Abstract
The recent viral pandemic in Wuhan, Hubei, China has led to the identification of a new species of beta-coronavirus, able to infect humans, the 2019-nCoV, later named SARS-CoV-2. SARS-CoV-2 causes a clinical syndrome named COVID-19, which presents with a spectrum of symptoms ranging from mild upper respiratory tract infection to severe pneumonia, with acute respiratory distress syndrome and frequent death. All age groups are susceptible to the infection, but children, especially infants, seem to be partially spared, having a more favorable clinical course than other age groups. There is currently no clear evidence showing vertical transmission and intrauterine SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy, and even if transmission is possible, the SARS-CoV2 positivity of the mother does not require delivery by caesarean section, does not contraindicate the management of the infant in rooming-in and allows breastfeeding. This review provides an overview on the biology of the virus, on the pathogenesis of the infection, with particular attention to pregnancy and neonatal age, on the clinical presentation of infection in newborns and young infants and summarizes the international recommendations currently available on the clinical care of neonates with SARS-CoV2 infection or at risk of catching the virus. The main objective of the review is to provide an update especially focused to the clinical management of COVID-19 infection in the perinatal and neonatal age.
Highlights
Coronaviridae is a family of enveloped, positive-strand RNA viruses that include four genera: alpha-coronavirus (α-CoV), beta-coronavirus (β-CoV), gamma-coronavirus and delta-coronavirus (δ-CoV) [1]
This review provides an overview on the pathogenesis of the SARS-CoV2 infection, with particular attention to pregnancy and neonatal age, on the clinical presentation of the infection in newborns and young infants and summarizes the international recommendations currently available on the management of neonates with SARS-CoV2 infection or at risk of catching the virus
In utero infection can be defined as confirmed only if there is (1) “evidence of maternal infection” at any time during pregnancy and (2) “fetal exposure in utero” and (3) “SARS-CoV-2 persistence or immune response in the newborn”
Summary
Coronaviridae is a family of enveloped, positive-strand RNA viruses that include four genera: alpha-coronavirus (α-CoV), beta-coronavirus (β-CoV), gamma-coronavirus (γCoV) and delta-coronavirus (δ-CoV) [1]. Other two β-coronaviruses (severe acute respiratory syndrome coronavirus— SARS-CoV—and Middle East respiratory syndrome coronavirus—MERS-CoV), that moved from animal reservoirs, have been identified as causing agents of severe respiratory outbreaks. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the seventh coronavirus that is contagious in humans. Protein S plays a key role in the pathogenesis of infection in humans since it allows to thePrvoitreuisntSo palnacyhsoar kitesyelfrotoletihnethhoespt artehcoepgetonressiasnodf einnfteryctiionntointhheuhmosatncseslilns.ceItiht aaslltowwos tmoatjhoer svuirbuusntitos,aSn1chanodr iSt2se. TThheeNd-tiesrtaml inSa1l sguableucntiint,-liwkeithdotmwaoins—truS1c-tNurTaDl )d, ohmasaainrsol(ethine rreecceeppttoorr-rbeicnodginnigtiodnoamnadinb—inRdiBnDg—toatnhde atnhgeioNte-ntesrimn-icnoanlvgeratliencgtinen-lzikyemedo2m(AaiCnE—2)Sr1e-cNeTpDto)r, hofashoastrocelellsi,nwrhecileeptthoer mreecmogbnraitnioe-nanacnhdorbeidndSi2nsgubtounthitemaendgiiaotteesntshine-fcuosniovnerotfinthgeevnizryalmaend (tAheChEo2s)t rceecllepmteomr bofrahnoest[7c]el(lFsi,gwurheil2e).the membrane-anchored S2 subunit mediates the fusioSnAoRf Sth-Ce ovVir-a2l iannfedcths ehuhomsatncseltlhmroeumgbhrbaninedsi[n7g] (bFeitgwueren2)t.he RBD-domain of protein S and human receptor ACE2, widely expressed in many human cells, such as those of the respiratory tract, gut, uterus, ovaries and placenta [8,9]. The main objective of the review is to provide an update and practical tips especially focused on COVID-19 infection in the perinatal and neonatal age
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