AnalesdePediatría95(2021)364---381 6.Trastoy-QuintelaJ,Moure-GonzálezJD,González-FernándezL,
Rey-NoriegaC,Rodríguez-Nú˜nezA.Formaciónmultinivel(aten- ción primaria-hospital) mediante simulación con conexión en tiemporeal entiemposde COVID-19.Unaherramientaa con- siderar.AnPediatr.2021;94:259---60.
7.Ikeyama T, Shimizu N, Ohta K. Low-cost and ready-to-go remote-facilitated simulation-based learning. Simul Healthc.
2012;7:35---9.
LauraButrague˜noLaisecaa,b,∗,AnnaZaninc,
JesúsLópez-HerceCida,b,d,SantiagoMencíaBartoloméa,b,d
aServiciodeCuidadosIntensivosPediátricos,Hospital GeneralUniversitarioGregorioMara˜nóndeMadrid, InstitutodeInvestigaciónsanitariadelHospitalGregorio Mara˜nón,Madrid,Spain
bReddeSaludMaternoinfantilydelDesarrollo
(RedSAMID),RETICSfinanciadaporelPNI+D+I2008-2011, ISCIII-EvaluaciónyFomentodelaInvestigaciónyelFondo EuropeodeDesarrolloRegional(FEDER),Madrid,Spain
cDivisionofPediatrics,DepartmentofWomen’sand Children’sHealth-UniversityofPadua,Padua,Italy
dDepartamentodeSaludPúblicayMaternoinfantil, FacultaddeMedicina,UniversidadComplutensede Madrid,Madrid,Spain
∗Correspondingauthor.
E-mailaddresses:laura [email protected], [email protected] (L.Butrague˜noLaiseca).
https://doi.org/10.1016/j.anpede.2021.06.007
2341-2879/©2021Asociaci´onEspa˜noladePediatr´ıa.Publishedby ElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCC BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc- nd/4.0/).
SARS-CoV-2 and prematurity. Any evidence of vertical transmission? 夽
SARS-CoV-2 y prematuridad. ¿Existe evidencia de transmisión vertical?
DearEditor,
Infection by the novel coronavirus (SARS-CoV-2) initially detectedin2019inWuhan,China,isthecausativeagentof thecoronavirusdisease2019(COVID-19),currentlyrespon- sibleofaglobalpandemicwithsignificantrepercussionsin Spain.
VerticaltransmissionofSARS-CoV-2remainsunknownto date.DifferentauthorshavesuggestedthatSARS-CoV-2may betransmittedinutero,butitisnotclearwhethertransmis- sionoccursbycrossingtheplacenta,throughthebirthcanal orduringtheimmediatepostpartumperiod.1Isolatedcase reports,caseseries2,3andguidelinesdevelopedbyexperts of differentscientific associations4,5have been published, withsignificant heterogeneity in the definitionof vertical transmission, types of samples used for investigation and clinicalmanifestationsdocumentedinnewborninfants.
We present the case of a preterm neonate born to a mother positive for COVID-19 that came to the emer- gency department aftergoing into labour at 29+6 weeks of gestation. 9 days before delivery she had a positive resultforSARS-CoV-2antigentestinrespiratoryswab,per- formed on account of close contact with a positive case (householdpartner).Polymerasechain reaction(PCR)test from nasopharyngeal swab before delivery was positive.
The mother wasasymptomatic. She had a normal course of pregnancyand attendedprenatalcare visits, withnor- malultrasoundandlaboratoryoutcomes.Drugsfortocolysis
夽 Pleasecitethisarticleas:MárquezIsidroEM,GarcíaGarcíaMJ, SolodeZaldívarTristanchoM,RomeroPegueroR.SARS-CoV-2ypre- maturidad.¿Existe evidencia de transmisiónvertical? AnPediatr (Barc).2021;95:375---377.
andfetallungmaturationwereadministered,butitwasnot possibletostoppretermlabour.
Amaleboywasbornbyvaginaldeliveryat29+6weeks, (1455gbirthweight)Intrapartumamniorrhexis.Apgarscore 6/8.Thepretermneonaterequiredintubationatbirthdue toineffectivebreathing,conventionalmechanical ventila- tionandsurfactantadministrationinthefirsthouroflife.
Chest radiographrevealed a bilateral reticularinterstitial patternsuggestingneonatalrespiratorydistresssyndrome.
The neonatewas admittedto theNICU intoan individual roomundercontactanddroplet isolationmeasures inthe incubator, according to current recommendations.4,5 Res- piratorysecretionsamplesobtained atbirth andonday3 were tested positive for SARS-CoV-2 using PCR, with low cycle threshold (Ct) values (Table 1). Blood test results werenormal,withoutlymphopeniaorincreasedinflamma- torymarkers(Table2).Thepatientwasextubatedonday2 andexhibitedimprovement,withnosymptomsotherthan apnoeaof prematurity. Polymerasechain reactiontestsin nasopharyngeal samples at 7, 12 and 15 days remained positive. Extended analytical study at 7th day revealed no evidence of increased systemic inflammatory markers (Table2)exceptford-dimerlevels(4788.00ng/mL).At10 days,PCRbloodtestwasnegativewithnodetectableviral loadin bloodevenviral sheddingin urineand faeceswas present.Resultsof antibodytestsintheneonate(IgMand IgG)werepersistentlynegative.ThefirstnegativePCRresult fromnasopharyngealsample at21daysalloweddiscontin- uation of isolation measures. There was no evidence of seroconversionat4weekspostbirth(Table1).
Duringdelivery,themotherworeaFFP2mask.Skin-to- skincontactanddelayedcordclampingwereavoided.The neonatewasfedwithdonorhumanmilkinitially,followedby artificialformula.Motherandchildremainedseparateduntil themother’squarantinecouldbelifted(positiveIgGtest), andthefirstmother-childvisittookplace5daysafterbirth.
However,testswerenotperformedfordetectionofthevirus intheplacenta,umbilicalcordbloodoramnioticfluid,sono definitiveresultscouldverifyverticaltransmissionofSARS- CoV-2.
375
SCIENTIFICLETTER Table1 SARS-CoV-2testresults.
2h 1day 3days 7days 10days 12days 15days 21days 33days
PCRinnasopharyngeal secretion(CtforgenS)
Positive(Ct:35) Positive(Ct:20) Positive(Ct:17) Positive(Ct:27) Positive(Ct:27) Negative PCRinbronchoalveolar
lavage(CtforgenS)
Positive(Ct:36)
Antibodytesting IgM--- IgM--- IgM--- IgM---
IgG--- IgG--- IgG--- IgG---
PCRinblood Negative
PCRinurine Positive
PCRinfaeces Positive
Ct,cyclethreshold;PCR,polymerasechainreaction.
Table2 Laboratoryvariables.
2h 1day 7days 15days 33days
Leucocytes(cells/mm3) 5830 6710 11820 14180 6970
Lymphocytes(cells/mm3;%) 1780(30.5%) 1590(23.7%) 3590(30.4%) 5980(42.2%) 4010(57.5%)
Neutrophils(cells/mm3;%) 5170(54.4%) 4250(63.4%) 5140(43.5%) 4780(33.7%) 1390(19.9%)
Platelets(cells/mm3) 147000 209000 202000 516000 384000
Prothrombintime(s) 22 15 12
Activatedpartialthromboplastintime(s) 79 48 36
Fibrinogen(g/dL) 2 2 4
d-dimer(ng/mL) 4788
CPR(mg/dL) 0.02 0.14 0.04
PCT(ng/mL) 0.27
AST(IU/L) 65 56 27 22 22
ALT(IU/L) <5 <5 6 11 11
LDH(IU/L) 642 561 330 291
Ferritin(ng/mL) 437
TroponinT(ng/L) 72.2
NT-proBNP(pg/mL) 915
ALT,alanineaminotransferase;AST,aspartateaminotransferase;CPR,C-reactiveprotein;LDH,lactatedehydrogenase;NT-proBNP,N-terminalpro-hormonebrainnatriureticpeptide;PCT, procalcitonin.
376
AnalesdePediatría95(2021)364---381 In this article, we present the case of a neonateborn
before term toa motherwith COVID-19 whose symptoms weremostlikelyduetoprematurity.Thepersistenceofpos- itive PCRresults withlow Ct valuesinthe infantand the earlytimingofthefirstpositiveresultsuggestearlyinfec- tion.Althoughitispossiblethattheinfantwasinfectedin utero,thiscaseis notsufficienttoprovethepossibilityof verticaltransmission.
The vertical transmission of SARS-CoV-2 is not well known.Althoughtherehavebeenreportsofdetectionofthe virus inthe placenta,amniotic fluid,umbilicalcordblood andhumanmilk,6mostoftheSARS-CoV-2testsconducted inneonatesborntoinfectedmothersarenegative,3sodata isinconclusivetoproveverticalinfection.
Itisreasonabletoconcludethatverticaltransmissionof SARS-CoV-2ininfantsborntomothersthatarepositivefor thevirusispossibleandrequiresfurtherresearch.Contact anddropletisolationmeasuresshouldbeimplementedand maintainedthroughthehospitalstayuntilthePCRtestsin respiratorysecretionsamplesbecomenegative,asserocon- versionisrareinneonates,especiallythosebornpreterm.
References
1.BlumbergDA,UnderwoodMA,HedrianaHL,LakshminrusimhaS.
VerticaltransmissionofSARS-CoV-2:whatistheoptimaldefini- tion?AmJPerinatol.2020;37:769---72.
2.KotlyarAM,GrechukhinaO,ChenA,PopkhadzeS,GrimshawA, TalO,etal.Verticaltransmissionofcoronavirus disease2019:
asystematic reviewandmeta-analysis.Am JObstetGynecol.
2021;224:35---53.
3.Solís-García G, Gutiérrez-Vélez A, Pescador Chamorro I, Zamora-FloresE,Vigil-Vázquez S,Rodríguez-CorralesE,et al.
Epidemiology,managementandriskofSARS-CoV-2transmission inacohortofnewbornsborntomothersdiagnosedwithCOVID-19 infection.AnPediatr(EnglEd).2021;94(3):173---8.
4.CalvoC,López-HortelanoMG,VicenteJCC,MartínezJLV.Grupo detrabajodelaAsociaciónEspa˜noladePediatríaparaelbrote deinfecciónporCoronavirus,colaboradoresconelMinisteriode Sanidad;MiembrosdelGrupodeExpertosdelaAEP.[Recommen- dationsontheclinicalmanagementoftheCOVID-19infectionby the«newcoronavirus»SARS-CoV2.SpanishPaediatricAssociation workinggroup].AnPediatr(Barc).2020;92:241.
5.SociedadEspa˜nola deNeonatología. Recomendacionesparael manejodelreciénnacidoenrelaciónconlainfecciónporSARS- CoV-2Versión6.2,2020.[Accessed14February2021].Available from:https://www.seneo.es/.
6.FeniziaC,BiasinM,CetinI,VerganiP,MiletoD,SpinilloA,etal.
Analysis ofSARS-CoV-2 verticaltransmissionduringpregnancy.
NatCommun.2020;11:5128.
ElenaMaríaMárquezIsidro∗,MaríaJesúsGarcíaGarcía, MaríaSolodeZaldívarTristancho,RafaelRomeroPeguero ServiciodePediatría,HospitalSanPedrodeAlcántara, Cáceres,Spain
∗Correspondingauthor.
E-mail address: [email protected] (E.M.MárquezIsidro).
https://doi.org/10.1016/j.anpede.2021.05.005
2341-2879/©2021Asociaci´onEspa˜noladePediatr´ıa.Publishedby ElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCC BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc- nd/4.0/).
E-mail consultation assessment during COVID-19 pandemic 夽
Balance de la consulta por correo electrónico en la pandemia COVID-19
DearEditor:
TheCOVID-19hasbroughtaboutarevolutioninthedoctor- patientrelationship worldwide.The diagnosis, treatment, controlandpreventionofthisinfectiousdiseasehasbecome the top priority for health care workers and the general population.
InadherencewiththeprotocolsestablishedbytheMin- istry of Health of Spain,1 health care delivery should be preferentiallyremotetopreventpotentialtransmissionof thevirusinhealthcaresettings.Thishasledtosignificant changesinworkpracticesforhealthcareprofessionals,and morelimitedaccessofpatientstohealthservices.In-person visitshavebeenpartlyreplacedbytelemedicine.
夽 Please citethisarticleas:Pe˜na BlascoG, BartoloméLalanza ML, Blasco Pérez-Aramendía MJ. Balance de la consulta por correoelectrónico enla pandemia COVID-19. AnPediatr (Barc).
2021;95:377---378.
Duringthepandemic,childrenwereconfinedtothehome betweenMarch15andApril26, 2020.In-personvisitshad tobeagreedonbytheproviderandthepatient,whohave todecide whether care should be delivered in person or remotely.
MostpatientswithCOVID-19canbemanagedremotely,2 butalargepartofotherhealthproblemsrequirein-person assessment.
Theextensiveuseofthetelephoneasavehicleforcom- municatingwithpatientshasmadeithardertogainaccess toproviders.Duetothepreferentialdeliveryofcarethrough thetelephone1,3andcontacttracingandtrackingofCOVID casesfromprimarycare centres,thephonelines aresat- urated.BasedontheprotocolsimposedbytheMinistryof Health,1COVID-19patientsandtheircontactsmustbequar- antined for a minimum of 10 days and monitored by the correspondingdoctoreveryday.
Inhealthcarefacilitieswhereemailhasbeenusedregu- larlyforyears,accesstoprovidersismoreagileandhealth careusersarefamiliarisedwithit.
Inourprimarycare centre,2paediatriciansand2pae- diatric nurses manage a caseload of 2400 children. The paediatric team uses a dedicated organizational email account.Weofferemailaccesstotheentirecatchmentpop- ulation.After 5 years,we have succeeded in establishing constant and sustained use of this means of communica- tion.The second year after introducing email access,we
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