Necrotizing Enterocolitis in Preterm Infants Born to Mother with COVID-19
Keywords:COVID-19, Necrotizing enterocolitis, Newborn, Pregnant women, Preterm
Background: The COVID-19 pandemic has had a wide impact on both pregnant women and their babies. Necrotizing enterocolitis (NEC) is a gastrointestinal emergency in neonates with high morbidity and mortality.
Objective: This study aims to investigate the incidence of NEC in preterm infants born to mothers with confirmed COVID-19.
Methods: This observational study was conducted in neonatal intensive care unit at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from May 2020 to April 2021. All preterm infants born to mothers with positive COVID-19 based on swab examination were included as study participants. PCR swab examination was performed within 48 hours after birth. The diagnosis of COVID-19 was defined as positive if the swab test result could detect the SARS-CoV-2 virus. The diagnosis of NEC was established by clinical symptoms and confirmed by abdominal radiography.
Results: Out of 45 preterm infants included in this study, 6 infants experienced NEC. Factors that were significantly associated with the incidence of NEC included asphyxia and intubated mother. Positive PCR results from the infants alone did not significantly increase the risk of NEC. The combination of asphyxia and intubated mother (Odds Ratio [OR]=10.000, 95% Confidence Interval [CI]=1.056-94.677, P=0.020) and the combination of positive PCR result, asphyxia, and intubated mother (OR=2.438, 95% CI=1.673-3.551, P=0.007) were found to be significantly associated with the incidence of NEC
Conclusion: Significant factors associated with the incidence of NEC in preterm infants born to mothers with COVID-19 included asphyxia and intubated mothers prior to delivery. A positive PCR result alone did not significantly increase the risk of NEC.
Plum Analytics Artifact Widget Block
Telles CR, Roy A, Ajmal MR, Mustafa SK, Ahmad MA, de la Serna JM, et al. The impact of COVID-19 management policies tailored to airborne SARS-CoV-2 transmission: Policy analysis. JMIR Public Health Surveill. 2021;7(4):e20699. http://doi.org/10.2196/20699 PMid:33729168
Khalid MS, Aljohani MM, Oyouni NA, Alzahrani O, Ahmad MA, Al-Aoh HA, et al. COVID-19 and immune function a-significant zinc. Orient J Chem. 2020;36(6):1026-36. http://doi.org/10.13005/ojc/360604
Mustafa SK, Ahmad MA, Baranova V, Deineko Z, Lyashenko V, Oyouni AA. Using wavelet analysis to assess the impact of COVID-19 on changes in the price of basic energy resources. Int J Emerg Trends Eng Res. 2020;8(7):2907-12. https://doi.org/10.30534/ijeter/2020/04872020
Kementerian Kesehatan RI. Situasi Terkini Perkembangan Coronavirus Disease. Available from: https://covid19.kemkes.go.id/document/situasi-terkini-perkembangan-coronavirus-disease-covid-19-18-juli-2021/view [Last accessed on 2021 Jul 18].
Mustafa SK, Ahmad MA, Sotnik S, Zeleniy O, Lyashenko V, Alzahrani O. Brief review of the mathematical models for analyzing and forecasting transmission of COVID-19. J Crit Rev. 2020;7(19):4206-10. https://doi.org/10.31838/jcr.07.19.493
Khalid MS, Lyashenko V, Ahmad NA, Ajmal MR, Ahmad MA. Some aspects of modeling in the study of COVID-19 data. Int J Pharm Res. 2021;13(1):4124-9. http://doi.org/10.31838/ijpr/2021.13.01.586
CNN Indonesia. POGI: 20 Persen Kematian ibu Hamil Akibat Positif COVID-19. Available from: https://www.cnnindonesia.com/nasional/20210819110357-20-682327/pogi-20-persen-kematian-ibu-hamil-akibat-positif-covid-19 [Last accessed on 2021 Aug 18].
Yikilmaz A, Hall NJ, Daneman A, Gerstle JT, Navarro OM, Moineddin R, et al. Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis. Korean J Pediatr. 2014;57(8):351-6.
Zozaya C, Gonzalez IG, Avila-Alvarez A, Oikonomopoulou N, Tamayo TS, Salguero E, et al. Incidence, treatment, and outcome trends of necrotizing enterocolitis in preterm infants: A multicenter cohort study. Front Pediatr. 2020;8:188. http://doi.org/10.3389/fped.2020.00188 PMid:32478014
Conde-Agudelo A, Romero R. SARS-CoV-2 infection during pregnancy and risk of preeclampsia: A systematic review and meta-analysis. Am J Obstet Gynecol. 2021;2021:00795. PMid:34302772
Perger L, Mukhopadhyay D, Komidar L, Wiggins-Dohlvik K, Uddin MN, Beeram M. Maternal pre-eclampsia as a risk factor for necrotizing enterocolitis. Matern Fetal Neonatal Med. 2016;29(13):2098-103. PMid:27480208
Trevisanuto D, Weiner G, Lakshminrusimha S, Azzimonti G, Nsubuga JB, Velaphi S, et al. Management of mothers and neonates in low resources setting during covid-19 pandemia. J Matern Fetal Neonatal Med. 2020;2020:1-12. http://doi.org/10.1080/14767058.2020.1784873 PMid:32602386
Gregory KE, Deforge CE, Natale KM, Phillips M, Van Marter LJ. Necrotizing enterocolitis in the premature infant: Neonatal nursing assessment, disease pathogenesis, and clinical presentation. Adv Neonatal Care. 2011;11(3):155-64; quiz 165-6. http://doi.org/10.1097/ANC.0b013e31821baaf4 PMid:21730907
Stout G, Lambert DK, Baer VL, Gordon PV, Henry E, Wiedmeier SE, et al. Necrotizing enterocolitis during the first week of life: A multicentered case-control and cohort comparison study. J Perinatol. 2008;28(8):556-60. http://doi.org/10.1038/jp.2008.36 PMid:18368057
Zhong YJ, Claveau M, Yoon EW, Azziz K, Singhal N, Shah PS, et al. Neonates with a 10-min Apgar score of zero: Outcomes by gestational age. Resuscitation. 2019;143:77-84. http://doi.org/10.1016/j.resuscitation.2019.07.036 PMid:31421194
Ayed A, Embaireeg A, Benawadh A, Al-Fouzan W, Hammoud M, Al-Hathal M, et al. Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait. BMC Pregnancy Childbirth. 2020;20(1):754. PMid:33267785
Hcini N, Maamri F, Picone O, Carod JF, Lambert V, Mathieu M, et al. Maternal, fetal and neonatal outcomes of large series of SARS-CoV-2 positive pregnancies in peripartum period: A single-center prospective comparative study. Eur J Obstet Gynecol Reprod Biol. 2021;257:11-8. http://doi.org/10.1016/j.ejogrb.2020.11.068 PMid:33310656
Duci M, Frigo AC, Visentin S, Verlato G, Gamba P, Fascetti-Leon F. Maternal and placental risk factors associated with the development of necrotizing enterocolitis (NEC) and its severity. J Pediatr Surg. 2019;54(10):2099-102. http://doi.org/10.1016/j.jpedsurg.2019.04.018 PMid:31084912
Yang R, Mei H, Zheng T, Fu Q, Zhang Y, Buka S, et al. Pregnant women with COVID-19 and risk of adverse birth outcomes and maternal-fetal vertical transmission: A population-based cohort study in Wuhan, China. BMC Med. 2020;18(1):330. PMid:33070775
Anand P, Yadav A, Debata P, Bachani S, Gupta N, Gera R. Clinical profile, viral load, management and outcome of neonates born to COVID 19 positive mothers: A tertiary care centre experience from India. Eur J Pediatr. 2021;180(2):547-59. http://doi.org/10.1007/s00431-020-03800-7 PMid:32910210
Brandt JS, Hill J, Reddy A, Schuster M, Patrick HS, Rosen T, et al. Epidemiology of coronavirus disease 2019 in pregnancy: Risk factors and associations with adverse maternal and neonatal outcomes. Am J Obstet Gynecol. 2021;224(4):389. e1-9. http://doi.org/10.1016/j.ajog.2020.09.043 PMid:32986989
Rasiah V, Yajamanyam PK, Ewer AK. Necrotizing enterocolitis: Current perspectives. Res Reports Neonatol. 2014;4:31-42.
Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK, et al. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics. 2012;129(2):e298-304. http://doi.org/10.1542/peds.2011-2022 PMid:22271701
Norman M, Naver L, Soderling J, Ahlberg M, Hervius H, Aronsson B, et al. Association of maternal SARS-CoV-2 infection in pregnancy with neonatal outcomes. JAMA. 2021;325(20):2076-86. http://doi.org/10.1001/jama.2021.5775 PMid:33914014
Yaman A, Kandemir I, Varkal MA. Infants infected with SARS-CoV-2 and newborns born to mother diagnosed with COVID-19: Clinical experience. Ir J Med Sci. 2021;2021:1-6. http://doi.org/10.1007/s11845-021-02662-8 PMid:34075529
Dumitriu D, Emeruwa UN, Hanft E, Liao GV, Ludwig E, Walzer L, et al. Outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 infection at a large medical center in New York City. JAMA Pediatr. 2021;175(2):157-67. http://doi.org/10.1001/jamapediatrics.2020.4298 PMid:33044493
Chi H, Chiu NC, Tai YL, Chang HY, Lin CH, Sung YH, et al. Clinical features of neonates born to mothers with coronavirus disease-2019: A systematic review of 105 neonates. J Microbiol Immunol Infect. 2021;54(1):69-76. http://doi.org/10.1016/j.jmii.2020.07.024 PMid:32847748
Patberg ET, Adams T, Rekamek P, Vahanian SA, Akerman M, Hernandez A, et al. Coronavirus disease 2019 infection and placental histopathology in women delivering at term. Am J Obstet Gynecol. 2021;224(4):382.e1-18. http://doi.org/10.1016/j.ajog.2020.10.020 PMid:33091406
Kong XY, Xu FD, Wu R, Wu H, Ju R, Zhao XL, et al. Neonatal mortality and morbidity among infants between 24 to 31 complete weeks: A multicenter survey in China from 2013 to 2014. BMC Pediatr. 2016;16(1):174. http://doi.org/10.1186/s12887-016-0716-5 PMid:27809893
How to Cite
Copyright (c) 2020 Dina Angelika, Risa Etika, Angelica Diana Vita, Setya Mithra, I Dewa Gede Ugrasena (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All rights reserved.