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ORIGINAL ARTICLE
Ahead of print publication  

The clinical manifestations and outcomes in neonates infected with COVID-19 in the West of Iran


1 Department of Pediatric, Hamadan University of Medical Sciences, Hamadan, Iran
2 Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
3 Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
4 Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
5 Department of Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
6 Department of Pediatric, Kurdistan University of Medical Sciences, Kurdistan, Iran
7 Department of Pediatric, Kermanshah University of Medical Science, Kermanshah, Iran
8 Department of Pediatric, Zanjan University of Medical Sciences, Zanjan, Iran
9 Department of Pediatric, Lorestan University of Medical Sciences, Lorestan, Iran

Date of Submission03-Jan-2022
Date of Acceptance27-Sep-2022
Date of Web Publication25-Nov-2022

Correspondence Address:
Ensiyeh Jenabi,
Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan
Iran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_4_22

  Abstract 


Introduction: So far, no study has been conducted in Iran on the effect of COVID-19 on neonates. Therefore, the present cross-sectional study has been evaluated to determine the clinical manifestations and outcomes in neonates infected with COVID-19 in the west of Iran. Materials and Methods: The present cross-sectional study was conducted among neonates infected with COVID-19 in six provinces of Hamadan, Kermanshah, Kurdistan, Ilam, Zanjan and Lorestan, located in the west of Iran, from 1 March to 1 July 2020. In these neonates, the polymerase chain reaction test was positive. The data were collected by a checklist and were analysed using SPSS Statistics Software. Result: During the study period, 16 neonates infected with COVID-19 were identified including Kurdistan Province with five cases, Hamadan Province four cases, Kermanshah with three cases, and Lorestan and Zanjan provinces with two cases. Neonate gender of them had equal distribution. Two (15.38%) of them needed CPR after delivery. The delivery method for 9 (56.25%) was vaginal, and one of them died during the study period. The medical care used for these neonates was as follows: 87.5% were hospitalized in the intensive care unit and antibiotics were used for 68.75%. 12.5% underwent COVID-19-specific treatment, and for 25%, a ventilator was used. The laboratory findings in neonates infected with COVID-19 showed that in 18.75%, blood urea nitrogen has increased. 46.15% of neonates reported lymphocytopenia. The blood haematocrit and haemoglobin decreased by 31.35% and 56.25%, respectively. Conclusion: The coronavirus disease 2019 has occurred among neonates, but they seemed to have a milder disease course and better prognosis than adults. Findings showed that there is a possibility of vertical intrauterine transmission from pregnant mothers to newborns.

Keywords: COVID-19, intrauterine transmission, Iran, manifestations, neonate, outcome



How to cite this URL:
Eghbalian F, Jenabi E, Bashirian S, Khazaei S, Shokouhi M, Basiri B, Sabzehei MK, Sheikhahmadi S, Babaei H, Vakiliamini M, Jafari N, Jafari M. The clinical manifestations and outcomes in neonates infected with COVID-19 in the West of Iran. Adv Hum Biol [Epub ahead of print] [cited 2022 Dec 1]. Available from: https://www.aihbonline.com/preprintarticle.asp?id=361967




  Introduction Top


The novel coronavirus 2019 (COVID-19) has given rise to an outbreak of viral pneumonia in many countries since December 2019.[1] The virus was first found in Wuhan (China) in December 2019 and spread to many countries.[2]

Researchers worldwide have integrated efforts to identify potential treatments, estimate future epidemic progression and sort the most vulnerable from existing data to prepare for patient-specific actions. Some studies reported that there is evidence that viruses such as H1N1 may cause respiratory infection from mother to child and from child to child.[3],[4]

Since 2019, coronavirus has been characterised by high mortality and high transmission rates among individuals.[5] The contagious disease is milder in children than in adults and may be associated with non-specific symptoms, especially in neonates.[6] The course of COVID-19 virus treatment is milder in children than in adults.[7]

Ludvigsson, in a systematic review study, showed that COVID-19 infection among neonates had a milder disease course and better prognosis than adults.[8]

Due to the fact that so far, no study has been conducted in Iran on the effect of COVID-19 on neonates; therefore, the present cross-sectional study has been performed to determine the clinical manifestations and outcomes in neonates infected with COVID-19 in the west of Iran.


  Materials and Methods Top


Study population and setting

The present cross-sectional study was conducted among neonates infected with COVID-19 in children's hospitals of six provinces of Hamadan, Kermanshah, Kurdistan, Ilam, Zanjan and Lorestan, located in the west of Iran, from 1 March to 1 July 2020.

The inclusion criteria were neonates infected with COVID-19 in children's hospitals, and in these neonates, the polymerase chain reaction (PCR) test was positive. The neonates with negative PCR tests and suspicious of COVID-19 were excluded from this study. All diagnoses in neonates were made using (real-time) reverse transcription-PCR on oropharyngeal specimens.

Ethics

All parents gave consent to contribute to this study. All data were fully anonymised before the analysis. We earned ethical approval for the present study from Hamadan University of Medical Sciences with the code of IR.UMSHA.REC.1399.271.

Data collection

The data were collected by a checklist included gestational age, neonate's disease, birth weight, delivery type, preterm delivery, neonate's gender, neonate Apgar score at 1 and 5 min, apnea, tachypnea, dyspnea, radiography findings, laboratory tests such as CPR, erythrocyte sedimentation rate, blood sugar, Ca, Na, K, blood urea nitrogen (BUN), creatinine, culture of blood, urine and stool, liver function tests, complete blood count and arterial blood gases. The validity and reliability of the checklist were assessed.

Statistical analysis

We reported descriptive statistics as number (%) for categorical variables and mean (standard deviation) for continuous variables in the form of tables and charts. All statistical analyses were carried out in STATA version 14 software (College Station, TX, USA). The geographical distribution of identified cases was depicted with ArcView® 9.2 GIS software.


  Results Top


During the study period, 16 neonates infected with COVID-19 were identified including Kurdistan Province with five cases, Hamadan Province four cases, Kermanshah with three cases, and Lorestan and Zanjan provinces with two cases [Figure 1].
Figure 1: Geographical position of investigated provinces.

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The baseline characteristics of the investigated neonates are shown in [Table 1]. Neonate gender of them had equal distribution, and 2 (15.38%) of them had to need CPR after delivery. The delivery method for 9 (56.25%) was vaginal, and one of them died during the study period [Table 1].
Table 1: Baseline characteristics of the investigated neonates

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[Table 2] shows the status of vital signs in neonates. The mean age of them was 2905 ± 708 g (ranging from 1800 to 4000 g). The average duration of their hospitalisation was 10.08 ± 8.58 days (ranging from 1 to 30 days). The mean temperature was 37.12 ± 0.71 c, and the median of Apgar at 1 and 5 min was 9.
Table 2: Vital signs of investigated neonates

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According to [Figure 2], tachypnoea and distress with 75% and 68.75%, respectively, were the common complication in the investigated neonates.
Figure 2: Common complications during delivery.

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The medical care used for these neonates was as follows: 87.5% were hospitalized in the intensive care unit and antibiotics were used for 68.75%. 12.5% underwent COVID-19-specific treatment, and for 25%, a ventilator was used [Figure 3].
Figure 3: Therapeutic care used for the investigated neonates.

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The laboratory findings in neonates infected with COVID-19 showed that in 18.75%, BUN has increased. 46.15% of neonates reported lymphocytopenia. The blood haematocrit and haemoglobin decreased by 31.35% and 56.25%, respectively [Table 3].
Table 3: The laboratory findings in neonates infected with COVID-19 (n=16)

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  Discussion Top


Our study showed that the therapeutic cares used for these neonates were 87.5% hospitalisation in NICU, 68.75% antibiotic use, 12.5% COVID-19-specific treatment and 25% ventilator. A fever in 18.75% was seen. The laboratory findings reported lymphocytopenia and anaemia among neonates. Tachypnoea and distress with 75% and 68.75%, respectively, were the common complications among neonates. Furthermore, one case of neonates infected with COVID-19 died.

Hou et al. reported that the mean of Apgar scores at 1 min and 5 min was recorded to be adequate, 8.7 and 9.7, respectively, while the mean of neonate weight was 3214.7 g, which is considered normal.[9] In our study, the mean of the Apgar scores at 1 min and 5 min was 7.3 and 9.1, respectively. Furthermore, the mean neonate weight at birth was 2860 g. However, Apgar scores and neonate weight were lower than in Hou et al.

Fan et al. reported that two neonates had mild lymphocytopenia and radiological outcomes of pneumonia. However, two neonates were discharged in good general condition.[10] In our study, lymphocytopenia and anaemia were reported.

In a systematic review study from 45 studies, the findings showed that 1%–5% of COVID-19 cases were diagnosed among children. They were often milder than adults and had very rare deaths. In our study, one of 16 neonates died. Therefore, our study was in line with the systematic review study.[8]

The other systematic review study among 108 pregnant women with COVID-19 showed that caesarean section was performed in most of the cases. However, the seven cases of normal vaginal delivery were not associated with adverse outcomes. In this systematic review, 75 newborns with PCR tests were well, but lymphocytopenia was seen.[11]

The present study showed that 18.75% of neonates had increased BUN. A study reported that acute kidney injury (AKI) occurred in up to 25% of neonates infected with COVID-19. The pathophysiology of COVID-19-related AKI can be related to COVID-specific mechanisms such as direct cell damage due to viral entry through the receptor (angiotensin-converting enzyme 2) that is highly expressed in the kidney, pro-inflammatory cytokines due to the viral infection and thrombotic events and a system of imbalanced renin–angiotensin–aldosterone.[12]

Li et al., in 2020, showed that newborns were no significant differences between the cases of infected with COVID-19 and controls in gestational age, intrauterine foetal distress and Apgar score at 5 min.[13]

In our study, 10 of 16 neonates had a positive PCR test in the first 24 h after birth. Therefore, the results of the present study show that there is a possibility of vertical intrauterine transmission from the pregnant mother to the newborn. In a case reported by Alzamora et al., the vertical transmission was confirmed by positive PCR in 16 h after delivery from a mother infected with COVID-19.[14] However, Chan et al. in China reported that vertical intrauterine transmission appears to be low.[1]

The limitation of the present study was the low sample size. Due to the increase the cases of this disease, it is recommended that the present study be performed on a larger sample size.


  Conclusion Top


The coronavirus (COVID-19) has happened among neonates. However, infants appear to have a milder course of disease than adults and have a better prognosis. Our findings showed that there is a possibility of vertical intrauterine transmission from pregnant mothers to newborns.

Ethics approval and consent to participate

We earned ethical approval for the present study from Hamadan University of Medical Sciences with the code of IR.UMSHA.REC.1399.271.

Consent for publication

All parents gave consent to contribute in this study. All data were fully anonymised before the analysis.

Financial support and sponsorship

This study was supported by the Hamadan University of Medical Sciences (grant number: 9903271849).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.  Back to cited text no. 1
    
2.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 2
    
3.
Shek CC, Ng PC, Fung GP, Cheng FW, Chan PK, Peiris MJ, et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics 2003;112:e254.  Back to cited text no. 3
    
4.
Takahashi N, Kitajima H, Kusuda S, Morioka I, Itabashi K. Pandemic (H1N1) 2009 in neonates, Japan. Emerg Infect Dis 2011;17:1763-5.  Back to cited text no. 4
    
5.
Available from: http://www.nhc. gov.cn/jkj/s7916 / 202001/44a3 b8245e8049d2837a4f27529cd386. [Last accessed on 2020 Aug 12].  Back to cited text no. 5
    
6.
Kamali Aghdam M, Jafari N, Eftekhari K. Novel coronavirus in a 15-day-old neonate with clinical signs of sepsis, a case report. Infect Dis (Lond) 2020;52:427-9.  Back to cited text no. 6
    
7.
Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020;9:51-60.  Back to cited text no. 7
    
8.
Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr 2020;109:1088-95.  Back to cited text no. 8
    
9.
Hou L, Wang X, Li G, Zou L, Chen Y, Zhang W. Cross sectional study in China: Fetal gender has adverse perinatal outcomes in mainland China. BMC Pregnancy Childbirth 2014;14:372.  Back to cited text no. 9
    
10.
Fan C, Lei D, Fang C, Li C, Wang M, Liu Y, et al. Perinatal transmission of 2019 coronavirus disease-associated severe acute respiratory syndrome coronavirus 2: Should we worry? Clin Infect Dis 2021;72:862-4.  Back to cited text no. 10
    
11.
Zaigham M, Andersson O. Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies. Acta Obstet Gynecol Scand 2020;99:823-9.  Back to cited text no. 11
    
12.
Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med 2020;46:1339-48.  Back to cited text no. 12
    
13.
Li N, Han L, Peng M, Lv Y, Ouyang Y, Liu K, et al. Maternal and neonatal outcomes of pregnant women with coronavirus disease 2019 (COVID-19) pneumonia: A case-control study. Clin Infect Dis 2020;71:2035-41.  Back to cited text no. 13
    
14.
Alzamora MC, Paredes T, Caceres D, Webb CM, Valdez LM, La Rosa M. Severe COVID-19 during pregnancy and possible vertical transmission. Am J Perinatol 2020;37:861-5.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

 
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