Case
The mother of the neonatal patient is a 24-year-old healthy primiparous
women. At about 1:00 am On March 6, 2020, the pregnant women (at
40+4 weeks’ gestational age) reported a sudden leakage
of watery fluid from the vagina. She presented to an emergency
department and was diagnosed as “Premature Rupture of Membranes”.
Because the patient is a citizen of Wuhan city, the epicenter of
coronavirus disease-2019 (COVID-19) outbreak, she was underwent chest
computed tomography (CT) as routine pre-hospital examinations. The CT
scan showed a small size of ground-glass opacities in the left lower
lobes, indicating the possibility of the convalescent phase of viral
pneumonia. On March 7, the pregnant women was referred to Wuhan Union
hospital, a designated hospital for COVID-19 patient. On admission, the
patient disclosed that she ever had fever for 2 days at the end of
January 2020 (temperature <38℃), but never had any other
symptom such as cough, sputum, myalgia or diarrhea. After orally took
azithromycin by herself, body temperature returned to normal and no
coronavirus related test was performed.
On admission, physical examination revealed a body temperature 37℃,
pulse of 98 beats per minute, blood pressure of 114/68mmHg, respiratory
rate of 22 breaths per minute and oxygen saturation of 98% (breathing
ambient air). Lung auscultation revealed no abnormality. Vaginal
examination revealed that fetal present descent was at -3, cervix didn’t
dilate, and amniotic fluid was Ⅱ-Ⅲ degree of fecal contamination.
Non-stress test was nonreactive. She was diagnosed as “PROM, Fetal
distress, Suspected COVID-19 patient”.
The pregnant woman underwent emergency cesarean delivery at 5 pm on
March 7 in a negative-pressure operating room. A 3800g healthy female
infant was delivered without complications. Apgar scores at 1 and 5min
were 7 and 9 respectively. Gross inspection of the umbilical cord and
placenta didn’t show any abnormality. Cord blood retained during the
operation was negative for nucleic acid and IgM antibody to SARS-CoV-2,
but positive for IgG antibody to SARS-CoV-2. After birth, the infant had
no moaning or spitting. Her skin was ruddy and she cried loudly. The
mother had been wearing a surgical mask throughout the operation, and
the infant had no contact with the mother. The infant was transferred to
the neonatology department of Wuhan Women and Children’s medical care
center for isolation and close observation.
After delivery, 4 repeat oropharyngeal swabs were samples from the
maternal patient from March 8 to March 14, all were negative for
SARS-CoV-2 RNA by RT-PCR. However, 3 repeat serum IgM and IgG antibody
to SARS-CoV-2 were analyzed from March 6 to March 14, all of the test
results showed that IgM antibody was negative, and IgG antibody was
positive. The maternal patient stayed in the hospital for 9 days. During
the hospitalization, she never reported fever, cough, diarrhea or
dyspnea, and her blood oxygen saturation maintained at
>95%. After the second chest CT obtained On March 16
showed no abnormalities, the maternal patient was discharged but further
quarantined in an isolation site for 14 days.
On admission into the neonatology department, the neonatal case was
immediately underwent a Chest CT scan, which showed bilateral pulmonary
interstitial emphysemas, indicating the possibility of viral pneumonia.
3 repeat oropharyngeal swabs were collected from March 8 to March 10,
and all of the test results were negative for SARS-CoV-2 RNA. On March
10, a first test of serum antibodies to SARS-CoV-2 was underwent and
showed that IgM level was 19.26AU/ml and IgG level was 107.88AU/ml(both
normal range<10AU/ml). However, the neonate nerve had fever, cough,
vomiting, feeding difficulties or dyspnea. She was closely monitored in
isolation unit and no special treatment was given. A second Chest CT was
obtained on March 16, and show all of lesions nearly disappeared.
Anti-SARS-CoV-2 IgM decreased to normal level (6.71AU/ml), while
anti-SARS-CoV-2 IgG level was still elevated (100.91AU/ml) on March 24
(Table 1 ). Because her parents were still isolated, the neonate
stayed in the hospital until March 30, 2020. So far, the neonate is
healthy and breastfeed at home.