Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia

Abstract

Background: The newly identified 2019-nCoV, which appears to have originated in Wuhan, the capital city of Hubei province in central China, is spreading rapidly nationwide. A number of cases of neonates born to mothers with 2019-nCoV pneumonia have been recorded. However, the clinical features of these cases have not been reported, and there is no sufficient evidence for the proper prevention and control of 2019-nCoV infections in neonates.

Methods: The clinical features and outcomes of 10 neonates (including 2 twins) born to 9 mothers with confirmed 2019-nCoV infection in 5 hospitals from January 20 to February 5, 2020 were retrospectively analyzed.

Results: Among these 9 pregnant women with confirmed 2019-nCoV infection, onset of clinical symptoms occurred before delivery in 4 cases, on the day of delivery in 2 cases, and after delivery in 3 cases. In most cases, fever and a cough were the first symptoms experienced, and 1 patient also had diarrhea. Of the newborns born to these mothers, 8 were male and 2 were female; 4 were full-term infants and 6 were born premature; 2 were small-for-gestational-age (SGA) infants and 1 was a large-for-gestational-age (LGA) infant; there were 8 singletons and 2 twins. Of the neonates, 6 had a Pediatric Critical Illness Score (PCIS) score of less than 90. Clinically, the first symptom in the neonates was shortness of breath (n=6), but other initial symptoms such as fever (n=2), thrombocytopenia accompanied by abnormal liver function (n=2), rapid heart rate (n=1), vomiting (n=1), and pneumothorax (n=1) were observed. Up to now, 5 neonates have been cured and discharged, 1 has died, and 4 neonates remain in hospital in a stable condition. Pharyngeal swab specimens were collected from 9 of the 10 neonates 1 to 9 days after birth for nucleic acid amplification tests for 2019-nCoV, all of which showed negative results.

Conclusions: Perinatal 2019-nCoV infection may have adverse effects on newborns, causing problems such as fetal distress, premature labor, respiratory distress, thrombocytopenia accompanied by abnormal liver function, and even death. However, vertical transmission of 2019-nCoV is yet to be confirmed.

Keywords: 2019-nCoV; clinical analysis; neonates; vertical transmission.

Figure 1

Chest CT images before and after treatment in a mother with 2019-nCov pneumonia. (A) Chest CT on the mother of neonates 8 and 9 on January 24 revealed slightly decreased diffuse and bilateral GGO, patchy lung consolidations, and blurred borders; (B) on January 27, chest CT revealed that the lesions had merged into strips with uneven densities; the disease had progressed; (C) on February 2, chest CT showed GGOs in both lungs were slightly decreased; some lesions were resolved; (D) on February 6, chest CT showed slightly decreased GGO in both lungs, and the lesions were remarkably resolved. GGO, ground-glass opacity.

Figure 2

Ultrasound of 2 cases in the third trimester (A) On January 6, ultrasound of the mother of Case 7 (at 33 weeks) showed a singleton pregnancy in head-down position; (B) on January 24, ultrasound of the mother of the twins (at 31 weeks) showed the twins (one in head-down position and another in transverse position). Fetal hearts beat at a rate of 158 and 154 bpm, respectively. The placentas were located at the anterior wall and the bottom of the uterus, where the echoes were echoes were homogeneous. Ultrasound showed no obvious abnormality in both cases.

Figure 3

Chest X-ray of 2 neonates before and after treatment (A) On January 20, chest X-ray of Case 7 showed that the markings of the lungs were blurred, granular and scattered patchy shadows were visible in the lower lungs, and the opacity was decreased; (B) on January 24th, chest X-ray showed that the markings of both lungs were blurred and rough, no obvious spotted shadows were seen, and the lesions were basically resolved; (C) on February 2, chest X-ray of neonate 10 showed bilateral pneumothorax and blurred bilateral lung markings; (D) on February 3, chest X-ray after thoracentesis catheter drainage showed that the bilateral pneumothorax had shrunk, the bilateral lung markings were blurred, and multiple GGOs were visible in the right middle lung field and the left lung apex; (E) on February 4, chest X-ray revealed that GGOs in both lungs were basically resolved. GGO, ground-glass opacity.