Discussion
The index case is a term newborn baby with nasopharyngeal swab sample
testing positive by reverse-transcription polymerase chain reaction
(rRT-PCR) for SARS -CoV-2 infection at 24 hours after birth. During the
whole hospital course, the patient was stable.
Several studies in newborn infants are currently available, suggesting
that infants usually have mild manifestations of the disease, which were
consistent with our case report 2-4.
However, a reported clinical analysis proposed that infants with SARS
-CoV-2 infection may present with premature delivery, respiratory
distress, gastrointestinal symptoms, laboratory results abnormalities
like elevated liver enzymes, thrombocytopenia, and increased mortality
rate 5.
One of the primary risk factors of COVID-19 infection is considered
close contact with an infected person within 14 days of symptoms onset
and an incubation period ranging
between 2 to 14 days, an average of five days. Presently, the
possibility of vertical transmission is a big question to neonatologists
and obstetricians. There is limited evidence for mother-to-child
transmission in women who developed SARS -CoV-2 in late pregnancy.
However, Wang et al. recently described cases of newborn infants with
proven COVID-19 infection where the nasopharyngeal swabs were taken 36
hours after birth4.
A recently published cohort study identified three newborn infants with
COVID-19. All these cases were delivered by the emergency cesarean
section because of fetal distress and had confirmed maternal SARS -CoV-2
infection. All neonates had nasopharyngeal and anal swab positive for
COVID-19 on day 2 of life despite strict infection prevention and
control during procedures that were done throughout the delivery6.
Also, Lan Dong et al. reported a newborn baby with elevated
anti-SARS-CoV-2 IGM antibodies two hours after the birth, and there was
no physical contact with the COVID-19 positive
mother 7. Detection of IgM is suggestive of the
intrauterine infection. Interestingly, at the same time several
requested nasopharyngeal swabs for COVID-19 were negative in the same
baby.
All these neonates were isolated from the mother from the beginning,
including our case, suggesting the possibility of vertical transmission
in these reported cases. There is also other evidence supporting the
ability of vertical transmission of SARS-CoV-2.
The latest reports identified the presence of SARS-CoV-2 in the villous
chorion and amniotic fluid 8. The possibility of
vertical transmission can occur during vaginal birth with exposure to
maternal stool infected with SARS-CoV-2 9.
Additionally, SARS-CoV-2 nucleic acid was found in the blood samples10.
Unfortunately, no testing of intrauterine tissue samples as placenta,
cord blood, amniotic fluid, and maternal milk was done in the index case
to confirm that the SARS -CoV-2 infection occurred due to vertical
transmission.