Classification system and case definition for SARS‐CoV‐2 infection in pregnant women, fetuses, and neonates

• Published in: Acta Obstetricia et Gynecologica Scandinavica Vol. 99; no. 5; pp. 565 - 568
• Main Authors: Shah, Prakesh S., Diambomba, Yenge, Acharya, Ganesh, Morris, Shaun K., Bitnun, Ari
• Format: Journal Article Web Resource
• Language: English
• Published: United States John Wiley & Sons, Inc 01.05.2020; John Wiley and Sons Inc
• Subjects: Asymptomatic Infections; Betacoronavirus; Clinical Laboratory Techniques; Coronavirus Infections - classification; Coronavirus Infections - diagnosis; COVID-19; COVID-19 Testing; Female; Fetus; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Medicin och hälsovetenskap; Newborn babies; Pandemics - classification; Pneumonia, Viral - classification; Pneumonia, Viral - diagnosis; Pregnancy; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Womens health
• ISSN: 0001-6349; 1600-0412; 1600-0412
• DOI: 10.1111/aogs.13870

In late gestation maternal infection, we need to consider the possibility that the newborn could have active infection and consequently at risk of adverse outcomes and also that the infant could pose a risk to healthcare workers. [...]in this paper, we focus solely on newborn infants whose mothers have documented or suspected COVID‐19 at the time of onset of labor and delivery. The role of serology in the diagnosis of SARS‐CoV‐2 infection is still uncertain and consequently it is difficult to envision how serology may contribute to newborn diagnosis – especially when maternal infection occurs late in pregnancy and there may not have been sufficient time for antibodies to be generated. [...]there is a clear understanding of appropriate diagnostic methods and interpretation of results for newborn infants, a detailed classification system is likely to be helpful. No detection of the virus by PCR in a single respiratory sample Not infected No detection of the virus by PCR in two respiratory samples taken at different time points Congenital infection with intrauterine fetal death/stillbirth Fetal tissues or autopsy material Confirmed Detection of the virus by PCR from fetal or placental tissue or electron microscopic detection of viral particle in tissue or viral growth in culture from fetal or placental tissue Possible Detection of the virus by PCR in surface swab from fetus or placental swab on fetal side Unlikely Detection of the virus by PCR in surface swab from maternal side of placenta only and no testing done or no detection of the virus by PCR from fetal or placental tissue Not infected No detection of the virus by PCR or by electron microscopy in fetal tissue(s) on autopsy Congenital infection in live born neonate Clinical features of infection in newborn and mother with SARS‐CoV‐2 infection Confirmed Detection of the virus by PCR in umbilical cord bloodb b Collected using sterile precaution and thorough cleaning of cord. or neonatal blood collected within first 12 hours of birth or amniotic fluid collected prior to rupture of membranec c Includes sample taken at cesarean section performed before rupture of membranes. No detection of the virus by PCR in nasopharyngeal swab at birth (collected after cleaning baby) BUT presence of anti‐SARS‐CoV‐2 IgM antibodies in umbilical cord blood or neonatal blood collected within first 12 hours of birth or placental tissue Unlikely No detection of the virus by PCR in nasopharyngeal swab at birth (collected after cleaning baby) or umbilical cord blood, or neonatal blood collected within first 12 hours of birth or amniotic fluid AND antibody testing not done Not infected No detection of the virus by PCR in nasopharyngeal swab at birth (collected after cleaning baby) or umbilical cord blood, or neonatal blood collected within first 12 hours of birth or amniotic fluid AND no anti‐SARS‐CoV‐2 IgM in umbilical cord blood or neonatal blood collected within first 12 hours of birth No clinical features of infection in newborn and mother with SARS‐CoV‐2 infection Confirmed Detection of the virus by PCR in cord bloodb b Collected using sterile precaution and thorough cleaning of cord. or neonatal blood collected within first 12 hours of birth Probable Detection of the virus by PCR in amniotic fluid collected prior to rupture of membrane but no detection in umbilical cord blood or neonatal blood collected within first 12 hours of birth Possible Presence of anti‐SARS‐CoV‐2 IgM in umbilical cord blood or detection of the virus by PCR in placental tissue but no detection of the virus by PCR in umbilical cord blood or neonatal blood collected within first 12 hours of birth or amniotic fluid Unlikely No detection of the virus by PCR in cord blood or neonatal blood collected within first 12 hours of birth or amniotic fluid collected prior to rupture of membranec c Includes sample taken at cesarean section performed before rupture of membranes.