Case study shows how COVID-19 ruptured the placenta and damaged the baby’s brain

Researchers from the UHealth-;University of Miami Health System and the University of Miami Miller School of Medicine have shown that in two cases, a COVID-19 infection ruptured the placenta and damaged the newborn’s brain.

While admitted to the neonatal intensive care unit (NICU) at Holtz Children’s Hospital at the University of Miami/Jackson Memorial Medical Center, a teaching hospital affiliated with UHealth and the Miller School, two infants were tested for the virus at birth. Although negative, a rise in detectable SARS-CoV-2 antibodies in the blood indicates that either the antibodies crossed the placenta or viral crossing occurred and the immune response was that of the baby.

Both infants experienced seizures, small head size, and developmental delay, and one infant died at 13 months of age. A study titled “SARS-CoV-2 in mothers, placental changes and brain damage in two newborns,” was published in the journal April 6. PediatricsThis is the first study to confirm cross-placental SARS-Cov-2 infection leading to brain damage in newborns.

While many women are affected by COVID-19 during pregnancy, it is clearly unusual for an infant to have such problems at birth. This she is trying to understand what are the differences between the two pregnancies so she can advance her research towards protecting vulnerable babies. ”

Shahnaz Duara, MD, professor of pediatrics at the University of Miami Miller College of Medicine, medical director of the NICU at Holtz Children’s Hospital, and senior author of the study

Early in the COVID-19 pandemic, this group of neonatologists observed transient lung disease and sometimes blood pressure problems in newborns born to Covid-19-positive mothers who were also negative at birth. was doing. This suggested an infection, but it remained unclear whether the problem was caused by inflammatory placental cytokines or whether the SARS-CV-2 virus crossed the placenta and harmed the baby.

“If you saw a baby presenting like this, you would call it hypoxic-ischemic encephalopathy (brain damage caused by reduced blood flow).” responsible person. “But it wasn’t the lack of blood flow to the placenta that caused this. As far as we could tell, it was a viral infection.” A sentinel event is required in the mother during delivery before any neurological damage can be detected.

Ali G. Saad, MD, Miller School professor, neuropathologist, and director of pediatric and perinatal pathology services at Holtz Children’s, examined both placentas and found that both placentas were affected by SARS-CoV-2. found characteristic placental pathologic changes that led to autopsy, and major changes in the brain that led to autopsy: “I believe the unexplained severity of the loss of white matter and the hypoxic/ischemic features of the cerebral cortex. Impressed by the existence, we suspect that the virus somehow manages to breach the placental barrier to damage the central nervous system, but this had not been documented before.

Dr. Jayakumar Aramugam, a neuroscientist and molecular biologist in the Department of Obstetrics, Gynecology and Reproductive Sciences, together with Dr. Paidas, showed that the virus is present in both the patient’s placenta and the dead infant’s brain. Analysis of both placentas clearly showed severe inflammatory changes in each placenta. Also striking was the absence of a key placental hormone, human chorionic gonadotropin. Human chorionic gonadotropin is essential for all fetal development, but is especially important for brain development.

The author emphasizes that these are rare occurrences. UM clinicians have seen hundreds of COVID-19 positive pregnant women and mothers. But these women were the only ones whose babies experienced the devastating brain damage described in this paper. In both cases, the mother had an infection in the second trimester and subsequently recovered, but one had recurring infections in the third trimester and involved an abnormal maternal and/or fetal immune response to the virus. There is a possibility that

“We need to continue our research to understand why these two babies experienced such devastating consequences,” said an assistant professor of pediatrics, neonatologist, and lead author of the paper. One Merline Benny, MD said. “When we fully understand the causes, we can develop the most appropriate interventions.”

The interdisciplinary team of researchers also includes pediatric neurologist Roberto Lopez, M.D., Ph.D., and Gaurav Saigal, M.D., pediatric radiologist and neuroimaging expert and director of the Miller School’s Department of Neuroradiology. It was UM’s team of doctors and scientists hope their case will alert obstetricians, pediatricians and raise awareness of the potential dangers of maternal COVID-19 to newborns. So far, data suggest that infants who test negative after birth have a relatively benign course. The next step the group is interested in is identifying biomarkers for potentially selecting the most at-risk babies.

For concerned parents, we recommend maternal COVID-19 vaccination as a first line of prevention, breastfeeding, masking if actively infected, and other preventative measures.

The study adds to ongoing research from the Miller School’s Maternal and Child COVID-19 Project, which examines the effects of the virus on pregnant mothers and infants, led by Dr. Paidus and colleagues.