Home Medizin Laut Studie besteht bei Neugeborenen, die im Mutterleib SARS-CoV-2 ausgesetzt waren, ein höheres Risiko für Atemnot

Laut Studie besteht bei Neugeborenen, die im Mutterleib SARS-CoV-2 ausgesetzt waren, ein höheres Risiko für Atemnot

von NFI Redaktion

New research published in Nature Communications has examined the risk of respiratory distress (RD) in newborns born to mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Study: Respiratory Distress in SARS-CoV-2-exposed, non-infected neonates tracked in the COVID Outcomes in Mother-Infant Pairs (COMP) study. Image source: Gorodenkoff / Shutterstock.com

Study: Respiratory distress in SARS-CoV-2-exposed, non-infected neonates tracked in the COMP study (COVID Outcomes in Mother-Infant Pairs). Image source: Gorodenkoff / Shutterstock.com

How are infants affected by maternal SARS-CoV-2 infection?

SARS-CoV-2 infection during pregnancy can lead to serious complications for mothers and infants, including stillbirths, preterm births, and severe health issues for mothers. While low rates of mother-to-child transmission have been reported, concerns remain about the long-term effects on newborns.

Specifically, RD has been observed in non-infected and SARS-CoV-2-exposed full-term newborns. Previous explanations focused on maternal health issues leading to preterm births, a known risk factor for rare diseases. New evidence, however, suggests that prenatal exposure could trigger an inflammatory response in the newborn’s airways, as indicated by specific proteins in affected infants.

The role of maternal coronavirus disease 2019 (COVID-19) vaccination in preventing neonatal RD after exposure remains unclear. Further research is needed to elucidate the mechanisms through which prenatal SARS-CoV-2 exposure leads to rare diseases in newborns and explore potential prevention strategies.

About the Study

The present study recruited participants aged 16 years and older from the Department of Obstetrics at the University of California, Los Angeles (UCLA) from April 15, 2020, to August 31, 2022. All women were admitted to UCLA for labor and delivery during this period and were tested for SARS-CoV-2.

The study included 221 pregnant individuals and 227 exposed fetuses, resulting in 199 live births. These mother-infant pairs were monitored until the infants were six months old. Informed consent was obtained from all participants or surrogates in case of incapacitation.

The researchers measured newborn RD based on criteria such as respiratory rate and cyanosis, with infants classified as preterm if born before 37 weeks. The severity of maternal COVID-19 illness and vaccination status were assessed, as well as self-reported race and ethnicity.

Statistical analyses compared the demographics of infants with and without RD, including maternal and infant characteristics and pregnancy complications. Logistic regression analyses identified maternal vaccinations and preterm births as key predictors of RD, with post-hoc analysis assessing the effects of vaccination on perinatal outcomes.

In addition to statistical analysis, the researchers conducted proteomic profiling to examine associations between RD and SARS-CoV-2 in a subset of infants. Blood samples from 52 infants were analyzed, comparing 45 SARS-CoV-2-exposed, non-infected (SEU) infants with seven control children born to healthy, non-exposed mothers. SEU infants were clustered for this analysis based on RD outcome and gestational age.

Study Findings

About 50% of study participants identified as Black or Hispanic, followed by 24% as Asian, mixed race, or other, and 25% as White. Around 13% of study participants experienced severe or critical COVID-19, with higher incidence reported in unvaccinated mothers.

The highest number of COVID-19 cases in the cohort occurred in winter 2020, followed by smaller peaks coinciding with the emergence of the Delta and Omicron SARS-CoV-2 variants. Most mothers were vaccinated before the Alpha variant became prevalent, resulting in a significant difference in maternal vaccination status across different virus variants. Notably, none of the infants tested positive for SARS-CoV-2 at birth; however, 17% were diagnosed with RD.

Among the 34 infants with RD, the most common diagnoses upon discharge from the neonatal intensive care unit were respiratory distress syndrome (RDS), transient tachypnea of the newborn, and other infections at 47%, 16%, and 16%, respectively. While many infants were labeled as early preterm due to being born before 34 weeks of gestation, most were late preterm or term deliveries. The average time to resolution of RD was approximately 24 days, with duration varying by gestational age.

Physical examination findings were nonspecific and included symptoms such as subcostal or intercostal retractions, abnormal breathing, or grunting. Chest X-ray findings frequently showed opacities such as interstitial infiltrates and ground-glass opacities; however, 8% were described as normal.

Unadjusted logistic regression models identified associations between neonatal RD and the severity of maternal illness, prematurity, and lack of maternal COVID-19 vaccination. In the proteome pathway analysis, 52 infants born in the first year of the pandemic were studied.

SEU infants with RD exhibited elevated levels of various cytokines and proteins, indicating a highly regulated inflammatory pathway involving NACHT, Leucine-Rich Repeat, and Pyrin Domain-Containing Protein 3 (NLRP3). This included higher concentrations of specific cytokines such as interleukin 18 (IL-18), caspase 1 (CASP1), and interleukin 1 β (IL-1β).

In preterm infants with RD, there was a marked upregulation of biological processes related to inflammation, chemotactic responses, and IL-8 production. Functional network analysis suggested a predominantly T-helper cell type 2 (Th2)-oriented response, which may tend towards hyperimmune reactions due to associations with higher production of immunoglobulin E (IgE).

Journal Reference:

  • Mann, OM, Azamor, T., Cambou, MC et al. (2024). Respiratory distress in SARS-CoV-2-exposed, non-infected neonates tracked in the COMP study (COVID Outcomes in Mother-Infant Pairs). Nature Communications. doi:10.1038/s41467-023-44549-5

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