Confirming Vertical Fetal Infection With Coronavirus Disease 2019
Confirming Vertical Fetal Infection With Coronavirus Disease 2019
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DOI：
10.5858/arpa.2020-0442-sa
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发表时间：
2020-12-01
影响因子：
4.6
通讯作者：
Patane, Luisa
中科院分区：
文献类型：
--
作者：
Schwartz, David A.;Morotti, Denise;Patane, Luisa
据报道，世界各地越来越多的孕妇患有2019年冠状病毒病。感染了严重急性呼吸综合征冠状病毒2型的孕妇所生的大多数新生儿对该病毒呈阴性，但少数新生儿的感染检测呈阳性。重要的是要确定2019年冠状病毒病是否发生垂直传播及其发展机制。根据一些临床和实验室发现，已经表明可能发生经胎盘传播，但需要一种方法来证实这一点。本文分析和评价了作为垂直传播，特别是宫内传播潜在指标的协变量，包括新生儿疾病发作时间、新生儿病毒检测阳性、新生儿免疫球蛋白（IG）G和IgM抗体检测以及胎盘组织完整标本拭子的病毒分析。这些方法都不能提供感染发生在分娩前或发生经胎盘传播的确证性证据。该评论提出，早发型新生儿冠状病毒病2019感染的诊断应限于出生后最初72小时内严重急性呼吸综合征冠状病毒2型逆转录聚合酶链反应检测阳性的新生儿。它还提出，在感染的母婴对中发生宫内经胎盘严重急性呼吸综合征冠状病毒2是基于使用免疫组织化学或核酸方法（如原位杂交）在绒毛细胞中鉴定严重急性呼吸综合征冠状病毒2。使用这些方法评估2019年冠状病毒病新生儿的胎盘将有助于确定冠状病毒经胎盘传播的潜在作用和流行率。
Increasing numbers of pregnant women with coronavirus disease 2019 are being reported around the world. The majority of neonates delivered to pregnant women infected with severe acute respiratory syndrome coronavirus 2 have been negative for the virus, but a small number have tested positive for infection. It is important to determine whether vertical transmission of coronavirus disease 2019 occurs and the mechanisms for its development. Based on a number of clinical and laboratory findings, it has been suggested that transplacental transmission may be occurring, but a method to confirm this is necessary. This communication analyzes and evaluates the covariables that have been discussed as potential indicators of vertical and, specifically, intrauterine transmission, including the timing of onset of neonatal illness, neonatal viral test positivity, neonatal antibody testing for immunoglobulin (Ig) G and IgM, and viral analysis of swabs of whole specimens of placental tissue. None of these methods can provide confirmatory evidence that infection developed prior to labor and delivery, or that transplacental transmission occurred. This commentary proposes that diagnosis of early-onset neonatal coronavirus disease 2019 infection should be limited to neonates with positive reverse transcription polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 within the initial 72 hours of life. It also proposes that the occurrence of intrauterine transplacental severe acute respiratory syndrome coronavirus 2 among infected mother-infant dyads be based upon identification of severe acute respiratory syndrome coronavirus 2 in chorionic villus cells using immunohistochemistry or nucleic acid methods such as in situ hybridization. Evaluating placentas from neonates with coronavirus disease 2019 using these methods will be instrumental in determining the potential role and prevalence of transplacental transmission of the coronavirus.