In recent months, for some time, the scientific community has considered it impossible for Sars-Cov-2 to be transmitted in the newborn. In fact, the disease also exists in the smallest, although in a much rarer form. Now, thanks to a meta-analysis on 176 cases around the world published in Nature Communications, the team headed by Professor Daniele De Luca, at the Paris Saclay Universityfinally clarifies the clinical presentation and transmission routes of Covid-19 in the first month of life.
Give mother to fetus
In a previous work always published on Nature Communications, the group of Professor De Luca (who is also a consultant to the World Health Organization for the study of the transmission of the Sars-CoV2 virus from mother to child), he discovered the possibility of vertical (mother to fetus) transmission of the virus (here the article). In this work, on the other hand, a meta-analysis was completed on 176 cases of neonatal SARS-CoV2 infection occurring in all parts of the world, also by contacting the doctors treating the site, and using rigorous methodologies for the synthesis and analysis of data. Until now many cases had been described as infected or suspected infants but these had never been analyzed with a rigorous and impartial classification, underlines the neonatologist.
Symptoms similar to those in adults
What evidence emerged from this methodology? Met of infants have no symptoms. The other half, on the other hand, presents various symptoms that can be superimposed in all respects with those of the adult (respiratory, cardiac, neurological, intestinal) and sometimes difficult to distinguish from those of other common neonatal diseases. Worthy of note instead the onset of fever in 44% of cases, and that it is instead a rarer possibility in common neonatal infections due to other germs, adds De Luca, who also holds the position of elected president of the European Society of Pediatric and Neonatal Intensive Care (Espnic: European Society of Paediatric and Neonatal Intensive Care) and at the head of the neonatal and pediatric intensive care division at the Antoine-Bclre hospital, AP-HP Universit Paris Saclay. 70% of infants infected with Sars-CoV2 were horizontally infected, ie the common route of transmission through air secretions mostly from parents or family members. However, 30% became infected in utero or at the time of delivery and this is consistent with the biological data that are accumulating on the virus concludes De Luca.
The Italian data of the national Covid-19 Register
The results are also in line with the first data emerging from the Covid National Register-19 established by Italian Society of Neonatology (Sin) presented at the XXVI National Congress of the Scientific Society held in Venice from 7 to 10 October. From the analysis of 215 cards relating to hospitalization at birth, it was found that the infection in newborns (confirmed positive) was often asymptomatic. The 13 infants who returned to hospital for home-acquired SARS-CoV-2 infection, although all were symptomatic (prevalent symptoms fever and feeding difficulties), also presented a mild or moderate symptoms, requiring only in 2 cases of ventilatory support.
Better to separate mom and baby
Even if we consider a certain publication bias (that is, these 176 cases certainly do not represent all the neonatal cases that have occurred so far in the world) – underlines De Luca – the risk of infection for a newborn seems low, but absolutely not null as was once thought. The good news that the neonatal infection is almost always not serious , although in some cases the newborns presented severe forms. Analyzing infants who became infected after the first 72 hours of life, therefore not vertically in the uterus or at the time of delivery, we saw that the risk of infection increases significantly if the symptomatic mothers, therefore in the period of highest contagiousness, are not separated from the children. This has been a controversial topic and the mother-child separation discussed around the world and in various countries, there are very different guidelines. At least partial separation appears to be a common sense recommendation in the period of greatest infectivity (ie in which it is more symptomatic) or the adoption of strict hygiene measures (hydroalcoholic gels, masks, gloves). The second good news is that breastfeeding by itself does not increase the risk of neonatal infection and this seems consistent with the biological data so far accumulated, he concludes.
15 October 2020 (change October 15, 2020 | 11:09)
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