RESUMEN
OBJECTIVE: COVID-19 infection may produce severe pneumonia, mainly in the adult population. Pregnant women with severe pneumonia are at high risk of developing complications, and conventional therapy sometimes fails to reverse hypoxemia. Therefore, extracorporeal membrane oxygenation (ECMO) is an option in cases with refractory hypoxemic respiratory failure. This study aims to evaluate the maternal-fetal risk factors, clinical characteristics, complications, and outcomes of 11 pregnant or peripartum patients with COVID-19 treated with ECMO. STUDY DESIGN: This is a retrospective descriptive study of 11 pregnant women undergoing ECMO therapy during the COVID-19 pandemic. RESULTS: In our cohort, four patients underwent ECMO during pregnancy (36.3%) and 7 during the postpartum period. Initially, they started on venovenous ECMO, and three patients were required to change modality due to clinical conditions. In total, 4/11 pregnant women (36.3%) died. We established two periods that differed in the implementation of a standardized care model for reducing associated morbidities and mortality. Neurological complications were responsible for most deaths. Regarding fetal outcomes at early-stage pregnancies on ECMO (4), we report three stillbirths (75%), and one newborn (twin pregnancy) survived and had a favorable evolution. CONCLUSION: At later-stage pregnancies, all newborns survived, and we did not identify any vertical infection. ECMO therapy is an alternative for pregnant women with severe hypoxemic respiratory failure due to COVID-19, and may improve maternal and neonatal results. Regarding fetal outcomes, the gestational age played a definitive role. However, the main complications reported in our series and others are neurological. It is essential to develop novel, future interventions to prevent these complications.
RESUMEN
Resumen Las medidas antropométricas se han usado para evaluar el crecimiento fetal y neonatal, además de determinar factores de riesgo de forma temprana. Clásicamente se han tomado el peso, talla, perímetro cefálico, torácico y abdominal. Son usadas para establecer condiciones como peso bajo o elevado para la edad gestacional, y con base en esto poder definir riesgos tempranos y tardíos. Otra medida sumamente importante es el perímetro cefálico, misma que determina neonatos con potencial riesgo neurológico. Estas tres medidas son clave como parte de la evaluación inicial neonatal, además de que se incluyen en el seguimiento del crecimiento y desarrollo infantil. No obstante, otras mediciones rutinarias como el perímetro torácico y abdominal, en neonatos con adaptación espontánea y exploración física normal (neonatos sanos), puede que aporten poco acerca del estado de salud neonatal. Estas últimas medidas no forman parte de los parámetros de seguimiento del crecimiento infantil, ni cuentan con gráficas de percentiles extrapolables para género y edad gestacional. Todas estas medidas están condicionadas por múltiples factores como genética, raza y nutrición, entre otros. Es momento de analizar las medidas rutinarias al momento del nacimiento de neonatos sanos, y priorizar las extrapolables a implicaciones clínicas relevantes.
Abstract Anthropometric measurements are used to assess fetal and neonatal growth and determine early risk factors. Classically, weight, height, head circumference, thoracic and abdominal circumference are the usual measures. They are used to identify conditions such as low or high weight for gestational age and, based on this, to determine early and late risks. Another important measurement is head circumference, which determines neonates with potential neurological risk. These three measures are key as part of the initial neonatal evaluation, and they are also a part of the child's growth monitoring and development. However, other routine measurements such as chest and abdominal circumferences, in newborns with spontaneous adaptation and normal physical examination (healthy neonates) may provide little information about the neonatal health status. These last measurements are not part of the child growth monitoring parameters, nor do they have percentile graphs that can be extrapolated to gender and gestational age. All these measures are conditioned by multiple factors such as genetics, race, and nutrition, among others. It is time to analyze routine measures at the time of birth of healthy newborns and prioritize those that can be extrapolated to relevant clinical implications.
