Maternal SARS-CoV-2, Placental Changes and Brain Injury in 2 Neonates.
Maternal SARS-CoV-2, Placental Changes and Brain Injury in 2 Neonates.
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DOI：
10.1542/peds.2022-058271
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发表时间：
2023-05-01
期刊：
影响因子：
8
通讯作者：
Duara, Shahnaz
中科院分区：
文献类型：
--
作者：
Benny, Merline;Bandstra, Emmalee S.;Saad, Ali G.;Lopez-Alberola, Roberto;Saigal, Gaurav;Paidas, Michael J.;Jayakumar, Arumugam R.;Duara, Shahnaz
长期神经发育后遗症是宫内暴露于严重急性呼吸综合征冠状病毒病2（SARS-CoV-2）的新生儿的一个潜在问题。我们报告了2例SARS-CoV-2阳性母亲所生的新生儿，他们表现出早发性（第1天）癫痫发作、获得性小头畸形和随时间推移的显著发育迟缓。序列MRI显示严重的脑实质萎缩和囊性脑软化。出生时，两个婴儿都不是SARS-CoV-2阳性（鼻咽拭子，逆转录聚合酶链反应），但都有可检测到的SARS-CoV-2抗体和增加的血液炎症标志物。来自两个母亲的胎盘显示SARS-CoV-2-核衣壳蛋白和合体滋养层中的刺突糖蛋白1，胎儿血管灌注不良，以及显著增加的炎症和氧化应激标志物pyrin结构域包含1蛋白，巨噬细胞炎症蛋白1 βη，基质细胞衍生因子1，白细胞介素13和白细胞介素10，而人绒毛膜促性腺激素显著降低。1名婴儿（病例1）在13个月大时发生意外猝死。死亡婴儿的大脑通过免疫荧光显示出SARS-CoV-2的证据，核衣壳蛋白和刺突糖蛋白在细胞核周围以及细胞质内共定位。临床发现，胎盘病理学和免疫组化变化的星座强烈表明，妊娠中期母体SARS-CoV-2感染胎盘炎引发了炎症反应和氧化应激损伤的胎儿胎盘单位，影响胎儿的大脑。死亡婴儿大脑中SARS-CoV-2的证明也提出了SARS-CoV-2感染胎儿大脑直接导致持续脑损伤的可能性。在这两个婴儿中，出生时的神经学结果模仿新生儿缺氧缺血性脑病的表现，神经学后遗症的进展远远超过新生儿期。
Long-term neurodevelopmental sequelae are a potential concern in neonates following in utero exposure to severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2). We report 2 neonates born to SARS-CoV-2 positive mothers, who displayed early-onset (day 1) seizures, acquired microcephaly, and significant developmental delay over time. Sequential MRI showed severe parenchymal atrophy and cystic encephalomalacia. At birth, neither infant was SARS-CoV-2 positive (nasopharyngeal swab, reverse transcription polymerase chain reaction), but both had detectable SARS-CoV-2 antibodies and increased blood inflammatory markers. Placentas from both mothers showed SARS-CoV-2-nucleocapsid protein and spike glycoprotein 1 in the syncytiotrophoblast, fetal vascular malperfusion, and significantly increased inflammatory and oxidative stress markers pyrin domain containing 1 protein, macrophage inflammatory protein 1 βη, stromal cell-derived factor 1, interleukin 13, and interleukin 10, whereas human chorionic gonadotropin was markedly decreased. One infant (case 1) experienced sudden unexpected infant death at 13 months of age. The deceased infant’s brain showed evidence of SARS-CoV-2 by immunofluorescence, with colocalization of the nucleocapsid protein and spike glycoprotein around the nucleus as well as within the cytoplasm. The constellation of clinical findings, placental pathology, and immunohistochemical changes strongly suggests that second-trimester maternal SARS-CoV-2 infection with placentitis triggered an inflammatory response and oxidative stress injury to the fetoplacental unit that affected the fetal brain. The demonstration of SARS-CoV-2 in the deceased infant’s brain also raises the possibility that SARS-CoV-2 infection of the fetal brain directly contributed to ongoing brain injury. In both infants, the neurologic findings at birth mimicked the presentation of hypoxic-ischemic encephalopathy of newborn and neurologic sequelae progressed well beyond the neonatal period.
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影响因子：
2.6
作者：
Movsas TZ;Weiner RL;Greenberg MB;Holtzman DM;Galindo R
通讯作者：
Galindo R
影响因子：
13.6
作者：
Shook LL;Sullivan EL;Lo JO;Perlis RH;Edlow AG
通讯作者：
Edlow AG
影响因子：
4.6
作者：
Baker BC;Heazell AEP;Sibley C;Wright R;Bischof H;Beards F;Guevara T;Girard S;Jones RL
通讯作者：
Jones RL
影响因子：
5.5
作者：
Meihe L;Shan G;Minchao K;Xiaoling W;Peng A;Xili W;Jin Z;Huimin D
通讯作者：
Huimin D
DOI：
10.1016/s2214-109x(21)00079-6
发表时间：
2021-06
期刊：
The Lancet. Global health
影响因子：
--
作者：
Chmielewska B;Barratt I;Townsend R;Kalafat E;van der Meulen J;Gurol-Urganci I;O'Brien P;Morris E;Draycott T;Thangaratinam S;Le Doare K;Ladhani S;von Dadelszen P;Magee L;Khalil A
通讯作者：
Khalil A