NICU.
Co-first authors.
Pediatrics. 2022 Nov 1;150(5). doi: 10.1542/peds.2022-056206.
To evaluate outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy, the dynamics of placental transfer of maternal antibodies, and its persistence during infancy.
Cohort study enrolling neonates born to mothers with SARS-CoV-2 infection in pregnancy. All infants were evaluated at birth. Those born to women with infection onset within 2 weeks before delivery were excluded from further analyses. Remaining infants underwent cerebral and abdominal ultrasound, fundoscopy evaluation, and were enrolled in a 12 month follow-up. Qualitative immunoglobulin G (IgG)/immunoglobulin M and quantitative IgG to S1/S2 subunits of spike protein were assessed in mother-neonate dyads within 48 hours postdelivery and during follow-up.
Between April 2020 and April 2021, 130 of 2745 (4.7%) neonates were born to mothers with SARS-CoV-2 infection in pregnancy, with 106 of 130 infections diagnosed before 2 weeks before delivery. Rates of preterm and cesarean delivery were comparable between women with and without infection (6% vs 8%, P = .57; 22% vs 32%, P = .06). No clinical or instrumental abnormalities were detected at birth or during follow-up. There was a positive correlation between maternal and neonatal SARS-CoV-2 IgG levels (r = 0.81, P < .001). Transplacental transfer ratio was higher after second-trimester maternal infections as compared with first and third trimester (P = .03). SARS-CoV-2 IgG level progressively decreased in all infants, with 89 of 92 (97%) infants seronegative at 6 months of age.
Clinical outcomes were favorable in all infants. Matching peak IgG level after infection and higher IgG transplacental transfer might result in the most durable neonatal passive immunity.
评估妊娠期间感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的母亲所生新生儿的结局，胎盘转运母体抗体的动态变化及其在婴儿期的持续时间。
本队列研究纳入了妊娠期间感染 SARS-CoV-2 的母亲所生的新生儿。所有新生儿均在出生时进行评估。对于在分娩前 2 周内感染开始的母亲所生的新生儿，排除进一步分析。其余的新生儿接受了脑部和腹部超声、眼底检查，并在 12 个月的随访中入组。在产后 48 小时内和随访期间，对母婴对中定性 IgG/IgM 和定量 IgG 针对刺突蛋白 S1/S2 亚基进行评估。
在 2020 年 4 月至 2021 年 4 月期间，2745 例新生儿中共有 130 例（4.7%）的母亲在妊娠期间感染了 SARS-CoV-2，其中 106 例感染是在分娩前 2 周前诊断的。感染组与未感染组的早产儿和剖宫产率相当（6%比 8%，P=.57；22%比 32%，P=.06）。在出生时或随访期间未发现临床或仪器异常。母亲和新生儿 SARS-CoV-2 IgG 水平呈正相关（r=0.81，P <.001）。与第一和第三孕期相比，第二孕期母体感染后的胎盘转运比更高（P=.03）。所有婴儿的 SARS-CoV-2 IgG 水平逐渐下降，92 例婴儿中有 89 例（89%）在 6 个月时 IgG 转为阴性。
所有婴儿的临床结局均良好。感染后匹配 IgG 峰值水平和更高的 IgG 胎盘转运可能导致新生儿被动免疫更持久。
