新生儿重型严重急性呼吸综合征冠状病毒2感染的临床诊疗分析

Severe SARS-CoV-2 in neonates:a report of three cases and literature review

目的探讨新生儿重型严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染的临床特征及诊断治疗经验,提高对新生儿重型SARS-CoV-2感染的认识。方法选取2022年12月至2023年1月北京清华长庚医院重型SARS-CoV-2感染患儿3例,同时以“新生儿”“新型冠状病毒感染”“新冠肺炎”“newborn”“neonate”“SARS-CoV-2”“COVID-19”为主题词,在中国期刊全文数据库、维普数据库、万方数据库、PubMed、Web of Science进行文献检索,共检索文献20篇,共有以呼吸系统受累为主的重型SARS-CoV-2感染新生儿20例。分析23例患儿的临床表现、实验室检查、诊断及治疗情况。结果23例患儿中男14例,女9例;早产儿7例,足月儿16例;顺产分娩14例,剖宫产分娩8例,未记录分娩方式1例;早期新生儿13例,晚期新生儿10例;几乎所有患儿均有SARSCoV-2接触史,大部分为母亲,其中4例为重型病例。所有患儿SARS-CoV-2核酸均提示阳性,持续时间最短为4 d,最长为32 d仍未转阴。起病症状以呼吸困难、呼吸急促等呼吸道表现为主,其次为发热和喂养困难。所有患儿需呼吸支持,其中13例需有创机械通气(有创通气最长时间26 d),其余10例需程度不等的无创呼吸支持。13例使用糖皮质激素以地塞米松为主。其中2例并发败血症,4例并发气胸,4例并发肺动脉高压,3例并发颅内出血及脑水肿、脑积水等改变,2例并发脑病,1例并发脑静脉血栓。22例患儿好转,1例继发肺出血死亡。结论新生儿重型SARS-CoV-2感染较少见,患儿临床表现多样,需注意早期识别。目前尚未有统一的治疗方案,以多模式治疗为主,注意监测其他系统并发症。

Objective To explore the clinical characteristics,diagnosis and treatment of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in neonates.Methods Three children with severe SARS-CoV-2 infection admitted to Tsinghua Changgeng Hospital in Beijing from December 2022 to January 2023 were selected."newborn""New coronavirus infection""New coronavirus pneumonia""newborn""neonate""SARS-CoV-2"and"COVID-19"as the main themes,literature search was conducted in China Journal full-text Database,VIP database,Wanfang database,PubMed and Web of Science.A total of 20 literatures were searched,and a total of 20 neonates with severe SARSCoV-2 infection were mainly affected by respiratory system.The clinical manifestations,laboratory examination,diagnosis and treatment of 23 cases were retrospectively analyzed.Results Among the 23 cases,there were 14 males and nine females.Seven cases were premature infants,and 16 cases were full-term infants.Vaginal delivery was observed in 14 cases,cesarean section in eight cases,and the delivery method was not recorded in one case.Thirteen cases were early neonates,and 10 cases were late neonates.Almost all patients had a history of SARS-CoV-2 exposure,primarily from their mothers,with four mothers being severe cases.All patients tested positive for SARS-CoV-2 nucleic acid,with a duration of positivity ranging from 4 to 32 days.Respiratory symptoms were the predominant presenting symptoms,with respiratory distress and tachypnea being the main manifestations,followed by fever and feeding difficulties.All patients required respiratory support,with 13 cases requiring invasive mechanical ventilation(with a maximum duration of 26 days)and the remaining 10 cases requiring varying degrees of non-invasive respiratory support.Thirteen cases received glucocorticoid,primarily dexamethasone.Among all those mentioned patients,there were two cases had septicemia,four cases had pneumothorax,four cases had pulmonary hypertension,three cases had intracranial hemorrhage,cerebral edema or hydrocephalus,two cases had encephalopathy,and one case had cerebral venous thrombosis.Clinical outcomes indicated improvement in 22 cases,while one case died from secondary pulmonary hemorrhage.Conclusions Severe SARS-CoV-2 infection in neonates is a rare condition with diverse clinical manifestations,which is why early recognition is crucial.Currently there is no unified treatment plan,and multimodal treatment should be the primary approach,with vigilance for concurrent complications in other organ systems.