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зменшення тимчасово1 координацil мiж стандарти-зованою м'язовою дiяльнiстю жувального i скроне-вого м'язiв (POCTM), ввдносно контрольно1 групи, розподiл м'язово! активностi значно змiстився вiд жувальних до скроневих м'язiв.
5. У хворих на хрошчш функцiональнi розлади виявленi функцiональнi змiни в 1х жувальних м'язах, в основному за рахунок функцiонального дисбалансу м'язово1 дiяльностi, що призвело до по-пршення координацi1' пвд час MBC та зб№шення задiяностi балансуючих бiчних м'язiв шд час жу-вання.
Список лггератури
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UDC: 616.98:578.834]-02-036.1-07-08-053.31
Koliubakina L. V.1, Vlasova O. V.1, Kretsu N. M.1, Trekush Ye. Z. 2
1Bukovinian State Medical University, Chernivtsi, Ukraine 2 MUI "Chernivtsi Regional Pediatric Clinical Hospital" DOI: 10.24412/2520-6990-2021-20107-10-12 SOME FEATURES OF SARS-CoV-2 IN NEWBORNS
Summary
Introduction. During the year of the pandemic,_caused by SARS-CoV-2, much data on the epidemiological features of the pathogen, clinical and paraclinical characteristics of the disease, diagnostic principles and treatment approaches have been published in the scientific literature. But there are still many unsolved problems regarding the epidemiological and clinical features of the course of coronavirus infection in newborns.
Aim. Study of the features of the course of coronavirus infection caused by SARS-CoV-2 in newborns who were treated during 2020 on the basis of the RMUI "Chernivtsi Regional Pediatric Clinical Hospital", Chernivtsi.
Methods and materials. To achieve this aim, 12 medical records of inpatient infants were retrospectively analyzed. The entry criteria were: age 0-28 days of life, confirmed coronavirus infection, which was detected by a positive nasopharyngeal swab result by polymerase chain reaction (PCR). The average age at the time of admission was 13.6±2.1 days, among which a third (33.3%) of newborns were admitted before the age of 10 days of life. The share of rural residents was 66.6%. Among the infants who became sick, girls prevailed (75%).
Conclusions. It was found that contact of the newborns with COVID-19 patients was confirmed in most cases. Most infants were admitted from home on average on the second day after the onset of the disease, with clinical symptoms typical of acute respiratory viral infections, and only two patients showed signs of gastrointestinal disorders at the onset of the disease. The course of the disease was favourable. The detected changes in the hemogram in the infants in catamnesis require further dynamic clinical and paraclinical monitoring.
Keywords: newborn; infection; SARS-CoV-2.
Introduction. At the end of November 2019, there were reports of an outbreak of pneumonia in the city of Wuhan (China) caused by a new infectious pathogen, and in March 2020, WHO stated a pandemic caused by an RNA-containing virus (group 2 beta-coronavirus). Information on the clinical course of the disease in infected children appeared a year ago, and information on the incidence among newborns became known from March 2020 [1].
During the year of the pandemic, a lot of data has been published in the scientific literature on the characteristics of the pathogen, the course of the disease, the principles of diagnosis and approaches to treatment.
But there are still many unsolved problems regarding the epidemiological and clinical features of the course of this disease in newborns [2,3,4].
According to the data, the disease can be variable: from asymptomatic or mild to rare cases of severe disease [5]. As for the presence of complications, there is also no final information to date. The severity of the disease may be due to the underlying condition in prematurely born infants or newborns with delayed intrau-terine development. However, there is a likely link between women's COVID-19 infection during pregnancy and the development of respiratory distress syndrome,
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thrombocytopenia, and impaired liver function in newborns [6].
Based on the above, the aim of the study included an investigation of the features of the course of coronavirus infection caused by SARS-CoV-2 in the newborns who were in inpatient treatment at the "Cher-nivtsi Regional Children's Clinical Hospital" in Cher-nivtsi in the period from April 2020 to December 2020.
Methods and materials. To achieve this aim, a retrospective analysis of the medical records of inpatient infants who were treated during 2020 on the basis of the RMUI "Chernivtsi Regional Children's Clinical Hospital" in Chernivtsi was carried out. During their hospital stay all the infants, according to the protocol, underwent general clinical, instrumental examinations and therapeutic measures. The study was conducted with the informed consent of the patients' parents and was carried out in compliance with the main provisions of the "Ethical Guidelines for Research Involving Human Subjects", approved by the Helsinki Declaration. Statistical processing of the study results was carried out using methods of variational statistics with the calculation of the arithmetic mean (M) and the standard error of the mean (m). Statistical processing of actual data was conducted using the StatSoft Statistica v 6.0 program, with a known number of observations (n). The critical significance level of "P" when testing statistical hypotheses in this study was considered at p < 0.05.
The entry criteria were: age 0-28 days of life, coro-navirus infection confirmed with a positive nasopha-ryngeal swab result by polymerase chain reaction. The first cases of the disease among newborns began to be registered in the Chernivtsi region in April 2020, and until December 2020, 12 sick infants were under observation in the hospital. The average age at the time of admission was 13.6±2.1 days, among which a third (33.3%) of the newborns were admitted before the age of 10 days of life. The share of rural residents was 66.6%. Among the infants who became sick, girls prevailed (75%).
Results and discussion. When analyzing the anamnestic features of the course of pregnancy and childbirth, it was found that most of the infants (58.3%) were born second at more than 37 weeks of gestation, and 11 newborns were born naturally, only one child was born by caesarean section because of medical reasons. Two mothers had a complicated course of pregnancy: in one case, intrauterine death of the second fetus occurred, and in the other - a congenital malformation of the fetus - a large teratoma of the lumbosacral region. The average birth weight of the infants was 3180±152.7 g. Three newborns (25%) were transferred from the hospital, due to documented contact with a COVID-19-infected mother during childbirth, and the other (75%) patients were admitted from home. Among the studied, 75% of infants were breastfed. The direct contact with an infected person was confirmed in 11 cases out of 12: 10 patients - with a mother with COVID-19 and one -with a sick father. In one case, contact with infected people could not be detected.
It should be noted that in three newborns at admission, the condition was regarded as satisfactory, and in 9 (75%) - as impaired with moderate severity. According to anamnestic data, in 8 (66.6%) infants the disease began with an increase in body temperature from subfebrile (in every third child) to febrile (in four infants). The vast majority of children became acutely ill (75%), on average, newborns were admitted on the second (1. 7±0. 3) day after the onset of the disease with clinical symptoms typical of acute respiratory viral infections. Only in 16.6% of cases, gastrointestinal disorders were observed in the form of refusal to feed, regurgitation and diluted bowel movements. One child was admitted with suspected nitrate methemoglobinemia due to cya-notic skin associated with artificial feeding using water from a non-certified well, but the diagnosis was refuted during the examination.
Clinical manifestations of the course of corona-virus infection caused by SARS-CoV-2 are shown in Figure 1.
60,0% 50,0% 40,0% 30,0% 20,0% 10,0%
1 ■ ■ ■
LnJ M i
J? ^ ^ ^ J? ^ J? " ^ ^ ^
Figure 1. Clinical manifestations of coronavirus infection in newborns during the hospital stay.
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Among the clinical signs in sick infants, mainly a runny nose, cough, refusal to feed, signs of intoxication syndrome and gastrointestinal disorders were observed, and only one child had respiratory disorders (0-I degree). Subfebrile fever lasts from one to two days. He-modynamic parameters were stable, children were on spontaneous breathing, saturation indicators (SpO2) ranged from 94-96%. Only one infant needed a short oxygen therapy due to a decrease in saturation at admission to 90-92%, without clinical and paraclinical signs of an inflammatory process in the lungs.
The data obtained give reason to believe that in most cases, contact with COVID-19 patients has been confirmed. Most infants were admitted from home on the second day after the onset of the disease. The infants who were transferred from the hospital did not have clear data on intrauterine infection, and they did not have clear clinical signs of an infectious and inflammatory process. In the other newborns admitted from home, the disease occurred typically of acute respiratory viral infections, and only two patients showed signs of gastrointestinal disorders at the onset of the disease.
The conducted complex of paraclinical studies did not allow us to establish clear features of laboratory parameters in infants with COVID-19.
Analyzing the indicators of the general blood test, it should be noted that they were within the physiological norm, no signs of lymphopenia were found in any case, which may be due to the anatomical and physiological characteristics of the newborns [7]. No cases of thrombocytopenia were reported, but during dynamic observation, thrombocytosis (more than 500 G/l) was detected in 3 newborns (43%) out of 7 examined, which can be explained by reactive changes associated with the infection. In the hemograms of the examined patients, relative monocytosis (more than 10%) was observed in 42% of cases, which may be due to the beginning of the recovery period secondary to the infectious process, and 15% of atypical mononuclears were found in one child.
In the course of dynamic observation and follow-up, it was revealed that coronavirus infection caused by SARS-CoV-2 in one child occurred secondary to urinary system infection with kidney hypoplasia, in other cases - acute otitis media, congenital malformation of the nervous system (teratoma of the lumbosacral region) and congenital heart disease (atrial membrane defect, interventricular membrane defect). In three infants, coronavirus infection occurred secondary to hy-poxic-ischemic damage to the central nervous system, depression syndrome.
Coronavirus infection caused by SARS-CoV-2 was verified based on a positive PCR test on the second day after admission to the hospital in all the newborns, and on the seventh day, positive tests were found in 42% of cases.
As part of the drug treatment, every second child received antibacterial drugs, in particular, cephalospor-ins of the third generation (before the diagnosis was verified), in 75% of cases laferobion was used, and only one child needed maintenance infusion therapy with glucose-salt solutions for two days.
The average duration of inpatient treatment was 9.0±0.5 bed-days. No deaths were registered.
Conclusions:
1. Coronavirus infection caused by SARS-CoV-2 was verified in infants based on a positive PCR test on the second day after admission to the hospital.
2. 11 newborns had a history of direct contact with an infected person, in one case no contact was established.
3. The vast majority of infants were admitted from home, on average on the second day after the onset of the disease and were naturally fed.
4. In most cases, a runny nose, cough, refusal to feed, signs of intoxication syndrome and gastrointestinal disorders were observed among the clinical signs in sick infants.
5. The course of the disease was favourable. All the infants were on spontaneous breathing and did not need hemodynamic support.
6. Taking into account the detected changes in the hemogram (thrombocytosis and relative monocytosis) secondary to a coronavirus infection in infants, dynamic clinical and paraclinical monitoring, performing a detailed blood test and coagulogram (if necessary) is advisable.
Prospects for further research. The prospect of further research is to study and analyze the features of the course and long-term consequences of coronavirus infection caused by SARS-CoV-2 in newborns.
Sources of funding. The article was published without any financial support.
Conflict of interest. The authors declare that there is no conflict of interest.
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