Maternal SARS-CoV-2, Placental Changes and Brain Injury in 2 Neonates

10 Apr 2023 • Researchers have found for the first time that COVID infection has crossed the placenta and caused brain damage in two newborns, according to a study published online in AAP Pediatrics. One of the infants died at 13 months and the other remained in hospice care at time of manuscript submission.

Both infants tested negative for the virus at birth, but had significantly elevated SARS-CoV-2 antibodies in their blood, indicating that either antibodies crossed the placenta, or the virus crossed and the immune response was the baby's. Those infants were born to mothers who became COVID positive in the second trimester and delivered a few weeks later.

What did the clinical picture look like?

  • The babies began to seize from the first day of life. They had profound low tone (hypotonia) in their clinical exam
  • They had very small head circumference, brain imaging on the two babies indicated significant brain atrophy, and neurodevelopment exams showed significant delay.
  • The experts examined the placentas and found some characteristic COVID changes and presence of the COVID virus. This was accompanied by increased markers for inflammation.
  • Coauthor Ali G. Saad, MD, pediatric and perinatal pathology said, "I have seen literally thousands of brains in autopsies over the last 14 years, and this was the most dramatic case of leukoencephalopathy or loss of white matter in a patient with no significant reason. That's what triggered the investigation."
  • One mother delivered at 32 weeks and had a very severe COVID presentation and spent a month in the intensive care unit. In contrast, the other mother had asymptomatic COVID infection in the second trimester and delivered at full term.
  • Because these cases happened in the early days of the pandemic, no vaccines were available.

The researchers emphasized that these instances are rare and have not been seen before or since the period of this study to their knowledge. "This is something we want to alert the medical community. We're trying to understand what made these two pregnancies different, so we can direct research towards protecting vulnerable babies."

Source: Medscape | Read full article

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