad
- Division of Anatomic Pathology, Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keith A. Webster
- Integene International, LLC, Miami, FL, United States
- Baylor College of Medicine, Everglades Biopharma, Cullen Eye Institute, Houston, TX, United States
| | - Lina A. Shehadeh
- Division of Cardiology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emmalee S. Bandstra
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
| | - Augusto F. Schmidt
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Holz Children's Hospital/Jackson Memorial Hospital, Miami, FL, USA
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Mehrpisheh S, Farhadi R, Ghaffari Saravi V, Dastourian F, Memarian A. Evaluation of clinical manifestations of coronavirus delta variant in neonates admitted to a hospital in northern Iran during the sixth wave: A case series. JOURNAL OF NEONATAL NURSING : JNN 2023:S1355-1841(23)00061-3. [PMID: 37362911 PMCID: PMC10110928 DOI: 10.1016/j.jnn.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Eleven newborns infected with COVID-19 delta variant admitted to a hospital in northern Iran during the sixth wave were evaluated. Fever, poor breastfeeding, lethargy, and lung involvement were the most prevalent symptoms in COVID-19 delta variant infected neonates. Infected mothers may be a main cause of infection for neonates.
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Affiliation(s)
- Shahrokh Mehrpisheh
- Department of Neonatology, Mazandaran University of Medical Science, Sari, Iran
| | - Roya Farhadi
- Department of Neonatology, Mazandaran University of Medical Science, Sari, Iran
| | | | - Farnaz Dastourian
- Department of Neonatology, Mazandaran University of Medical Science, Sari, Iran
| | - Azadeh Memarian
- Department of Emergency Medicine, School of Medicine, Mazandaran University of Medical Science, Sari, Iran
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Stafstrom CE. Neurological effects of COVID-19 in infants and children. Dev Med Child Neurol 2022; 64:818-829. [PMID: 35243616 PMCID: PMC9111795 DOI: 10.1111/dmcn.15185] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022]
Abstract
Neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children are becoming increasingly apparent as the coronavirus disease (COVID-19) pandemic continues. While children manifest relatively milder features of the disease, accumulating evidence warrants concern that COVID-19 exacts both acute- and long-term effects on the developing central and peripheral nervous systems. This review focuses on the relatively underinvestigated topic of the effects of SARS-CoV-2 on the brain in infancy and childhood, concluding that clinicians should be attentive to both the acute effects and long-term consequences of COVID-19 from a neurological perspective.
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Affiliation(s)
- Carl E. Stafstrom
- Division of Pediatric NeurologyDepartments of Neurology and PediatricsThe Johns Hopkins University School of MedicineBaltimoreMDUSA
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Wang L, Li G, Yuan C, Yang Y, Ling G, Zheng J, Zhou Y, Zhang T, Lin W, Lin Z. Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review. Int J Gen Med 2021; 14:8097-8108. [PMID: 34795516 PMCID: PMC8594783 DOI: 10.2147/ijgm.s335888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been circulating in many countries around the world, characterized by long incubation period, strong infectivity, strong variability, high population susceptibility and diversified transmission methods. Its causative agent is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Compared with adult patients, the clinical manifestations of COVID-19 in children are often dominated by mild or asymptomatic infections, but children are also important virus carriers and play an important role in the transmission of the virus. In addition, some children will show excessive inflammatory response and experience serious complications such as multisystem inflammatory syndrome in children (MIS-C). At present, the research on COVID-19 in children is still imperfect. This article will review epidemiological characteristics, the mechanism of action, variant characteristics, clinical manifestations, auxiliary examinations and treatment of children with COVID-19, in order to provide help for the diagnosis, treatment and research of children with COVID-19.
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Affiliation(s)
- Libo Wang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Gan Li
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Chang Yuan
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yuele Yang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Gongxia Ling
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jinyu Zheng
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yiyang Zhou
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Tianlei Zhang
- Department of Clinical Medicine, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Wei Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Zhenlang Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
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Tumanova UN, Schegolev AI, Chausov AA, Shuvalova MP. Analysis of causes of early neonatal mortality during covid-19 pandemic in 2020 in Russia. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In March 2020, the World Health Organization declared a COVID-19 pandemic. The aim of this study was to compare the causes of and statistics on neonatal mortality in Russia in the years 2020 and 2019 using the Rosstat A-5 forms that aggregate data from perinatal death certificates. In 2020, there was a 7.6% reduction in the absolute number of live births relative to 2019. In 2020, the early neonatal death rate (1.59‰) fell by 4.4% relative to 2019 (1.67‰). But neonatal death rates in the Southern and Far Eastern Federal Districts rose by 20.5% and 6.1%, respectively. Respiratory diseases were the most common cause of early neonatal mortality across Russia (37.3% and 40.2% relative to the total number of neonatal deaths in 2019 and 2020, respectively). Congenital sepsis accounted for 43.6% and 46.6% of neonatal deaths from infectious diseases and for 7.3% and 7.9% of all neonatal deaths reported in 2019 and 2020, respectively. There was an increase in the proportion of respiratory diseases among neonates, including congenital pneumonia and other respiratory conditions, and infections, including congenital sepsis, which reflects the direct and indirect effects of SARS-CoV-2 infection in pregnant women and neonates.
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Affiliation(s)
- UN Tumanova
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - AI Schegolev
- Pirogov Russian National Medical Research University, Moscow, Russia
| | - AA Chausov
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
| | - MP Shuvalova
- Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
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Principi N, Esposito S. Is the Immunization of Pregnant Women against COVID-19 Justified? Vaccines (Basel) 2021; 9:970. [PMID: 34579207 PMCID: PMC8473171 DOI: 10.3390/vaccines9090970] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Maternal immunization against some infectious diseases can offer significant advantages for women, preventing maternal morbidity and mortality, or for offspring, preventing fetal disease and conferring passive immunity to neonates. Recently, clinical trials specifically to evaluate the immunogenicity, safety, and tolerability of some of the available coronavirus disease 2019 (COVID-19) vaccines in pregnant and lactating women have been planned, initiated and, in some cases, completed. This paper discusses whether the immunization of pregnant women against COVID-19 is justified and presents knowledge about the immunogenicity and safety of mRNA COVID-19 vaccines for these subjects. The results of recent studies indicate that pregnant women are at increased risk of developing severe disease compared with nonpregnant women of the same age. Studies carried out with mRNA vaccines indicate that the immunogenicity, safety and tolerability of these preventive measures in pregnant women are not different from those in nonpregnant women of the same age. Moreover, antibodies are efficiently transferred through the placenta and can be detected in breastmilk, suggesting a potential prevention of infection in the child. All these findings authorize the use of mRNA vaccines in pregnant women to protect both the mother and the child. However, further studies with larger sample size and with follow-up of the pregnant women vaccinated during different periods of pregnancy and their children are needed to better characterize the immune response of pregnant women, to define when these vaccines should be administered to obtain the best protection, and to measure vaccine efficacy against virus variants in both mothers and infants. COVID-19 vaccines based on different technological platforms cannot presently be used, and their role in pregnant women should be clarified.
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Affiliation(s)
- Nicola Principi
- Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy;
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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Nosetti L, Agosti M, Franchini M, Milan V, Piacentini G, Zaffanello M. Long-Term Pulmonary Damage From SARS-CoV-2 in an Infant With Brief Unexplained Resolved Events: A Case Report. Front Med (Lausanne) 2021; 8:646837. [PMID: 34179037 PMCID: PMC8225923 DOI: 10.3389/fmed.2021.646837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
A brief unexplained resolved event (BRUE) is an event observed in a child under 1 year of age in which the observer witnesses a sudden, brief but resolved episode of change in skin color, lack of breathing, weakness or poor responsiveness. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease-2019 (COVID-19). We report the case of a previously healthy, full-term infant infected with SARS-CoV-2 when he was 8 months old. Previous to this event, both his grandfather and great-uncle had died of severe pneumonia and his mother had developed respiratory symptoms and fever. Over the following month he was seen five times in the emergency room and was hospitalized twice for recurrent BRUE. At the first hospital admission, after the second emergency room visit, he twice tested positive for COVID-19 after nasopharyngeal swab tests. During his second hospital admission, after the fifth emergency room visit, chest computed tomography revealed typical SARS-CoV-2 pneumonia. During a follow-up examination 6 months later, mild respiratory distress required administration of inhaled oxygen (0.5 L/min) and chest computed tomography disclosed a slight improvement in pulmonary involvement. The clinical manifestation of pulmonary complications from COVID-19 infection was unusual. This is the first report of an infant at high-risk for BRUE, which was the only manifestation of long-term lung involvement due to SARS-CoV-2 pneumonia.
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Affiliation(s)
- Luana Nosetti
- Lombardy Regional Sudden Infant Death Syndrome Center, Division of Pediatrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Massimo Agosti
- Department of Neonatology, Neonatal Intensive Care Unit, and Pediatrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale, Mantova, Italy
| | - Valentina Milan
- Division of Pediatrics, F. Del Ponte Hospital, Varese, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
| | - Marco Zaffanello
- Department of Surgical Sciences, Dentistry, Gynecology, and Pediatrics, University of Verona, Verona, Italy
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