Case report suggests intrauterine transmission of SARS-CoV-2 infection in a preterm infant
A case report published in The Pediatric Infectious Disease Journal represents a case of congenital SARS-CoV-2 infection in an infant born via vaginal delivery to a mother with COVID-19.
“We present a preterm infant who developed a fever and mild respiratory disease on the second day of life,” reported Julide Sisman, MD, University of Texas Southwestern Medical Center, Dallas, Texas, and colleagues. “Infant SARS-CoV-2 nasopharyngeal testing was positive at 24 and 48 hours of life. Placenta histopathology revealed SARS-CoV-2 infection by electron microscopy and immunohistochemistry.”
The infant was born to a mother diagnosed with coronavirus disease 2019 (COVID-19), presenting primarily with gastrointestinal manifestations. The mother also had type 2 diabetes with a BMI of 55. The infant was born at 34 weeks’ gestation after the mother had premature rupture of the membranes. The baby was born large for gestational age and was treated in the neonatal intensive care unit for management of prematurity, glucose monitoring and SARS-CoV-2 exposure.
The infant appeared initially healthy, with normal breathing and other vital signs. On the second day of life, she developed fever and respiratory distress (mild subcostal retractions, tachypnea and hypoxia [lowest oxygen saturation on room air of 78%]) and required nasal cannula at 1L/min flow with minimal oxygen supplementation.
“It is unlikely that the respiratory distress observed in this infant was due to prematurity since it did not start until the second day of life,” the authors wrote.
The baby tested positive for SARS-CoV-2 infection at 24 hours and 48 hours after birth. She was treated with supplemental oxygen for several days but did not need mechanical ventilation. COVID-19 tests remained positive for up to 14 days. At 21 days, the mother and infant were sent home in good condition.
The researchers performed histopathologic examination of the placenta, which showed patchy histiocytic (CD68 positive) intervillositis and villitis associated with villous karyorrhexis and necrosis, focal basal chronic villitis, focal parabasal infarct and features of meconium exposure in the fetal membranes. Meanwhile, immunohistochemistry for SARS-CoV-2 showed cytoplasmic staining in the syncytiotrophoblastic cells. Additionally, ultrastructural examination found 89 to 129 nm diameter structures consistent with viral particles clustered within membrane-bound cisternal spaces in the syncytiotrophoblastic cells.
“Although the histologic placental findings of histiocytic intervillositis and chronic villitis are not specific to SARS-CoV-2 infection, the presence of cytoplasmic staining for the SARS-CoV-2 nucleocapsid protein by immunohistochemistry and demonstration of viral particles by electron microscopy in the syncytiotrophoblastic cells strongly suggest in utero transmission,” the authors concluded.
“Overall, intrauterine transmission of SARS-CoV-2 appears to be a rare event,” the authors wrote, noting that transmission in the reported infant could have occurred either due to ascending infection with premature rupture of membranes and primary involvement of the maternal gastrointestinal tract, or by hematogenous spread if the mother was viremic during her initial infectious period.
The authors also highlighted that further studies are needed to determine the risks of vaginal delivery of mothers with COVID-19, mechanisms and risk factors of in utero SARS-CoV-2 transmission and the outcomes of congenital infection. “In particular, the susceptibility to intrauterine transmission by gestational age and the relation to maternal active disease needs to be explored,” they added.
SOURCE: The Pediatric Infectious Disease Journal
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