Probable congenital SARS-CoV-2 infection in a neonate born t
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A 40-year-old woman (gravida 2, para 1) was admitted to a tertiary hospital in Toronto, Ontario. She had familial neutropenia, gestational diabetes and a history of frequent bacterial infections, including 3 episodes (sinusitis, skin infection and bronchitis) during this pregnancy, which resolved with antibiotic treatment. The patient presented with myalgia, decreased appetite, fatigue, dry cough and temperature of 39°C in the preceding 24 hours. A nasopharyngeal swab was positive for suspected SARS-CoV-2 gene targets via RT-PCR testing.

There were no fetal concerns during the pregnancy or following admission. A semiurgent cesarean delivery was done under regional anesthesia, with airborne, droplet and contact precautions, owing to worsening coagulopathy and reducing platelet count at 35 weeks and 5 days’ gestation. Artificial rupture of membranes was performed at operation. The amniotic fluid was clear. The male neonate was vigorous and did not require resuscitation. His Apgar scores were 9 at 1 minute and 9 at 5 minutes, and his birth weight was 2.93 kg. In line with our local protocol, delayed cord clamping was not performed, and the neonate was immediately removed from the operative field, in a sterile fashion, to a resuscitator 2 m away in the same room.

Placental swabs were obtained. Placental tissue was sent for PCR and histopathologic examination. Nasopharyngeal swabs were obtained from the neonate on the day of birth, day 2 and day 7, after thorough cleansing of the baby and before contact with the mother. All 3 of the neonate’s nasopharyngeal swabs were positive for SARS-CoV-2 gene targets via RT-PCR testing; neonatal plasma tested positive on day 4, and stool was positive on day 7.

In this case, maternal familial neutropenia and the associated immunocompromised state may have contributed to the widespread dissemination of the virus throughout body tissues and secretions. It is possible that the neutropenia in the neonate was secondary to inheritance of the maternal condition, which may have altered his immunologic state, contributing to the acquisition of SARS-CoV-2 infection.

Source: https://www.cmaj.ca/content/cmaj/early/2020/05/14/cmaj.200821.full.pdf
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