In Utero Vertical Transmission of Coronavirus Disease 2019 in a Severely Ill 29-week Preterm Infant.

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) or coronavirus disease 2019 (COVID-19) is currently in worldwide pandemic state with very limited data about the mode of transmission to the growing fetus. There are a few published cases of COVID-19 infection in the infants born to COVID-19 positive mothers where most of the reported cases were either mildly symptomatic with positive COVID-19 polymerase chain reaction (PCR) or had negative COVID-19 PCR raising the question of vertical transmission. We present a case of likely intrauterine transmission of COVID-19 infection in a critically ill premature infant born to a COVID-19 infected mother and describing her clinical course thus far. The clinical presentation in the infant is consistent with COVID-19 infection described so far in literature along with positive PCR, and positive COVID-19 serology: immunoglobulin G, immunoglobulin M, and immunoglobulin A.

Serum surfactant protein D as a marker for bronchopulmonary dysplasia.

BACKGROUND: Lung epithelial cells express surfactant protein D (SP-D), a calcium-dependent lectin that plays an important role in antibody-independent pulmonary host defense. Previous studies have shown that it is found in the peripheral circulation in patients with pulmonary disease, likely because of translocation into the blood when lung epithelial barriers are disrupted by inflammation or acute injury. In adults, serum SP-D levels are biomarkers for the progression and severity of chronic lung disease. In neonates, elevated SP-D levels in cord blood and on day 1 have been associated with prenatal risk factors and with an increased risk of respiratory distress syndrome and infections. It is not known whether serum SP-D during the first week of life is a marker for bronchopulmonary dysplasia (BPD), a form of chronic lung disease of prematurity that is associated with lung parenchymal maldevelopment and injury. OBJECTIVE: The goal of this study is to determine whether serum SP-D on days 3 and 7 of life are associated with the development of BPD in preterm infants. DESIGN/METHODS: Serum samples were obtained on postnatal days 3 and 7 from 106 preterm infants (500-2000 g birth weight, 23-32-week gestation). SP-D was quantified by Western blot. BPD was determined at 36 weeks PMA using NICHD criteria. RESULTS: The mean birth weight was 1145 ± 347 g and gestational age 29.2 ± 7.4 weeks. BPD was diagnosed in 7 and "BPD or death" in 16 infants. Days 3 and 7 values tracked significantly (r = 0.648), and did not correlate with birth weight or gestational age. Contrary to expectations, serum SP-D was not associated with BPD. Significant gender differences were noted, with SP-D dropping from day 3 to day 7 in males, while increasing in females (p < .05). CONCLUSION: Elevated serum SP-D does not appear to be a useful marker for BPD. Decreasing serum SP-D levels in males, as compared to females, during the first week of life are likely related to gender differences in lung maturation, consistent with the higher incidence of BPD in males.

Bile-stained amniotic fluid: a case report.

BACKGROUND: Green-stained amniotic fluid does not always indicate that meconium was passed in utero. CASE PRESENTATION: We report the case of a 2280-g Hispanic preterm female born at 32 weeks of gestation with congenital jejunal atresia. The amniotic fluid was greenish stained; the initial impression was meconium-stained amniotic fluid. Postnatal findings revealed no meconium in her rectum. The content of her first stool appeared sticky and white. CONCLUSION: In the absence of meconium in the rectum, the pediatrician should consider the possibility that the greenish amniotic fluid is not meconium stained, but rather stained with bile due to the fetus vomiting in utero secondary to intestinal obstruction.