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Goyal M, Mascarenhas D, RR P, Nanavati R. Long-Term Growth and Neurodevelopmental Outcomes of Neonates Infected with SARS-CoV-2 during the COVID-19 Pandemic at 18-24 Months Corrected Age: A Prospective Observational Study. Neonatology 2024; 121:450-459. [PMID: 38583433 PMCID: PMC11318580 DOI: 10.1159/000537803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/07/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION During the early coronavirus disease (COVID-19) pandemic in 2020, researchers cautioned about the potential neuroinvasive capability of the virus and long-term neurological consequences. Although a few preliminary studies have found delayed communication, fine motor, and problem-solving skills in infants after COVID-19 infection, there continues to be a paucity of data on long-term development of neonates diagnosed with COVID-19. METHODS We conducted a prospective study of 20 neonates who acquired severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the first wave of the pandemic (April-July 2020). At 18-24 months corrected age, we assessed neurodevelopment by Bayley Scales of Infant and Toddler Development, the third edition (BSID-III), along with growth, hearing, and vision evaluation. RESULTS The mean corrected age at assessment was 21 months 11 days ± 1 month 28 days. We found developmental delay in nearly half of the children with scores below one standard deviation in either of the BSID-III domains. Mild delay in either motor, cognitive, or language domains was found in 9 (45%) children and moderate delay in 2 (10%). Expressive language, fine motor, and receptive language were predominantly affected. None of the children had hearing impairment, blindness, or significant growth faltering including clinically severe microcephaly. The mean composite cognitive, language, and motor scores were significantly lower in those with neurodevelopmental delay (p value - 0.02, 0.000, and 0.03, respectively) without any differences in their disease characteristics. CONCLUSION Neonates infected with SARS-CoV-2 have an increased risk of developmental delays in expressive language, fine motor, and receptive language skills at 18-24 months of age. The severity of delays is predominantly mild.
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Affiliation(s)
- Medha Goyal
- Division of Neonatology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Dwayne Mascarenhas
- Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Prashanth RR
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Ruchi Nanavati
- Department of Neonatology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
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Santos CAD, Paula AP, Filho GGF, Alves MM, Nery AF, Pontes MGA, Macedo EYL, Oliveira RM, Freitas SM, Lima S, Varela FVC, Viana ALS, Silva ALP, Silva ÉGC, D'Souza-Li L. Developmental impairment in children exposed during pregnancy to maternal SARS-COV2: A Brazilian cohort study. Int J Infect Dis 2024; 139:146-152. [PMID: 38061413 DOI: 10.1016/j.ijid.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/31/2023] Open
Abstract
OBJECTIVES To determine the effects of in-utero exposure to maternal SARS-CoV-2 infection on offspring's neurodevelopment during the first year of life. METHODS We performed a prospective cohort of babies exposed to SARS-CoV-2 during pregnancy, and a control group (CG) of unexposed babies in a low-income area in Brazil. Children's neurodevelopment was assessed using the guide for Monitoring Child Development in the Integrated Management of Childhood Illness context for both groups (at 1,2,3,4,5,6, 9, and 12 months), and the Ages & Stages Questionnaire (ASQ-3) for the exposed group (EG) (at 4, 6 and 12 months). RESULTS We followed 137 children for 1 year, 69 in the COVID-19-EG, and 68 in the CG. All mothers were unvaccinated at the time of cohort inclusion, and maternal demographics were similar in the two groups. 20.3% of EG children and 5.9% of the CG received a diagnosis of neurodevelopmental delay within 12 months of life (P = 0.013, relative risk = 3.44; 95% confidence interval, 1.19- 9.95). For the EG, the prevalence of neurodevelopment impairment using Ages & Stages Questionnaire was 35.7% at 4 months, 7% at 6 months, and 32.1% at 12 months. CONCLUSION SARS-CoV-2 exposure was associated with neurodevelopmental impairment, and specific guidelines are needed for the follow-up of these high-risk children to mitigate the long-term effects on children's health.
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Affiliation(s)
- Carolina A D Santos
- University of Campinas, UNICAMP, Faculty of Medical Science, Campinas, Brazil; Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil.
| | - Artemis P Paula
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Gentil G Fonseca Filho
- Federal University of Rio Grande do Norte, Natal, Brazil; Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Manoella M Alves
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil; Federal University of Rio Grande do Norte, Natal, Brazil
| | - Andréia F Nery
- Federal University of Rio Grande do Norte, Natal, Brazil
| | - Monise G A Pontes
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Erianna Y L Macedo
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Ruy M Oliveira
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Sabrinna M Freitas
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Sarah Lima
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Fernanda V C Varela
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Andrezza L S Viana
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Aline L P Silva
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Érika G C Silva
- Santos Dumont Institute, Anita Garibaldi Center for Education and Research in Health, Macaíba, Brazil
| | - Lília D'Souza-Li
- University of Campinas, UNICAMP, Faculty of Medical Science, Department of Pediatrics, Campinas, Brazil
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Recaioglu H, Kolk SM. Developing brain under renewed attack: viral infection during pregnancy. Front Neurosci 2023; 17:1119943. [PMID: 37700750 PMCID: PMC10493316 DOI: 10.3389/fnins.2023.1119943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/26/2023] [Indexed: 09/14/2023] Open
Abstract
Living in a globalized world, viral infections such as CHIKV, SARS-COV-2, and ZIKV have become inevitable to also infect the most vulnerable groups in our society. That poses a danger to these populations including pregnant women since the developing brain is sensitive to maternal stressors including viral infections. Upon maternal infection, the viruses can gain access to the fetus via the maternofetal barrier and even to the fetal brain during which factors such as viral receptor expression, time of infection, and the balance between antiviral immune responses and pro-viral mechanisms contribute to mother-to-fetus transmission and fetal infection. Both the direct pro-viral mechanisms and the resulting dysregulated immune response can cause multi-level impairment in the maternofetal and brain barriers and the developing brain itself leading to dysfunction or even loss of several cell populations. Thus, maternal viral infections can disturb brain development and even predispose to neurodevelopmental disorders. In this review, we discuss the potential contribution of maternal viral infections of three relevant relative recent players in the field: Zika, Chikungunya, and Severe Acute Respiratory Syndrome Coronavirus-2, to the impairment of brain development throughout the entire route.
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Affiliation(s)
| | - Sharon M. Kolk
- Faculty of Science, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
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