Abstract

Background

SARS-CoV-2 infections during pregnancy continue in this ongoing pandemic. Care of mother-infant dyads affected by SARS-CoV-2 infection in pregnancy has evolved. Perinatal viral transmission is rare. However, there remain few detailed reports on characteristics and management of these infants during neonatal hospitalization. Our objective was to investigate management and outcomes of infants born to women with laboratory-confirmed SARS-CoV-2 infection in pregnancy including resuscitation, NICU care, separation, and breastfeeding.

Methods

This is a study of mother-infant dyads with SARS-CoV-2 in pregnancy at Prentice Women’s Hospital in Chicago, IL (3/2020-11/2020). Dyads were tracked prospectively with data obtained by review of electronic medical records including demographics, maternal clinical history, COVID symptoms, and neonatal course. Women were universally screened with SARS-CoV-2 PCR at admission. Mothers were categorized as 1) acute infection (-14–0 days from delivery) vs. previous infection (>14 days), and 2) symptomatic vs. asymptomatic (defined by CDC criteria). Infants of mothers with acute infection were tested for SARS-CoV-2.

Results

We report a diverse cohort of 210 women with SARS-CoV-2 in pregnancy, 114 acute and 96 previous infection (range 0–229 days between positive PCR and delivery) [Table 1]. Over half (56%) of women were symptomatic, 29/114 (25%) with acute infection, 89/96 (93%) with previous infection. Of 211 infants, one asymptomatic infant tested positive for SARS-CoV-2. The overall rate of preterm birth was 10.9% in this cohort. The rate of preterm birth was 26.6% (8/30) in the symptomatic acute infection group (p=0.055) and birthweight was significantly lower (p=0.03). There was no apparent increased need for resuscitation at delivery. APGARs were 8 (8–9) and 9 (8–9) at 1 and 5 minutes, respectively. Six percent of infants >35 weeks had respiratory distress. About 7% had failed hearing screen (historic Prentice rate ~4%). Separation of infants from mothers with acute infection decreased over time due to policy changes based on available safety data for rooming in (Cuzick’s test for trend p<0.001). Most infants (75%) received breastmilk in the hospital over this timeframe; this was low initially and increased over this timeframe (p<0.001). For example, 45% of mothers with acute infection provided breastmilk in May compared to nearly 100% in November. Twelve women were diagnosed with chorioamnionitis due to fever in labor and also had acute SARS-CoV-2 infection.

Conclusion

Infants of mothers with SARS-CoV-2 in pregnancy had favorable short-term outcomes, with decrease in separation and increase in breastfeeding over this timeframe. Complex factors likely contribute to differences in birthweight and prematurity in the acute symptomatic group. Isolated fever in the setting of acute SARS-CoV-2 presents a dilemma regarding maternal chorioamnionitis, resulting in antibiotic exposure. Longitudinal follow-up is needed to determine infant outcomes (true hearing loss, development) following maternal SARS-CoV-2 infection.Table 1:Characteristics and Outcomes of Infants of Women with SARS-CoV-2 Infection in PregnancyTotal N=211 1 twinAcute Infection(n= 115)Previous Infection(n = 96)Symptomatic^#Acute Infection(n = 30)Symptomatic^#Previous Infection(n = 89)p-value*Agemean (std)30.5 (6.2)29. 8 (6.1)31.4 (6.2)30.5 (6.3)31.7 (6.1)0.06 0.36Maternal Racen (%)<0.01 0.20Black/African American45 (21%)35 (30%)10 (10%)7 (23%)10 (11%)White61 (29%)30 (26%)31 (32%)7 (23%)29 (33%)Asian8 (4%)5 (4%)3 (3%)2 (7%)3 (3%)American Indian or Alaskan Native1 (0.5%)1 (1%)01 (3.5%)0Other96 (46%)44 (38%)52 (54%)13 (43%)47 (53%)Latina/Hispanicn (%)110 (52%)51 (44%)59 (62%)15 (50%)53 (60%).03 .39Days between test and delivery0 - 3 days91 (43%)91 (79%)14 (47%)4 - 14 days24 (11%)24 (21%)15 (50%)15 - 60 days49 (23%)49 (51%)49 (55%)61 - 120 days31 (15%)31 (32%)28 (32%)121+16 (8%)16 (17%)15 (17%)Vaginal delivery147 (70%)79 (69%)68 (71%)18 (60%)63 (71%)0.81 0.38Gestational age at birth0.67^ 0.055^<32 weeks2 (1%)1 (1%)1 (1%)1 (4%)1 (1%)32–36 weeks21 (10%)11 (10%)10 (10%)7 (23%)8 (9%)37+ weeks188 (89%)103 (90%)85 (89%)22 (73)80 (90%)Birth weight (g) mean (std dev)3263 (550)3264 (583)3263 (511)2997 (640)3260 (517)0.88 0.03NICU admission39 (18%)23 (20%)16 (17%)10 (31%)15 (17%)0.53 0.06ResuscitationDry and Stimulation151 (72%)96 (83%)55 (57%)24 (79%)52 (58%)<0.01 0.04Oxygen/Positive pressure19 (9%)9 (7%)10 (10%)5 (14%)10 (11%)0.46 0.74Intubation4 (2%)3 (2%)1 (1%)1 (4%)1 (1%)0.62 0.43Volume Expansion1 (0.5%)1 (1%)000Hearing screen failed196 (93%)109 (96%)87 (91%)28 (97%)80 (90%)0.26 0.58Respiratory distress17 (8%)12 (8%)5 (5%)7 (21%)5 (6%).21 .01Infants >35 weeks gestation12/199 (6%)7/108 (7%)5/87 (6%)4/27 (15%)5/84 (6%)1 0.21Administration of antibiotics30 (14%)20 (17%)10 (10%)9 (30%)9 (10%)0.15 <0.01Maternal chorioamnionitis20 (10%)12 (10%)8 (8%)2 (7%)8 (9%)0.64 0.99^#Symptomatic infection was defined as any symptom consistent with SARS-CoV-2 infection/COVID-19 including fever, upper or lower respiratory symptoms, nausea, vomiting, diarrhea, myalgia/fatigue, anosmia*The top p-value listed comapres pregnancies affected by acute vs. previous infection. Bottom p-value listed compares only symptomatic acute vs. symptomatic previous infection. Comparisons were by Chi-square and Fisher’s exact tests.^Comparing dichotomized preterm (<37 weeks) vs full term

中文翻译：

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#49：怀孕期间感染 SARS-CoV-2 的母亲所生婴儿的管理和结果

摘要

背景

在这场持续的大流行中，怀孕期间的 SARS-CoV-2 感染仍在继续。对怀孕期间受 SARS-CoV-2 感染影响的母婴双胞胎的护理已经发展。围产期病毒传播很少见。然而，关于新生儿住院期间这些婴儿的特征和管理的详细报告仍然很少。我们的目标是调查实验室确诊感染 SARS-CoV-2 的孕妇所生婴儿的管理和结果，包括复苏、新生儿重症监护病房护理、分离和母乳喂养。

方法

这是在伊利诺伊州芝加哥普伦蒂斯妇女医院 (3/2020-11/2020) 对怀孕期间患有 SARS-CoV-2 的母婴双胞胎的研究。通过审查电子病历获得的数据，包括人口统计学、母亲临床病史、COVID 症状和新生儿病程，前瞻性地跟踪了二元组。女性在入院时普遍接受了 SARS-CoV-2 PCR 筛查。母亲被分类为 1) 急性感染（分娩后 -14-0 天）与既往感染（>14 天），以及 2）有症状与无症状（由 CDC 标准定义）。对患有急性感染的母亲的婴儿进行了 SARS-CoV-2 检测。

结果

我们报告了 210 名怀孕期间患有 SARS-CoV-2 的女性、114 名急性感染和 96 名既往感染（PCR 阳性和分娩之间的范围为 0-229 天）的多样化队列[表 1]。超过一半 (56%) 的女性有症状，29/114 (25%) 有急性感染，89/96 (93%) 有既往感染。在 211 名婴儿中，一名无症状婴儿的 SARS-CoV-2 检测呈阳性。该队列的早产总率为 10.9%。有症状的急性感染组的早产率为 26.6% (8/30) (p=0.055)，出生体重显着较低 (p=0.03)。分娩时复苏的需求没有明显增加。APGAR 在 1 分钟和 5 分钟时分别为 8 (8-9) 和 9 (8-9)。超过 35 周的婴儿中有 6% 出现呼吸窘迫。大约 7% 的听力筛查失败（历史 Prentice 率约 4%）。由于基于现有的同房安全数据的政策变化，婴儿与急性感染母亲的分离随着时间的推移而减少（Cuzick 趋势检验 p<0.001）。大多数婴儿 (75%) 在这段时间内在医院接受了母乳喂养；这最初很低，并在此时间范围内增加（p <0.001）。例如，5 月份有 45% 的急性感染母亲提供母乳，而 11 月份这一比例接近 100%。12 名妇女因分娩发热被诊断出患有绒毛膜羊膜炎，并且还感染了急性 SARS-CoV-2。45% 的急性感染母亲在 5 月份提供了母乳，而 11 月份这一比例接近 100%。12 名妇女因分娩发热被诊断出患有绒毛膜羊膜炎，并且还感染了急性 SARS-CoV-2。45% 的急性感染母亲在 5 月份提供了母乳，而 11 月份这一比例接近 100%。12 名妇女因分娩发热被诊断出患有绒毛膜羊膜炎，并且还感染了急性 SARS-CoV-2。

结论

怀孕期间患有 SARS-CoV-2 的母亲的婴儿有良好的短期结果，在这段时间内分离减少和母乳喂养增加。复杂因素可能导致急性症状组出生体重和早产的差异。急性 SARS-CoV-2 环境中的孤立性发热给母体绒毛膜羊膜炎带来了两难境地，导致抗生素暴露。需要进行纵向随访以确定母亲感染 SARS-CoV-2 后的婴儿结局（真正的听力损失、发育）。 表 1：妊娠期 SARS-CoV-2 感染女性婴儿的特征和结局总计N=211 1双胞胎急性感染(n = 115)既往感染(n = 96) 有症状的^#急性感染(n = 30) 有症状的^#先前感染(n = 89) p 值*年龄平均值 (std)30.5 (6.2)29。8 (6.1)31.4 (6.2)30.5 (6.3)31.7 (6.1)0.06 0.36母系n (%)<0.01 0.20黑人/非裔美国人45 (21%)35 (30%)10 (10%)7 (23%) 10 (11%)白人61 (29%)30 (26%)31 (32%)7 (23%)29 (33%)亚洲人8 (4%)5 (4%)3 (3%)2 (7%) 3 (3%)美洲印第安人或阿拉斯加原住民1 (0.5%)1 (1%)01 (3.5%)0其他96 (46%)44 (38%)52 (54%)13 (43%)47 (53%)拉丁裔/西班牙裔n (%)110 (52%)51 (44%)59 (62%)15 (50%)53 (60%).03测试和交付之间的天数0 - 3 天91 (43%)91 (79%)14 (47%)4 - 14 天24 (11%)24 (21%)15 (50%)15 - 60 天49 (23%)49 (51%)49 (55%)61 - 120 天31 (15%)31 (32%)28 (32%)121+16 (8%)16 (17%)15 (17%)阴道分娩147 (70%)79 (69%) )68 (71%)18 (60%)63 (71%)0.81 0.38出生胎龄0.67^ 0.055^<32 周2 (1%)1 (1%)1 (1%)1 (4%)1 ( 1%)32–36 周21 (10%)11 (10%)10 (10%)7 (23%)8 (9%)37+ 周188 (89%)103 (90%)85 (89%)22 ( 73)80 (90%)出生体重 (g ) 平均 (std dev)3263 (550)3264 (583)3263 (511)2997 (640)3260 (517)0.88 0.03 NICU 入院39 (18%)23 (20%) )16 (17%)10 (31%)15 (17%)0.53 0.06复苏干燥和刺激151 (72%)96 (83%)55 (57%)24 (79%)52 (58%)<0.01 0.04氧气/正压19 (9%)9 (7%)10 (10%)5 ( 14%)10 (11%)0.46 0.74插管4 (2%)3 (2%)1 (1%)1 (4%)1 (1%)0.62 0.43扩容1 (0.5%)1 (1%)000听力筛选失败196 (93%)109 (96%)87 (91%)28 (97%)80 (90%)0.26 0.58呼吸窘迫17 (8%)12 (8%)5 (5%)7 (21%) )5 (6%).21 .01>35 周妊娠的婴儿12/199 (6%)7/108 (7%)5/87 (6%)4/27 (15%)5/84 (6%)1 0.21抗生素使用30 (14%)20 (17%)10 (10%)9 (30%)9 (10%)0.15 <0.01母体绒毛膜羊膜炎20 (10%)12 (10%)8 (8%)2 ( 7%)8 (9%)0.64 0.99 ^#对症感染被定义为与SARS-CoV的-2感染相一致的任何症状/ COVID-19，包括发烧，上或下呼吸道症状，恶心，呕吐，腹泻，肌痛/疲劳，嗅觉丧失*顶部p值列出comapres怀孕受急性与既往感染。列出的底部 p 值仅比较有症状的急性感染与有症状的既往感染。比较通过卡方检验和 Fisher 精确检验进行。^比较二分早产（<37 周）与足月