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Four full-term, singleton infants were born to pregnant women who tested positive for COVID in the city of Wuhan, the capital of Hubei province, China, where the disease was first identified. Of the three infants, for who consent to be diagnostically tested was provided, none tested positive for the virus. None of the infants developed serious clinical symptoms such as fever, cough, diarrhea, or abnormal radiologic or hematologic evidence, and all four infants were alive at the time of hospital discharge.

Two infants had rashes of unknown etiology at birth, and one had facial ulcerations. One infant had tachypnea and was supported by non-invasive mechanical ventilation for 3 days.

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One had rashes at birth but was discharged without parental consent for a diagnostic test. This case report describes the clinical course of four live born infants, born to pregnant women with the COVID infection. As the epidemic progresses, there remains little understanding of infant and childhood COVID infections and their clinical picture.

During this epidemic, four live-born infants were born in our medical center, to pregnant women with the COVID infection. Three of the four pregnant women gave birth by cesarean section due to concerns about symptomatic maternal infection. The other infant was born by vaginal delivery to a mother experiencing fever highest temperature The most important question is whether the COVID could be transmitted vertically to the fetus from the pregnant mother and cause a clinically ificant infection.

Recently, a finding from nine other cases suggested that there is no evidence for intrauterine infection caused by vertical transmission in women who develop COVID pneumonia in late pregnancy 1. We believe this present report is the second case report on vertical transmission between COVID pregnant women and their infants.

Moreover, this report will focus more on infants. This case report describes the clinical course of four live born infants born to pregnant women with the COVID infection. On admission, the regular symptoms of pregnant mothers with COVID were fever three out of four patientscough two out of four patientsmyalgia or fatigue two out of four patientsand headache two out of four patients.

Only one patient felt reduced fetal movement and one experienced dyspnea. There was a ificant increase of the level of C-response protein in all pregnant mothers. Coagulation function and blood biochemistry of all the mothers were normal. Five respiratory pathogens Mycoplasma, Chlamydia, Respiratory syncytial virus, Adenovirus, and Coxsackie virus and the nucleic acid of influenza viruses A and B of all patients were negative laboratory findings shown in Table 1.

Abnormalities in chest CT images and bilateral involvement were detected among all pregnant women. A cesarean section was performed for three patients in the acute phase of the disease while one patient underwent vaginal delivery because of the onset of labor.

Four full-term infants were born. All infants were isolated from their mother immediately after birth. We describe the clinical course of these four infants laboratory findings shown in Table 2. Three mothers of the infants recovered from their COVID infections and were released 3—5 days after delivery.

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However, one mother suffered severe dyspnea after delivery which required respiratory support—she did, however, survive. All four infants and their mothers were healthy upon a post-discharge follow-up. Three male, and one female infant was born beyond 37 weeks' gestation and had a birthweight above 3, g. All infants had a 1-min Apgar score of 7—8 and 5-min Apgar score of 8—9 Table 2. They were isolated from their mothers immediately after birth and received formula feeding. Two of the four infants were healthy. Two of the four infants had rashes after birth, however, the rash distribution and shape differed.

The infant in Case 2 had some maculopapules scattered all over the body, and one facial skin ulceration on the forehead size about 0. The rash disappeared and skin desquamation appeared the next day without any treatment.

The rash of the infant in Case 3 was present on the forehead and seemed to diffuse small miliary red papules on day 2. The rash disappeared on day 10 without treatment Table 2. The baby was taking full formula feeds on day 4. The baby was discharged from the NICU neonatal intensive care unit 6 days after birth. Breathing became regular within 3 days. One mother experienced reduced fetal movement. One mother developed anemia and dyspnea after admission. Of the three infants whose parents provided consent to be diagnostically tested, none tested positive for the virus.

None of the infants developed serious clinical symptoms such as fever, cough, or diarrhea. Two newborns had a rash, which disappeared spontaneously without treatment; one newborn had mild dyspnea, and was considered to suffer from TTN and supported by non-invasive mechanical ventilation for 3 days. All of the four babies are doing well and have been formula feeding since birth.

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Coronavirus CoVs 2 is an enveloped positive-sense RNA virus, which infects humans and a wide variety of animals, causing diseases in the respiratory, enteric, hepatic, and neurological systems with varying severity 3. As reported herein, four pregnant women were confirmed to have the COVID infection in our medical center, which is deated as one of the treatment centers for pregnant women with the COVID infection. In these four pregnant women with the COVID infection, three had fever, two had a cough and experienced headache. In laboratory data, there was lower lymphocyte count and higher CRP in blood analysis.

These four pregnant women had no critical maternal illness. Only one of them experienced reduced fetal movement and one had dyspnea. These symptoms, at onset of delivery, were similar to other populations 8. To prevent COVID intrauterine, perinatal, and postnatal transmission, three pregnant women received a cesarean section. One of the three pregnant women suffered placenta previa, which made it necessary to opt for a cesarean section. Only one pregnant mother adopted a vaginal delivery because of an emergency labor process.

Shek et al. In addition, none of the infants developed clinical, radiologic, hematologic, or biochemical evidence suggestive of SARS. We regret that the infant in Case 2 did not have a COVID diagnosis as the baby's guardian's did not provide consent. Assiri et al. Among the five pregnancies, two pregnant women died during their illnesses, two resulted in perinatal death one pregnancy resulted in intrauterine fetal demise, and one infant died 4 h after an emergency cesarean delivery.

Seven mothers presented in the first trimester, and the rest were in their late second and third trimester. In this study, all four cases reported on were delivered during the acute phase of the illness, at 37—39 weeks of gestation, and the birth weight of all the babies were appropriate for their gestational age. Throughout the clinical course, there were no manifestations or radiologic, hematologic, or biochemical evidence suggestive of COVID infection.

Coronaviruses cause respiratory and intestinal infections in animals and humans For adult patients, the clinical manifestations of COVID infection include fever, cough, shortness of breath, muscle ache, sore throat, diarrhea, and so on The minority of patients showed severe and even fatal respiratory diseases such as acute respiratory distress syndrome. According to imaging examination, most patients showed bilateral pneumonia, multiple mottling, or ground-glass opacity. In this study, only the infant in Case 3 showed dyspnea and required oxygen therapy. A chest radiograph of the infant in Case 3 showed that the brightness of the left lung was slightly decreased, and the texture of the right lung was slightly blurred.

His condition was relieved gradually after 3 days of nCPAP treatment. It has been confirmed that COVID gravely damages leucocytes, and could lead to multiple organ damage along with the respiratory system In this study, blood assays of the three infant cases were normal, and all the blood cell counts and hemoglobin concentrations fluctuated within the normal reference range. It is worth noting that both Case 2 and Case 3 presented a transient skin rash after birth.

Whether this was attributable to the maternal inflammatory toxin effect requires further study. At follow up, the four newborns were health and had grown on formula feeding. Therefore, the reliability of diagnostic testing should be further evaluated, especially in children. Another limitation of this report was the small of cases, and imperfect clinic data. Further studies for viral infection in placenta, amniotic fluid, neonatal blood, gastric fluid, and anal swab, and the viral depending receptor on children will be detected in future.

The datasets generated for this study are available on request to the corresponding author.

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YC and HP deed the study, drafted the initial manuscript, and reviewed and revised the manuscript. YL deed the study, coordinated, and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be able for all aspects of the work. This study was supported by the National Natural Science Foundation of China, and The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Clinical characteristics and intrauterine vertical transmission potential of COVID infection in nine pregnant women:a retrospective review of medical records. Phan T. Novel coronavirus: from discovery to clinical diagnostics.

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Infect Genet Evol. Global epidemiology of bat coronaviruses. Measures for diagnosing and treating infections by a novel coronavirus responsible for a pneumonia outbreak originating in Wuhan, China. Microbes Infect. SARS and pregnancy: a case report. Emerg Infect Dis. Severe acute respiratory syndrome and pregnancy. Middle east respiratory syndrome coronavirus infection during pregnancy: a report of 5 cases from Saudi Arabia.

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