Neurodevelopmental delay in children exposed to maternal SARS-CoV-2 in-utero.

It is unclear if SARS CoV-2 infection during pregnancy is associated with adverse neurodevelopmental repercussions to infants. We assessed pediatric neurodevelopmental outcomes in children born to mothers with laboratory-confirmed SARS CoV-2 infection during pregnancy. Neurodevelopmental outcomes of in-utero exposed children were compared to that of pre-pandemic control children in Los Angeles (LA), CA, USA and Rio de Janeiro, Brazil. Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), the gold standard tool for evaluating neurodevelopment until 36 months of age and Ages and Stages Questionnaires (ASQ-3), a frequently used screening instrument for evaluating neurodevelopment in this same age group were the assessment tools used. Developmental delay (DD) was defined as having a score < - 2 SD below the norm (< 70) in at least one of three Bayley-III domains, (cognitive, motor or language) or a score below the cut-off (dark zone) in at least one of five ASQ-3 domains (communication, gross motor, fine motor, problem solving, personal-social). Exposed children were born between April 2020 and December 2022 while control children were born between January 2016 to December 2019. Neurodevelopmental testing was performed in 300 children total: 172 COVID-19 exposed children between 5-30 months of age and 128 control children between 6-38 months of age. Bayley-III results demonstrated that 12 of 128 exposed children (9.4%) had DD versus 2 of 128 controls (1.6%), p = 0.0007. Eight of 44 additional exposed children had DD on ASQ-3 testing. Fully, 20 of 172 exposed children (11.6%) and 2 of 128 control children (1.6%), p = 0.0006 had DD. In Rio, 12% of exposed children versus 2.6% of controls, p = 0.02 had DD. In LA, 5.7% of exposed children versus 0 controls, p = 0.12 had DD. Severe/critical maternal COVID-19 predicted below average neurodevelopment in the exposed cohort (OR 2.6, 95% CI 1.1-6.4). Children exposed to antenatal COVID-19 have a tenfold higher frequency of DD as compared to controls and should be offered neurodevelopmental follow-up.

Respiratory distress in SARS-CoV-2 exposed uninfected neonates followed in the COVID Outcomes in Mother-Infant Pairs (COMP) Study.

Respiratory distress (RD) has been reported in SARS-CoV-2 exposed uninfected (SEU) term neonates. Prior studies suggest that prenatal exposure to Coronavirus Disease 19 (COVID-19) may activate an inflammatory cascade in the newborn airway. In this study, we examine the relationship between maternal COVID-19 vaccination and neonatal RD using a longitudinal cohort of mother-infant pairs in Los Angeles, CA. Two-hundred and twenty-one mothers with laboratory confirmed SARS-CoV-2 during pregnancy and 227 exposed fetuses are enrolled in our study. Maternal disease severity and neonatal RD variables were defined based on current accepted clinical criteria. To explore the multifactorial associations between maternal COVID-19 parameters and infant RD, we utilize a multivariable logistic regression model and a proteomic sub-analysis to propose a pathway for the development of RD following in utero exposure to SARS-CoV-2. Unusually high rates of RD are observed in SEU infants (17%). The odds ratio of RD is 3.06 (95% CI:1.08-10.21) in term neonates born to unvaccinated individuals versus those born to individuals vaccinated prior to maternal infection. Proteomic analysis reveals a robust inflammatory response associated with ciliary dysregulation and enhanced IgE production among SEU neonates with RD. Maternal vaccination against COVID-19 reduces the frequency of neonatal RD.

Outbreak of rotavirus gastroenteritis with high mortality, Nicaragua, 2005 / Brote de gastroenteritis por rotavirus con alta mortalidad, Nicaragua, 2005

OBJECTIVES: We investigated a nationwide outbreak of severe rotavirus gastroenteritis in Nicaragua in children under 5 years old, leading to many consultations, hospitalizations, and deaths. We questioned whether a vaccine might have prevented these illnesses and deaths, sought to identify risk factors for death, and developed a clinical profile of children hospitalized with diarrhea. METHODS: We conducted a case-control study to determine whether children who died had access to routine immunizations, a proxy predicting access to a rotavirus vaccine. We identified risk factors for death among children who died in the outbreak compared with surviving age-matched controls with diarrhea. We collected stools, clinical data, and immunization data on children hospitalized for diarrhea to test for rotavirus, develop the profile, and forecast future access to a rotavirus vaccine. RESULTS: The outbreak from February to April 2005 caused 47 470 consultations and 52 deaths. Approximately 80 percent of cases and controls and 60 percent of children hospitalized with diarrhea had access to routine immunizations and would likely have had access to a rotavirus vaccine. With a vaccine efficacy of 85 percent, up to 51 percent of severe rotavirus cases and up to 68 percent of deaths could have been prevented if a rotavirus vaccine were available as part of routine child-hood immunizations. Study of 35 case-control pairs indicated that severe illnesses, malnutrition, and care by traditional healers were risk factors for death. Rotavirus was found in 42 percent of samples from hospitalized children and was associated with severe disease and dehydration. CONCLUSIONS: The impact of the seasonal outbreaks of rotavirus disease could be diminished with a rotavirus vaccine, improvements in oral rehydration programs, and training of traditional healers in the proper management of children with acute diarrhea.

OBJETIVOS: Se investigó un brote nacional de gastroenteritis grave por rotavirus en niños menores de 5 años de edad que provocó numerosas consultas, hospitalizaciones y muertes en Nicaragua. Se analizó si la vacunación habría evitado estos casos de enfermedad y fallecimiento, se buscaron factores de riesgo de muerte y se elaboró un perfil clínico de los niños hospitalizados con diarrea. MÉTODOS: Se realizó un estudio de casos y controles para determinar si los niños que murieron tuvieron acceso a programas de vacunación, como medida indirecta del acceso a la vacuna contra rotavirus. Se identificaron los factores de riesgo de muerte en los niños que fallecieron durante el brote en comparación con los controles con diarrea sobrevivientes, emparejados según la edad. Se tomaron muestras de heces fecales, datos clínicos y de vacunación de los niños hospitalizados con diarrea para realizar el diagnóstico de rotavirus, elaborar el perfil clínico y pronosticar el acceso futuro a una vacuna contra rotavirus. RESULTADOS: El brote ocurrido entre febrero y abril de 2005 ocasionó 47 470 consultas y 52 muertes. Aproximadamente 80 por ciento de los casos y controles y 60 por ciento de los niños hospitalizados con diarrea tuvieron acceso a la vacunación programada y posiblemente tuvieron acceso a una vacuna contra rotavirus. Si en los programas de vacunación se hubiera dispuesto de una vacuna de 85 por ciento de eficacia, se hubieran prevenido hasta 51 por ciento de los casos graves de rotavirus y hasta 68 por ciento de las muertes. El estudio de 35 pares de casos y controles demostró que la enfermedad grave, la desnutrición y la atención por curanderos tradicionales fueron los factores de riesgo de muerte. Se encontró rotavirus en 42 por ciento de las muestras de niños hospitalizados, asociado con la enfermedad grave y la deshidratación. CONCLUSIONES: El efecto de los brotes estacionales de la enfermedad por rotavirus podría reducirse mediante la vacunación...