scholarly journals Clinical Findings, Laboratory Assessment, and Outcomes of 44 Infants Born to Mothers with Confirmed or Suspected COVID-19: A Multicenter Cohort Study

2021 ◽  
Vol 31 (4) ◽  
Author(s):  
Ziba Mosayebi ◽  
Tahereh Esmaeilnia ◽  
Vafa Ghorban Sabagh ◽  
Amir Naddaf ◽  
Setareh Sagheb ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Distress ◽  
Clinical Features ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Clinical Feature ◽  
X Rays ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Gastrointestinal Problems

Background: Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, causing a significant public health disaster. Objectives: The present study aimed to evaluate the clinical features and laboratory data of neonates born to mothers with COVID-19. Methods: A retrospective multicenter cohort study was conducted from March 20 to September 5, 2020, on all neonates born to mothers with positive real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 or clinically suspected COVID-19. Neonates enrolled in this study were from five different hospitals affiliated with the Tehran University of Medical Sciences. All the newborns were tested for SARS-CoV-2 using nasopharyngeal swabs during the first 24 - 48 hours of life, and a second-time swabbing was performed as indicated at subsequent visits. All categorical data were manifested as frequency (%), and continuous data were shown as mean ± SD. Results: Forty-four neonates born to 39 infected mothers were evaluated during the study period. Nineteen women had complications during pregnancy, including hypertensive disorders, gestational diabetes, preterm labor, etc. Besides, 54.5% of the neonates were born preterm. The mean gestational age and birth weight were 35.11 ± 4.01 weeks and 2,567 ± 898 g, respectively. Fifteen (34.1%) neonates were symptomatic at birth, and during the observation, more neonates became symptomatic. Finally, 27/44 (61.3%) neonates became symptomatic, and 17/44 remained asymptomatic. The most common clinical manifestations were respiratory distress (77.7%), followed by fever or hypothermia (18.5%), gastrointestinal problems (14.8%), and neurologic findings (3.7%). Also, the most common clinical feature of eight neonates with positive RT-PCR was respiratory distress, followed by neurologic symptoms, temperature instability, and gastrointestinal disorder, in sequence. Few abnormalities were seen in laboratory findings. Chest X-rays were abnormal in 22.2% of the neonates. Conclusions: The SARS-CoV-2 infection during pregnancy may cause severe maternal and neonatal morbidities. Neonates with positive SARS-CoV-2 may demonstrate a spectrum of clinical features. The most common feature of neonates born to mothers with COVID-19 was respiratory distress.

scholarly journals Hospitalized Children with Critical SARS-CoV-2 Infection Cared for in a Limited Resource Setting: Multicenter Cohort Study

2021 ◽  
Author(s):  
Emmerson C.F. de Fariasa ◽  
Jefferson P. Piva ◽  
Manoel J.C. Pavão Junior ◽  
Susan C.D. Sales ◽  
Luciana M.P. Nascimento ◽  
...  
Keyword(s):  
Cohort Study ◽  
Children And Adolescents ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Length Of Hospital Stay ◽  
Limited Resource ◽  
Hospitalized Children ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Resource Setting

Abstract Background: Some children can develop severe forms of SARS-CoV-2 infection either acutely or later, as represented by multisystemic inflammatory syndrome in children (MIS- C). To identify the risk factors for worse outcomes in hospitalized children and adolescents with severe acute SARS-CoV-2 infection and MIS-C. Methods: This multicenter cohort study included all children and adolescents with confirmed or suspected critical SARS-CoV-2 infection admitted to the PICU between April 2020 and September 2021. The exclusion criteria were incomplete vaccinal status, immunocompromised status, and end-of-life decision. The main variables analyzed were epidemiological, clinical, and laboratory data, and ventilator settings at admission and after 72 h. The patients were divided into three groups (G): confirmed coronavirus disease (COVID-19) with MIS-C criteria (G1), confirmed COVID-19 without MIS-C criteria (G2), and MIS-C criteria without confirmed COVID-19. Results: The median age of the patients was 28 months in G1, with comorbidities in 40 patients (72.7%) (p < 0.0001). The duration of exposure (median 23 days; p = 0.004) and fever were longer in G1 (12 days; p = 0.001). Moreover, invasive mechanical ventilation (IMV) was required in 44 patients (80%, p < 0.0001), and cardiogenic shock occurred in 26 patients (54.2%, p < 0.0001) in G1. Subnutrition was most frequent in G1 in 55 cases (57.3%; p = 0.01). Under nutrition (< 2 SD for weight), longer exposure time (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.37–3.25; p = 0.001), IMV time (OR: 2.6; 95% CI: 1.15–5.85; p = 0.03), and length of hospital stay (OR: 10.94; 95% CI: 1.93–63.1; p = 0.007) were associated with critical MIS-C in G1. Conclusions: In the Brazilian Amazon area, specifically in the Pará state, we identified a cluster of more severe forms of pediatric acute or late SARS-CoV-2 infection.

scholarly journals Clinical features and predictors for patients with severe SARS-CoV-2 pneumonia at the start of the pandemic: a retrospective multicenter cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chao Cao ◽  
Li He ◽  
Jingping Ma ◽  
Meiping Chen ◽  
Yiting Li ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Features ◽  
Lymphocyte Count ◽  
Odds Ratio ◽  
Small Sample Size ◽  
Demographic Data ◽  
Small Sample ◽  
Clinical Trial Registry ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort

Abstract Background This study was performed to investigate clinical features of patients with severe SARS-CoV-2 pneumonia and identify risk factors for converting to severe cases in those who had mild to moderate diseases at the start of the pandemic in China. Methods In this retrospective, multicenter cohort study, patients with mild to moderate SARS-CoV-2 pneumonia were included. Demographic data, symptoms, laboratory values, and clinical outcomes were collected. Data were compared between non-severe and severe patients. Results 58 patients were included in the final analysis. Compared with non-severe cases, severe patients with SARS-CoV-2 pneumonia had a longer: time to clinical recovery (12·9 ± 4·4 vs 8·3 ± 4·7; P = 0·0011), duration of viral shedding (15·7 ± 6·7 vs 11·8 ± 5·0; P = 0·0183), and hospital stay (20·7 ± 1·2 vs 14·4 ± 4·3; P = 0·0211). Multivariate logistic regression indicated that lymphocyte count was significantly associated with the rate of converting to severe cases (odds ratio 1·28, 95%CI 1·06–1·54, per 0·1 ×  109/L reduced; P = 0·007), while using of low-to-moderate doses of systematic corticosteroids was associated with reduced likelihood of converting to a severe case (odds ratio 0·14, 95%CI 0·02–0·80; P = 0·0275). Conclusions The low peripheral blood lymphocyte count was an independent risk factor for SARS-CoV-2 pneumonia patients converting to severe cases. However, this study was carried out right after the start of the pandemic with small sample size. Further prospective studies are warranted to confirm these findings. Trial registration Chinese Clinical Trial Registry, ChiCTR2000029839. Registered 15 February 2020 - Retrospectively registered.

scholarly journals Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis: A multicenter cohort study

2020 ◽  
Author(s):  
Xiaolong Qi ◽  
Yanna Liu ◽  
Jonathan A. Fallowfield ◽  
Jitao Wang ◽  
Jianwen Wang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Direct Bilirubin ◽  
Multicenter Cohort Study ◽  
Platelet Counts ◽  
Multicenter Cohort

SummaryBackgroundPatients with pre-existing cirrhosis are considered at increased risk of severe coronavirus disease 2019 (COVID-19) but the clinical course in these patients has not yet been reported. This study aimed to provide a detailed report of the clinical characteristics and outcomes among COVID-19 patients with pre-existing cirrhosis.MethodsIn this retrospective, multicenter cohort study, we consecutively included all adult inpatients with laboratory-confirmed COVID-19 and pre-existing cirrhosis that had been discharged or had died by 24 March 2020 from 16 designated hospitals in China.Demographic, clinical, laboratory and radiographic findings on admission, treatment, complications during hospitalization and clinical outcomes were collected and compared between survivors and non-survivors.FindingsTwenty-one patients were included consecutively in this study, of whom 16 were cured and 5 died in hospital. Seventeen patients had compensated cirrhosis and hepatitis B virus infection was the most common etiology. Lymphocyte and platelet counts were lower, and direct bilirubin levels were higher in patients who died than those who survived (p= 0·040, 0·032, and 0·006, respectively). Acute respiratory distress syndrome and secondary infection were both the most frequently observed complications. Only one patient developed acute on chronic liver failure. Of the 5 non-survivors, all patients developed acute respiratory distress syndrome and 2 patients progressed to multiple organ dysfunction syndrome.InterpretationLower lymphocyte and platelet counts, and higher direct bilirubin level might represent poor prognostic indicators in SARS-CoV-2-infected patients with pre-existing cirrhosis.

scholarly journals Clinical Features and Predictors for Patients with Severe SARS-CoV-2 Pneumonia: a retrospective multicenter cohort study

2020 ◽  
Author(s):  
Chao Cao ◽  
Meiping Chen ◽  
Yiting Li ◽  
Lili Yu ◽  
Weina Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Clinical Features ◽  
Lymphocyte Count ◽  
Odds Ratio ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Novel Coronavirus

SummaryBackgroundStarting from early December 2019, cases of human infection with a novel coronavirus were identified in Wuhan, Hubei Province, China. It spreads rapidly to other cities and numerous countries. This study was performed to investigate clinical features of patients with severe SARS-CoV-2 pneumonia and identify risk factors for converting to severe cases in those who had mild to moderate diseases.MethodsIn this retrospective, multicenter cohort study, patients with mild to moderate SARS-CoV-2 pneumonia were included from Ningbo First Hospital and Jingzhou Central Hospital. Demographic data, symptoms, laboratory values, comorbidities, and clinical outcomes were collected. Data were compared between non-severe and severe patients. Logistic regression analysis was performed to assess risk factors in predicting the patients with SARS-CoV-2 pneumonia who would convert to severe cases.Findings120 patients (36 from Ningbo First Hospital and 84 from Jingzhou Central Hospital) were included in this study, among which 62 were excluded and 58 were included in the final analysis. Compared with non-severe cases, severe patients with SARS-CoV-2 pneumonia had a longer: time to clinical recovery (12.9±4.4 vs 8.3±4.7; p=0.0011), duration of viral shedding (15.7±6.7 vs 11.8±5.0; p=0.0183), and hospital stay (20.7±1.2 vs 14.4±4.3; p=0.0211). Multivariate logistic regression indicated that lymphocyte count was significantly associated with the rate of converting to severe cases (odds ratio 1.28, 95%CI 1.06–1.54, per 0.1×109/L reduced; p=0.007), while using of low-to-moderate doses of systematic corticosteroids was associated with reduced likelihood of converting to a severe case (odds ratio 0.14, 95%CI 0.02–0.80; p=0.0275).InterpretationThe low peripheral blood lymphocyte count was an independent risk factor for SARS-CoV-2 pneumonia patients converting to severe cases. This finding may help clinicians more accurately predict prognosis, and triage priorities to improve clinical outcomes.Research in contextEvidence before this studySevere Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) is a novel coronavirus that have emerged in early December 2019, and has caused a novel coronavirus disease (COVID-19). It has been deemed as a public health emergency of global concern by The World Health Organization (WHO). We searched PubMed for articles published up to March 11, 2020, using the search terms (“novel coronavirus” OR “SARS-CoV-2” OR “COVID-19”) with no language or time restrictions. Previous work has described clinical characteristics of critically ill and non-critically ill patients with COVID-19. However, no published works have focused on clinical features of patients with severe SARS-CoV-2 pneumonia and identify risk factors for converting to severe cases in those who had mild to moderate diseases.Added value of this studyIn this retrospective and multicenter cohort study, we reported demographics characteristics, baseline symptoms, laboratory findings, corticosteroid usage and hospital course of patients with non-severe COVID-19 and severe COVID-19. Comparing with non-severe patients, severe patients with COVID-19 was found to have a longer: time to clinical recovery (12.9±4.4 vs 8.3±4.7; p=0.0011), duration of viral shedding (15.7±6.7 vs 11.8±5.0; p=0.0183), and hospital stay (20.7±1.2 vs 14.4±4.3; p=0.0211). By multivariate logistic regression, we found increasing odds of converting to severe cases associated with lower lymphocyte count (odds ratio 1.28, 95%CI 1.06–1.54, per 0.1×109/L reduced; p=0.007). Using of low-to-moderate doses of systematic corticosteroids was associated with reduced likelihood of converting to a severe case (odds ratio 0.14, 95%CI 0.02–0.80; p=0.0275).Implications of all the available evidenceLow lymphocyte count in peripheral blood was an independent risk factor for patients who converted to severe cases. In addition, using of systematic corticosteroids in mild to moderate patients with SARS-CoV-2 pneumonia was associated with a reduced risk of converting to severe cases. These findings may help clinicians predict prognosis more accurately, and triage priorities to improve clinical outcomes. Further prospective studies are warranted to confirm these findings.

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