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.