SARS-CoV-2 infection present in the pregnant woman involves risks for the newborn. We had no case of vertical transmission in our unit during the mentioned period. To prevent perinatal transmission and to prevent contamination of the medical staff, in the period of onset of the pandemics, our national guidelines for obstetrics and neonatology recommended delivery by cesarean section in pregnant women positive for SARS-CoV-2, as well as for pregnant women suspected to be infected (those with travel history, contacts of SARS –Cov-2 positive persons or presenting respiratory symptoms) , , , .
The exact rate of vertical transmission of the infection is not known. Currently, only a limited number of cases with vertical transmission are reported. Seven independent studies, report the outcomes 70 newborns of mothers with confirmed SARS-CoV-2 infection: 65 neonates (92.9% of cases) were negative following RT-PCR analysis of oropharyngeal or nasopharyngeal swab performed in the first hours or days of life; in four patients (5.7% of cases), early infection was diagnosed on the second day of life; thus, vertical transmission cannot be excluded; finally, one patient had a negative throat swab but positive immunoglobulin M( IgM) and immunoglobulin G( IgG )count, and was considered as potentially infected in utero. Consequently, in 5 out of 70 cases (7.1% of neonates), vertical transmission could not be excluded or was considered possible , , .
In our group, all five neonates of SARS-CoV-2 positive mothers were born by cesarean section. In the majority of the reported cases, the delivery of the newborns of mothers with SARS-CoV-2 infection was performed by cesarean section. The aim of this mode of delivery is to limit the perinatal transmission of the infection from the mother to the neonate, as well as to limit the contamination of the medical staff by assisting the infected pregnant woman during labor and expulsion, which can last few hours .
The neonates of our study group had a good clinical outcome, without events during hospitalization. They had no changes in the values of lymphocytes, neutrophils or leukocytes. Inflammatory syndrome was negative, except for one patient. (Table 2) Early inflammatory syndrome present in one neonate had a favorable evolution following antibiotic treatment. This patient had no clinical elements suggestive of neonatal sepsis and had negative blood culture. One week before delivery, the mother had symptoms suggestive of SARS-CoV-2 infection (fever, cough, sore throat). There were no other maternal risk factors explaining inflammatory syndrome of newborn. No analysis of the placenta was performed. The creatine kinase value was out of normal range in three patients on first day of life, but the third day value was in normal range. The aspartate aminotranspherase and lactat dehydrogenase had the same behavior in two of the patients. We could not find any explanations for this finding. It is known that SARS-Cov-2 infection can associate liver function abnormalities. We did not expect to have infants with this type of abnormal laboratory data as there RT –PCR tests were negative, and infection wasn’t confirmed.
The analysis of the oropharyngeal or nasopharyngeal swab was negative in all newborns of the study group, on the first day as well as on the fifth day of life. Umbilical vein catheterization was carried out in all patients to facilitate their laboratory tests collection, to limit the length of time spent for blood sample collection and to allow a safe venous approach for an eventual medication. After obtaining the second negative test, the venous catheter was removed in all patients.
Enteral nutrition was given in accordance to the local national guidelines. In all neonates of mothers with positive RT-PCR, enteral nutrition was initiated with formula. Although there are studies showing that the breast milk of women with SARS-CoV-2 infection was negative, we chose to give formula to the neonates , . The mothers were placed in a dedicated area of maternity wards in the first 72 hours after cesarean section, after which they were transferred to the contagious disease unit.
Feeding with breast milk has a number of benefits for both the mother and the newborn, the immunological benefit playing an important role in the protection of the newborn from infections through the transfer of immunoglobulin with a protective role for the neonate. The recommendation for breast feeding in the case of mothers infected with SARS-CoV-2 is to maintain rigorous hygiene conditions, to wash and disinfect hands, to wear a mask during breastfeeding. If the mother cannot breastfeed the newborn, expressed breast milk can be used, while respecting the same rigorous hygiene conditions for expressing breast milk. If the mother is separated from the neonate, it is recommended to help the mother maintain lactation by manual or mechanical expression. Also, counseling of the mother and the family in case of separation from the newborn should be taken into consideration, and permanent communication with the family and their information about the health of the neonate should be ensured. Whenever it is possible, feeding the neonate with breast milk is recommended if the mother’s condition allows it and if she wishes to breastfeed in the current health conditions , , .
The strengths of this study include the timely nature of our findings as the COVID-19 pandemic ensues, the evaluation of the incidence of infection among the pregnant women in our region. The weakness of our study is the relatively small size of the group, but the evidenced data are in accordance with those obtained by similar studies. These data are useful for the analysis of the obstetric population, for the knowledge of the risk of infection in this population. We consider that testing all pregnant women at admission to the maternity unit is an important method to reduce the spread of SARS-CoV-2 infection, representing a guide in the approach of delivery in pandemic conditions.