Clinical characteristics and evolution of 71 neonates born to mothers with COVID-19 at a tertiary center in Brazil

Duarte, Bruna de Paula; Krebs, Vera Lucia Jornada; Calil, Valdenise Martins Laurindo Tuma; Carvalho, Werther Brunow de; Gibelli, Maria Augusta Bento Cicaroni; Francisco, Rossana Pulcineli Vieira

doi:10.1016/j.clinsp.2022.100136

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Sumário

Original articles • Clinics 77 • 2022 • https://doi.org/10.1016/j.clinsp.2022.100136 copy

Clinical characteristics and evolution of 71 neonates born to mothers with COVID-19 at a tertiary center in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Limited data are available on pregnant women with COVID-19 and their neonates.

Objective

This study aimed to describe clinical characteristics and evolution from birth to discharge of a retrospective cohort of 71 neonates, with one set of twins, born to women with COVID-19 diagnosed at the end of pregnancy. The authors included all newborns admitted into a neonatal unit of a tertiary hospital in Brazil, between March 2020 and March 2021, whose unvaccinated mothers had COVID-19 symptoms and RT-PCR (Real-Time Polymerase Chain Reaction) for SARS-CoV-2 positive within fourteen days prior to delivery. Newborns to mothers with COVID-19 symptoms and negative tests for SARS-CoV-2 were excluded.

Results

The main route of birth delivery was cesarean, corresponding to 60 pregnant women (84.5%). The foremost indications for cesarean were pregnant with critical disease (24.6%) and acute fetal distress (20.3%). The mean birth weight was 2452 g (865‒3870 g) and the mean gestational age was 34^5/7weeks (25‒40 weeks). There were 45 premature newborns (63.3%), of which 21 newborns (29.5%) were less than 32 weeks of gestational age. RT-PCR for SARS-CoV-2 on oropharyngeal swabs was positive in 2 newborns (2.8%) and negative in the other 69 newborns (97.2%). Most newborns (51.4%) needed respiratory support. Therapeutic interventions during hospitalization were inotropic drugs (9.9%), antibiotics (22.8%), parenteral nutrition (26.8%), and phototherapy (46.5%).

Conclusion

Maternal COVID-19 diagnosticated close to delivery has an impact on the first days of neonatal life.

Keywords
Neonatology; COVID-19; Newborn; Brazil

Highlights

This study's main objective is to describe the clinical characteristics and evolution from birth to discharge of 71 neonates born to unvaccinated women with COVID-19 with RT-PCR for SARS-CoV-2 positive within fourteen days prior to delivery in a Brazilian hospital.
The neonatal SARS-CoV-2 positivity rate was 2.8% and these newborns had few clinical symptoms.
The prematurity rate was 63.4%, indicating that maternal disease may lead to neonatal complications associated with a higher prematurity rate.

Perinatal and neonatal characteristics		n (%)
Maternal
Type of delivery	Cesarean	60 (84.5)
	Vaginal	10 (14.1)
	Forceps	1 (1.4)
Ceserean indication	Mild, moderate or severe disease^a a WHO classification23.	8 (11.6)
	Critical disease^a a WHO classification23. with mechanical ventilation or inotropes required	17 (24.6)
	COVID and fetal distress	14 (20.3)
	COVID and oligohydramnios	6 (8.7)
	Others	13 (18.8)
Mechanical ventilation	Yes	20 (28.6)
Antenatal corticosteroid	Yes	12 (16.9)
Neonatal
Gender	Female	38 (53.5)
Gender	Male	33 (46.5)
Neonatal resuscitation	Yes	22 (31.4)
Respiratory support	No	34 (48.6)
	Supplemental oxygen	3 (4.3)
	CPAP^b b Continuous Positive Airway Pressure.	16 (22.9)
	Mechanical ventilation	17 (24.3)
Inotropes	Yes	7 (9.9)
Antibiotics < 72 h of life	Yes	20 (28.2)
Parenteral nutrition	Yes	19 (26.8)
Phototherapy	Yes	33 (46.5)
Neonate RT-PCR^c c Real-Time Polymerase Chain Reaction. SARS-CoV-2	Positive result	2 (2.8)
Neonatal mortality	‒	2 (2.8)

Neonatal variables	Mean	SD^a a Standart Deviation.	Minimum	Median	Maximum
Lenght (centimeters)	44.3	4.7	30.0	45.8	52.0
Length percentile^b b Fenton growth charts classification.24	34.5	24.3	1.0	29.0	81.0
Head circumference (centimeters)	32.1	3.2	21.0	33.0	37.0
Head circumference percentile^b b Fenton growth charts classification.24	59.5	28.4	1.0	60.0	99.0
Weight (grams)	2452	864	580	2500	3870
Weight percentile^b b Fenton growth charts classification.24	50.0	24.6	2.0	55.0	97.0
Apgar at 1 min	‒	‒	0.0	8.0	10.0
Apgar at 5 min	‒	‒	1.0	9.0	10.0

Perinatal and neonatal characteristics	Delivery indication	OR^a a Odds Ratio (95% CI^b b Confidence Intervals 95%. )	p
Neonatal resuscitation at birth	Mild, moderate or severe disease^c c WHO classification.23	1.0
	Critical disease^c c WHO classification.23 with mechanical ventilation or inotropes required	1.8 (0.14‒23.83)	0.643
	COVID and fetal distress	15.7 (2.76‒89.55)	*0.002*
	COVID and oligohydramnios	14.6 (2.44‒88.13)	*0.003*
	Others	2.2 (0.17‒29.31)	0.551
Apgar at 1 min ≤ 7	Mild. moderate or severe disease	1.0
	Critical disease with mechanical ventilation or inotropes required	1.0 (0.09‒11.24)	1.000
	COVID and fetal distress	10.0 (2.13‒47.02)	*0.004*
	COVID and oligohydramnios	5.2 (1.05‒26.20)	*0.043*
	Others	1.4 (0.12‒16.46)	0.789
Apgar at 5 min ≤ 7	Mild. moderate or severe disease	1.0
	Critical disease with mechanical ventilation or inotropes required
	COVID and fetal distress	16.1 (1.74‒148.67)	*0.014*
	COVID and oligohydramnios	9.2 (0.91‒93.02)	0.060
	Others
Respiratory support	Mild. moderate or severe disease	1.0
	Critical disease with mechanical ventilation or inotropes required	0.8 (0.13‒5.03)	0.821
	COVID and fetal distress	7.2 (1.74‒30.55)	*0.007*
	COVID and oligohydramnios	6.0 (1.42‒26.03)	*0.015*
	Others	12.1 (1.19‒123.62)	*0.035*
Parenteral nutrition	Mild. moderate or severe disease	1.0
	Critical disease with mechanical ventilation or inotropes required
	COVID and fetal distress	2.7 (0.63‒11.78)	0.179
	COVID and oligohydramnios	6.6 (1.48‒30.11)	*0.014*
	Others	1.0 (0.09‒11.03)	1.000

Perinatal and neonatal characteristics	Maternal mechanical ventilation (n = 20)
	n (%)	p	OR (95% IC)
Neonatal resuscitation at birth	18 (90.0)	*< 0.001*	103.5 (17.4‒615.4)
Apgar at 1 min ≤7	16 (80.0)	*< 0.001*	26.8 (6.6‒108.8)
Apgar at 5 min ≤7	12 (60.0)		36.0 (8.6‒150.9)
RT-PCR SARS-CoV-2 test	0 (0.0)	1.000

Clinical findings	Case 1	Case 2
Gender	Male	Female
Gestational Age (weeks)	38 ^4/7	33 ^4/7
Maternal disease classification^a a WHO classification.23	Mild	Severe
Maternal mechanical ventilation	No	No
Maternal death	No	No
Route of delivery	Vaginal	Cesarean
Neonatal resuscitation at birth	No	No
Weight / Classification^b b Fenton growth charts classification.24 cAppropriate for Gestational Age.	2980 g/AGA³	2130 g/AGA³
Apgar at 1/5 min	9/9	9/9
Respiratory support	No	Oxygen therapy
Signs. symptoms and labs	Bradycardia e hypocalcemia	Hypoxemia e enterorrhagia
Echocardiograma	Patent foramen ovale	Patent foramen ovale
Positive RT-PCR SARS-CoV2	2nd e 3rd day of life	2, 3 e 17th day of life
Leght of hospital stay	8 days	26 days

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[1] ⁎ Corresponding author. E-mail address: brunadpduarte@gmail.com (B.d.P. Duarte).