Multisystem Inflammatory Syndrome in Neonates (MIS-N) Associated with Perinatal SARS CoV-2 Infection: Does it Exist?

Placenta a potential gateway of prenatal SARS-CoV-2 infection: A review

SARS-CoV-2, the causative agent of COVID-19, can infect various tissues in the body apart from the lungs. Although placental infection remains controversial, COVID-19-associated placental abnormalities have been reported worldwide. Therefore, COVID-19 poses a significant risk for fetal distress as well. Scientists are currently debating whether such distress results from direct viral induced assault or placental damage caused by the mother's immune response. The placenta develops different histopathological lesions in response to maternal SARS-CoV-2 infection. While some studies support both theories, the transmission rate through the placenta remains low. Therefore, a more in-depth study is necessary to determine the primary cause of maternal SARS-CoV-2-induced fetal distress. This comprehensive review is aimed to shed light on the possible reasons towards fetal distress among mothers with COVID-19. This review describes the various mechanisms of viral entry along with the mechanisms by which the virus could affect the placenta. Reported cases of placental abnormalities and fetal distress symptoms have been collated to provide an overview of the current state of knowledge on vertical transmission of COVID-19.

How to Manage a Neonate Born from a SARS-CoV-2-Positive Mother: A Narrative Review

From 2020 to today, considerable knowledge on SARS-CoV-2 has been collected, even on pregnant women and their fetuses and newborns, and clinical guidelines have been written and implemented worldwide. Vaccination has considerably improved outcomes, but hesitancy amongst pregnant patients and the emergence of variants remain challenging, and SARS-CoV-2 positivity during pregnancy continues to be associated with an increased risk of maternal complications, premature delivery, and higher neonatal mortality and morbidity. A body of data now exists on the effect of SARS-CoV-2 during pregnancy on early neonatal outcomes, medical education in obstetrics and pediatrics, and longer-term developmental outcomes. This review aimed to present important findings on clinical outcomes and health recommendations for neonate born from a SARS-CoV-2-positive mother in order to summarize effective preventive healthcare guidelines.

Newborns at risk of COVID-19, the story continues

After more than 4 years of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. Guidelines for mode of delivery, cord clamping, skin to skin, breastfeeding, and rooming-in have become uniform across the world. Vaccination has considerably improved outcomes, but hesitancy amongst pregnant patients and the emergence of variants remain challenged and SARS-CoV-2 positivity during pregnancy continues to be associated with an increased risk of maternal complications, premature delivery and higher neonatal mortality and morbidity. An emerging body of data now exists on the effect of SARS-CoV-2 in pregnancy on early neonatal outcomes, medical education in obstetrics and pediatrics, and longer-term developmental outcomes. In this article, we review the development in this field since our last review.

Multisystem inflammatory syndrome in neonates (MIS-N): an updated systematic review

Introduction

The aim of the study was to summarize and update clinical features and outcomes of multisystem inflammatory syndrome in neonates (MIS-N).

Methods

A systematic literature search was conducted of studies on MIS-N published in PubMed, MEDLINE, EMBASE, CNKI, and WHO COVID-19 databases between 1 December 2019 and 30 June 2023. Reference lists of selected articles, Google Scholar, and pre-print servers were searched for additional studies. The methodological quality of included studies was assessed.

Results

Of 1,572 records screened after the initial search, 35 studies involving a total of 201 neonates with MIS-N were included. One study was retrieved from a pre-print server. For those with available data, 34/47 (78.7%) mothers were infected in the third trimester. Of the 199 mothers (two with twin pregnancies), 183 (92.0%) were from India. The median age of neonates at presentation was 2.0 days (interquartile range 1.0-9.5). Over two-thirds (144/201, 71.6%) presented with respiratory distress, while 112 (55.7%) had cardiac involvement, such as ventricular dysfunctions, involvement of coronary arteries, and atrioventricular blocks. Arrhythmias and thrombosis were reported in 15/201 (7.5%) and 2/201 (3.0%) neonates, respectively. All neonates, except one, required critical care; 64/160 (40.0%) required inotropic support and 105/187 (56.1%) required respiratory support, of whom 59/105 (56.2%) were specified to require intubation. The mortality rate was 5.0% (10/201).

Discussion/Conclusion

MIS-N should be considered in ill neonates presenting with involvement of two or more organ systems, especially among those neonates with cardiorespiratory dysfunctions, in the presence of proven or suspected maternal COVID-19 infection during pregnancy.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278717, PROSPERO, identifier CRD42021278717.

Maternal COVID-19 Infection Associated with Fetal Systemic Inflammatory Complications in COVID-19-Negative Neonates: A Case-Series

OBJECTIVE

This study aimed to examine fetal and neonatal inflammatory and neurologic complications associated with maternal coronavirus disease 2019 (COVID-19) infection.

STUDY DESIGN

Case-series using a convenience sample of neonates cared for in a large referral-based children's hospital neonatal intensive care unit between September 2021 and May 2022.

RESULTS

We identified seven neonates with exposure to maternal severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) and a presentation consistent with inflammatory complications. All had some degree of neurologic injury with neuroimaging findings including restricted diffusion indicating injury in the white matter, cortex, deep gray structures, and splenium of the corpus callosum as well as intracranial hemorrhage. In addition, many infants had cytopenia and abnormal coagulation studies. Placental pathology, when available, revealed inflammation, clot with calcifications, and hematomas with associated infarcts.

CONCLUSION

Neonates born to mothers with SARS-CoV-2, even when negative for the virus themselves, may have complications consistent with a systemic inflammatory syndrome. Placental pathology as well as neurologic imaging in infants with neurologic findings may help to support this diagnosis.

KEY POINTS

· A systemic inflammatory response may cause illness in babies born to mothers with a history of COVID-19.. · Inflammatory markers and placental pathology are helpful in supporting this diagnosis.. · Consider neuroimaging in infants of mothers with a history of COVID-19 with neurologic findings..

Management of neonates with maternal prenatal coronavirus infection and influencing factors

The coronavirus disease 2019 (COVID-19) in pregnancy causes adverse outcomes for both the mother and the fetus. Neonates are at risk of vertical transmission and in-utero infection. Additionally, intensive care unit (ICU) admission and impairment in the organ systems of the mother are associated with neonatal outcomes, including impaired intrauterine growth, prematurity, and neonatal ICU admission. The management of neonates born from infected mothers has changed over the progress of the pandemic. At the beginning of the pandemic, cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoiding of skin-to-skin contact, breast milk, and breastfeeding were the main practices to reduce vertical and horizontal transmission risk in the era of insufficient knowledge. The effects of antenatal steroids and delayed cord clamping on COVID-19 were also not known. As the pandemic progressed, data showed that prenatal, delivery room, and postnatal care of neonates can be performed as pre-pandemic practices. Variants and vaccines that affect clinical course and outcomes have emerged during the pandemic. The severity of the disease and the timing of infection in pregnancy also influence maternal and neonatal outcomes. The knowledge and lessons from COVID-19 will be helpful for the next pandemic if it happens. IMPACT: Prenatal infection with COVID-19 is associated with adverse maternal and neonatal outcomes. Our review includes the management of neonates with prenatal COVID-19 infection exposure, maternal-fetal, delivery room, and postnatal care of neonates, clinical features, treatment of neonates, and influencing factors such as variants, vaccination, severity of maternal disease, and timing of infection during pregnancy. There is a growing body of data and evidence about the COVID-19 pandemic. The knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.

Neonatal outcomes of maternal prenatal coronavirus infection

The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in life and healthcare all over the world. Pregnant women and their newborns require extra attention due to the increased risk of adverse outcomes. Adverse pregnancy outcomes include intensive care unit (ICU) admission, pulmonary, cardiac, and renal impairment leading to mortality. Immaturity and variations of the neonatal immune system may be advantageous in responding to the virus. Neonates are at risk of vertical transmission and in-utero infection. Impaired intrauterine growth, prematurity, vertical transmission, and neonatal ICU admission are the most concerning issues. Data on maternal and neonatal outcomes should be interpreted cautiously due to study designs, patient characteristics, clinical variables, the effects of variants, and vaccination beyond the pandemic. Cesarean section, immediate separation of mother-infant dyads, isolation of neonates, and avoidance of breast milk were performed to reduce transmission risk at the beginning of the pandemic in the era of insufficient knowledge. Vertical transmission was found to be low with favorable short-term outcomes. Serious fetal and neonatal outcomes are not expected, according to growing evidence. Long-term effects may be associated with fetal programming. Knowledge and lessons from COVID-19 will be helpful for the next pandemic if it occurs. IMPACT: Prenatal infection with SARS-CoV-2 is associated with adverse maternal and neonatal outcomes. Our review includes the effects of COVID-19 on the fetus and neonates, transmission routes, placental effects, fetal and neonatal outcomes, and long-term effects on neonates. There is a growing body of data and evidence about the COVID-19 pandemic. Knowledge and lessons from the pandemic will be helpful for the next pandemic if it happens.