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新型冠状病毒肺炎阳性母亲所生孩子与患有先天性胃肠畸形且住院期间接受适当肠外营养的新型冠状病毒肺炎阴性孕妇所生孩子术后一年的病情演变比较

Comparison of One-Year Post-Operative Evolution of Children Born of COVID-19-Positive Mothers vs. COVID-19-Negative Pregnancies Having Congenital Gastrointestinal Malformation and Having Received Proper Parenteral Nutrition during Their Hospital Stay.

作者信息

Brandibur Timea Elisabeta, Kundnani Nilima Rajpal, Ramakrishna Kakarla, Mederle Alexandra, Manea Aniko Maria, Boia Marioara, Popoiu Marius Calin

机构信息

Neonatology and Puericulture Department, "Victor Babes" University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania.

Neonatology and Preterm Department, "Louis Ţurcanu" Children Emergency Hospital, 300011 Timisoara, Romania.

出版信息

Pediatr Rep. 2024 Sep 25;16(4):823-832. doi: 10.3390/pediatric16040070.

Abstract

The long-term effects on neonates born of COVID-19-positive pregnancies are still unclear. Congenital gastrointestinal malformations (CGIMs) often require urgent surgical intervention and antibiotic coverage. We aim to compare the health status at one-year post-surgical follow-up of cases of CGIM born of COVID-19-positive pregnancies to those of non-COVID-19 pregnancies. We conducted a comparative, observational study of 41 patients who underwent surgery at our hospital for congenital gastrointestinal malformations in 2022. They were initially treated with antibiotics and parenteral nutrition, which was later replaced with enteral nutrition gradually after the surgery. We then analyzed the data related to their growth and development during their 12-month follow-up visit at our outpatient clinic. We classified the children born of COVID-19-positive mothers as Group 1 ( = 14) and those born of mothers without COVID-19 symptoms or with unconfirmed status as Group 2 ( = 33). Forty-one patients showed up for a one-year follow-up (between 11 and 13 months of life). Hence, the final Group 1 comprised 12 and Group 2 comprised 29 children. The patients were categorized based on their anatomical location. Of the cohort, 56.09% were preemies, and 43.91% were full-term newborns. We used seven parameters to evaluate both groups based on growth and developmental milestones: verbal skills, cognitive development, weight gain, height achieved, fine motor movements, gross motor movements, and social/emotional behavior. Group 1 children showed a significant decrease in height and weight compared to Group 2 children. In Group 1, 83.33% of patients were prescribed antibiotics, while only 10.34% in Group 2 were in the same situation. There were no cases of malabsorption syndrome in Group 2, but 16.66% of patients in Group 1 had it, with patients being operated on for duodenal malformations. None of the infants had necrotizing enterocolitis, post-surgical complications, or sepsis. All the children received antibiotics to prevent infection before and after surgery. No mortality was noted. In our one-year follow-up study, it was seen that even after surgical correction of congenital gastrointestinal malformations, children born of COVID-19-positive pregnancies can suffer serious growth and developmental delays, and gastrointestinal health issues might be more common. Since the long-term effects of COVID-19-positive pregnancies are not yet clear, larger cohort-based studies are required in this domain. Antibiotics destroy gut microbiota, especially in cases of gastrointestinal malformations and surgical resections. Growth and developmental milestones can not only be affected by CGIMs but also be further delayed by COVID-19 infections.

摘要

新型冠状病毒肺炎(COVID-19)阳性孕妇所生新生儿的长期影响仍不明确。先天性胃肠道畸形(CGIM)通常需要紧急手术干预和抗生素治疗。我们旨在比较COVID-19阳性孕妇所生CGIM患儿与非COVID-19孕妇所生患儿术后一年随访时的健康状况。我们对2022年在我院接受先天性胃肠道畸形手术的41例患者进行了一项对比观察性研究。他们最初接受抗生素和肠外营养治疗,术后逐渐改为肠内营养。然后,我们分析了他们在门诊12个月随访期间与生长发育相关的数据。我们将COVID-19阳性母亲所生儿童分为第1组(n = 14),将无症状或状态未确诊母亲所生儿童分为第2组(n = 33)。41例患者进行了为期一年的随访(在11至13个月大之间)。因此,最终第1组有12名儿童,第2组有29名儿童。患者根据解剖位置进行分类。在该队列中,56.09%为早产儿,43.91%为足月儿。我们使用七个参数根据生长发育里程碑来评估两组:语言能力、认知发展、体重增加、身高增长、精细运动、大运动以及社交/情感行为。与第2组儿童相比,第1组儿童的身高和体重显著下降。在第1组中,83.33%的患者使用了抗生素,而第2组中只有10.34%的患者处于相同情况。第2组没有吸收不良综合征病例,但第1组有16.66%的患者出现该病症,这些患者因十二指肠畸形接受了手术。所有婴儿均未发生坏死性小肠结肠炎、术后并发症或败血症。所有儿童在手术前后均接受抗生素预防感染。未观察到死亡病例。在我们为期一年的随访研究中发现,即使先天性胃肠道畸形经过手术矫正,COVID-19阳性孕妇所生儿童仍可能出现严重的生长发育迟缓,胃肠道健康问题可能更常见。由于COVID-19阳性妊娠的长期影响尚不清楚,该领域需要开展更大规模的队列研究。抗生素会破坏肠道微生物群,尤其是在胃肠道畸形和手术切除的情况下。生长发育里程碑不仅会受到CGIM的影响,还会因COVID-19感染而进一步延迟。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a4f6/11503270/89fec8b4d131/pediatrrep-16-00070-g001.jpg

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