Abstract
Severe coronavirus disease in neonates is rare. We analyzed clinical, laboratory, and autopsy findings from a neonate in the United States who was delivered at 25 weeks of gestation and died 4 days after birth; the mother had asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preeclampsia. We observed severe diffuse alveolar damage and localized SARS-CoV-2 by immunohistochemistry, in situ hybridization, and electron microscopy of the lungs of the neonate. We localized SARS-CoV-2 RNA in neonatal heart and liver vascular endothelium by using in situ hybridization and detected SARS-CoV-2 RNA in neonatal and placental tissues by using reverse transcription PCR. Subgenomic reverse transcription PCR suggested viral replication in lung/airway, heart, and liver. These findings indicate that in utero SARS-CoV-2 transmission contributed to this neonatal death.
Highlights
We describe the detection and localization of SARS-CoV-2 in autopsy tissues from a 25-week neonate who died at 4 days of age with clinical history, laboratory, and pathologic findings consistent with severe COVID-19
We provide direct evidence of SARS-CoV-2 infection and probable viral replication in multiple autopsy tissues from a premature infant who died with severe COVID-19
We found extensive staining of SARS-CoV-2 antigens and RNA and evidence of plausible virus replication in the lungs, which demonstrated significant pathology
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is associated with severe maternal coronavirus disease (COVID-19) and preterm birth and may increase the risk for other complications of pregnancy [1–5]. We describe the detection and localization of SARS-CoV-2 in autopsy tissues from a 25-week neonate who died at 4 days of age with clinical history, laboratory, and pathologic findings consistent with severe COVID-19.
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