Case study shows how COVID-19 pierced placenta and caused brain damage in baby

Researchers from UHealth-; University of Miami Health System and University of Miami Miller School of Medicine showed that in two cases, COVID-19 infection pierced the placenta and caused brain damage in the newborn. born.

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, the two infants had been tested negative for the virus at birth, but had detectable significantly high SARS-CoV-2 antibodies in the blood, indicating that either the antibodies crossed the placenta or virus passage occurred and the immune response was that of the baby.

Both infants experienced seizures, small head size and developmental delays, and one infant died aged 13 months. The study titled “Maternal SARS-CoV-2, Placental Changes and Brain Injury in Two Neonates” was published April 6 in the journal Pediatrics. This is the first study to confirm transplacental transmission of SARS-Cov-2 leading to brain damage in newborns.

Many women are affected by COVID-19 during pregnancy, but seeing these kinds of issues in their infants at birth was clearly unusual. We’re trying to understand what made these two pregnancies different, so we can direct the research towards protecting vulnerable babies.”

Shahnaz Duara, MD, Professor of Pediatrics at the University of Miami Miller School of Medicine, Medical Director of NICU at Holtz Children’s Hospital, and lead study author

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

“If we saw a baby presenting this way, we would call it hypoxic ischemic encephalopathy (brain damage caused by decreased blood flow),” said Michael Paidas, MD, professor and chair of the Department of Obstetrics, gynecology and reproductive sciences at the University of Miami Miller School of Medicine and chief of the Jackson Department of Obstetrics and Gynecology. “But it wasn’t the lack of blood flow to the placenta that caused this. As far as we can tell, it was the viral infection.” Hypoxic ischemic encephalopathy in neonates, by definition, requires a sentinel event in the mother during labor before detecting neurological injury in the neonate at birth.

Ali G. Saad, MD, a Miller School professor, neuropathologist, and director of Pediatric and Perinatal Pathology at Holtz Children’s, examined both placentas and found characteristic placental pathologic changes caused by SARS-CoV-2 in the two placentas, and also looked at major changes in the brain that came out at autopsy: “I was struck by the unexplained severity of white matter loss and the presence of hypoxia/ischemia features in the cerebral cortex We began to suspect that the virus somehow managed to cross the placental barrier to damage the central nervous system, but this had not been documented before.”

Jayakumar Aramugam, Ph.D., a neuroscientist and molecular biologist in the Department of Obstetrics, Gynecology and Reproductive Sciences, who together with Dr. Paidas showed the presence of viruses in the placenta of patients and also in the brain of the deceased infant. Analysis of both placentas clearly demonstrated severe inflammatory changes in each placenta. Also striking was the absence of an essential placental hormone, human chorionic gonadotropin, which, although essential for all fetal development, is particularly important for brain development.

The authors point out that these were rare cases. UM clinicians have seen hundreds of pregnant women and birthing mothers positive for COVID-19; however, they are the only two women whose babies suffered the devastating brain damage described in the article. In both cases, the mothers acquired the infection during their second trimester and then cleared it, but one of them had a repeat infection during her third trimester, suggesting that an unusual maternal and/or fetal immune response to the virus may have played a role.

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

The interdisciplinary team of researchers also included pediatric neurologist Roberto Lopez, MD and pediatric radiologist and neuroimaging expert Gaurav Saigal, MD, chief of the Miller School’s Neuroradiology Section. UM’s team of doctors and scientists hope their cases will alert obstetricians, pediatricians, and educate newborns about the potential dangers of maternal COVID-19; data so far have suggested a relatively benign course in infants who test negative after birth. The next step that interests the group is potentially to identify biomarkers to select the babies most at risk.

For concerned parents, the authors recommend maternal vaccination against COVID-19 before or during pregnancy as a first line of defense, breastfeeding, as well as masking in case of active infection and other precautionary measures.

The study adds to ongoing research from the Miller School’s Mother-Baby COVID-19 Project examining the impact of the virus on pregnant mothers and infants, led by Dr. Paidas and associates.