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《Lancet，3月6日，Managing neonates with respiratory failure due to SARS-CoV-2 – Authors' reply》

  • 来源专题：COVID-19科研动态监测
  • 编译者： xuwenwhlib
  • 发布时间：2020-03-07

  • Managing neonates with respiratory failure due to SARS-CoV-2 – Authors' reply

    Jianhui Wang

    Yuan Shi

    Published:March 06, 2020DOI:https://doi.org/10.1016/S2352-4642(20)30072-9

    We thank Daniele De Luca for his reflections on our Comment.1 We agree that testing all admitted neonates for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not necessary. We recommended screening all newly admitted infants at high risk of coronavirus disease 2019 (COVID-19) on the basis of their family history. Only high-risk patients should receive a nucleic acid test for SARS-CoV-2. However, all high-risk neonates should be isolated in a single room, preferably in a neonatal intensive care unit (NICU). Based on existing experience, some patients initially present with mild flu-like symptoms but rapidly develop respiratory distress and multiple organ failure. Admitting all neonates with COVID-19 to the NICU could ensure the availability of close monitoring and necessary interventions.2 However, each clinical setting should consider its bed surge capacity in case of a COVID-19 outbreak and adopt a flexible and variable approach to admitting patients.

  • 原文来源：https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30072-9/fulltext
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  • 《Lancet，3月6日，Managing neonates with respiratory failure due to SARS-CoV-2》
    • 来源专题：COVID-19科研动态监测
    • 编译者：xuwenwhlib
    • 发布时间：2020-03-07
    • Managing neonates with respiratory failure due to SARS-CoV-2 Daniele De Luca Published:March 06, 2020DOI:https://doi.org/10.1016/S2352-4642(20)30073-0 In their Comment in The Lancet Child & Adolescent Health, Jianhui Wang and colleagues1 suggested a plan to handle neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and outbreaks in neonatal intensive care units (NICUs). This is a timely reflection, given the public health problem represented by this infection and the need to anticipate any critical care issue, irrespective of patients' ages. However, the plan is incomplete or unsuitable in many points. We do not know anything about neonatal SARS-CoV-2 infections, and we must reasonably follow data from adult critical care. First, testing all NICU-admitted neonates for SARS-CoV-2 represents a wrongful use of resources. Neonatal respiratory failure can result from a wide range of causes, and testing everybody when other causes are reasonably suspected will divert laboratory resources from adult critical care. Tests should be done for infants from families infected by SARS-CoV-2 or exposed to other infected people, irrespective of their symptoms.
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  • 《LANCET，3月17日，COVID-19 in pregnant women – Authors' reply》
    • 来源专题：COVID-19科研动态监测
    • 编译者：zhangmin
    • 发布时间：2020-03-18
    • COVID-19 in pregnant women – Authors' reply David Baud Eric Giannoni Léo Pomar Xiaolong Qi Karin Nielsen-Saines Didier Musso et al. Show all authors Published:March 17, 2020DOI:https://doi.org/10.1016/S1473-3099(20)30192-4 We are grateful for the concerns of Manuel Schmidt and colleagues about our previous guidelines1 for pregnant women with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. At the time we developed the algorithm (February, 2020), there were no data regarding potential vertical transmission from infected mothers and outcomes in newborns. To date, there has been no evidence of vertical transmission of coronavirus disease 2019 (COVID-19) based on two small clinical series.2, 3 According to WHO, delayed umbilical cord clamping is highly unlikely to increase the risk of transmitting pathogens from the mother to the fetus even in the case of maternal infection.4 Because the vernix caseosa contains antimicrobial peptides, we recommend leaving it in place until 24 h after birth.5 New data examining neonates from infected mothers could be reassuring, but transmission after birth via contact with infectious respiratory secretions is still a concern, and physical separation of mother from child should be considered. Separation is a standard practice in pulmonary tuberculosis and is discussed in cases of maternal influenza infection.6 Therefore, separation of the mother and her newborn baby should be individually discussed by an interdisciplinary team, considering local facilities and risk factors for adverse neonatal outcomes, such as prematurity and fetal distress.
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