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Developmental Biology - Infant Immune System

COVID-19 Not Transmitted Pregnant Mom to Newborn

Four babies born in a hospital in Wuhan, the epicenter of the novel coronavirus outbreak, did not show signs of infection and remain healthy today...


Finally, some good news has emerged about the novel coronavirus that has spread to about 50 countries across the world. Chinese professors report in the journal Frontiers in Pediatrics that it doesn't appear the virus is transmittable from pregnant mothers to newborns at birth.

The study is the second out of China within the last month to confirm that mothers infected with coronavirus disease 2019 (COVID-19) during pregnancy did not infect their babies.

All four mothers in the current study, which focused on the health of the newborns, gave birth at Wuhan's Union Hospital while infected. Wuhan in Hubei Province is believed to be the epicenter of the current outbreak that has sickened more than 100,000 people worldwide and killed more than 3,400 - most of them in China.
None of the infants developed any serious symptoms associated with COVID-19 such as fever or cough, though all were initially isolated in neonatal intensive care units and fed formula.

Three of the four tested negative for the respiratory infection following a throat swab, while the fourth child's mother declined permission for the test.

One newborn did experience a minor breathing issue for three days that was treated by non-invasive mechanical ventilation. Two babies, including the one with a respiratory problem, did have body rashes that eventually disappeared on their own.

It's impossible to conclude whether there's a connection betwen these other medical issues and COVID-19.

"We are not sure the rash was due to the mother's COVID-19 infection," said study co-author Dr. Yalan Liu at Huazhong University of Science and Technology. She also works in the Department of Pediatric at Union Hospital.

All four infants remain healthy, and their mothers also fully recovered.

In the previous retrospective study on nine pregnant mothers infected with COVID-19, researchers also found no evidence that the viral infection can pass to the child. All nine births were done by cesarean section. Three of the four pregnancies in the current study were also brought to term by C-section.
"To avoid infections caused by perinatal and postnatal transmission, our obstetricians think that C-section may be safer. Only one pregnant mother adopted vaginal delivery because of the onset of the labor process. The baby was normal. Maybe vaginal delivery is OK. It needs further study."

Valan Liu, Assistant Professor, Huazhong University of Science and Technology, Wuhan, China.

In previous coronavirus outbreaks, scientists found no evidence of viral transmission from mother to child, but SARS and MERS were both associated with "critical maternal illness, spontaneous abortion, or even maternal death," according to Liu.

Globally, an estimated 3.4 percent of reported COVID-19 cases have died, according to the latest data from the World Health Organization. In comparison, seasonal flu generally kills far fewer than 1 percent of those infected. However, COVID-19 does not appear to spread as easily as influenza. Note that transmission and fatality rates are currently subject to change and revision as more research is done on the virus.
The authors feel further investigations into other aspects of potential COVID-19 infection in newborns and children are needed. For example, the sensitivity of the current diagnostic test for detecting the virus is about 71%. So the authors suggest revaluating its reliability in children.

Toward that end, researchers are collecting additional samples from newborns, including placenta, amniotic fluid, neonatal blood and gastric fluid to detect possible receptors for the virus.

Abstract
A novel viral respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for an epidemic of the coronavirus disease 2019 (COVID-19) in cases in China and worldwide. Four full-term, singleton infants were born to pregnant women who tested positive for COVID-19 in the city of Wuhan, the capital of Hubei province, China, where the disease was first identified. Of the three infants, for who consent to be diagnostically tested was provided, none tested positive for the virus. None of the infants developed serious clinical symptoms such as fever, cough, diarrhea, or abnormal radiologic or hematologic evidence, and all four infants were alive at the time of hospital discharge. Two infants had rashes of unknown etiology at birth, and one had facial ulcerations. One infant had tachypnea and was supported by non-invasive mechanical ventilation for 3 days. One had rashes at birth but was discharged without parental consent for a diagnostic test. This case report describes the clinical course of four live born infants, born to pregnant women with the COVID-19 infection.

Authors
Yan Chen, Hua Peng, Lin Wang, Yin Zhao, Lingkong Zeng, Hui Gao and Yalan Liu.


Acknowledgements
Ethics Statement
The studies involving human participants were reviewed and approved by the Institutional Review Board of Union Hospital, Huazhong University of Science & Technology. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. Written informed consent was obtained from the individual(s), and minor(s)' legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.

Author Contributions
YC and HP designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. LW, HG, YZ, and LZ designed the data collection instruments, collected the data, and reviewed and revised the manuscript. YL designed the study, coordinated, and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Funding
This study was supported by the National Natural Science Foundation of China (81500218, 81601324, and 81300523).

Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publication
Frontiers is an award-winning Open Science platform and leading Open Access scholarly publisher. Our mission is to make research results openly available to the world, thereby accelerating scientific and technological innovation, societal progress and economic growth. We empower scientists with innovative Open Science solutions that radically improve how science is published, evaluated and disseminated to researchers, innovators and the public. Access to research results and data is open, free and customized through Internet Technology, thereby enabling rapid solutions to the critical challenges we face as humanity. For more information, visit http://www.frontiersin.org and follow @Frontiersin on Twitter.

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Mar 17 2020   Fetal Timeline   Maternal Timeline   News 



"To avoid infections caused by perinatal and postnatal transmission, our obstetricians think that C-section may be safer." Yalan Liu, Assistant Professor, Huazhong University of Science and Technology, Wuhan, China.


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