Infants Born to Mothers With Severe Acute Respiratory Syndrome Chi C. Shek, MRCP*; Pak C. Ng, MD‡; Genevieve P. G. Fung, MRCP*; Frankie W. T. Cheng, MRCPCH‡; Paul K. S. Chan, MD§; Malik J. S. Peiris, DPhil; Kim H. Lee, FRCS¶; Shell F. Wong, MRCOG#; Hon M. Cheung, MB‡; Albert M. Li, MRCP‡; Ellis K. L. Hon, FAAP‡; Chung K. Yeung, MD¶; Chun B. Chow, FRCP*; John S. Tam, PhD§; Man C. Chiu, FRCP*; and Tai F. Fok, MD‡ ABSTRACT. Severe acute respiratory syndrome (SARS) is a newly discovered infectious disease caused by a novel coronavirus. During the community outbreak in Hong Kong, 5 liveborn infants were born to pregnant women with SARS. A systematic search for perinatal transmission of the SARS-associated coronavirus, includ- ing serial reverse transcriptase-polymerase chain reaction assays, viral cultures, and paired serologic titers, failed to detect the virus in any of the infants. In addition, none of the infants developed clinical, radiologic, hematologic, or biochemical evidence suggestive of SARS. One preterm infant developed jejunal perforation and another devel- oped necrotizing enterocolitis with ileal perforation shortly after birth. This case series is the first report to describe the clinical course of the first cohort of liveborn infants born to pregnant women with SARS. Pediatrics 2003;112:e254 –e256. URL: http://www.pediatrics.org/cgi/ content/full/112/4/e254; bowel perforation, coronavirus, necrotizing enterocolitis, preterm, severe acute respiratory syndrome. ABBREVIATIONS. SARS, severe acute respiratory syndrome; SARS-CoV, severe acute respiratory syndrome-associated corona- virus; RDS, respiratory distress syndrome; NEC, necrotizing en- terocolitis; RT-PCR, reverse transcriptase-polymerase chain reac- tion. T he outbreak of severe acute respiratory syn- drome (SARS) in Southeast Asia shocked the world. 1 In just over 3 months, this highly con- tagious disease affected 8400 patients in 29 coun- tries worldwide. Hong Kong has been one of the most severely affected cities. A community outbreak in a densely populated residential complex, Amoy Gardens, and a nearby housing estate in late March affected 300 local residents and claimed 30 lives. During this outbreak, 5 liveborn infants were born to pregnant women with SARS. Cesarean section was performed in the acute phase of the disease, between 6 and 7 days of onset of fever, in 3 of the 5 pregnant women because of deteriorating maternal condition with hypotension and progressive worsening of pul- monary function (cases 1, 2, and 3). The other 2 infants were born after the mothers had fully recov- ered from their illnesses (cases 4 and 5). Viral studies confirmed the presence of SARS-associated corona- virus (SARS-CoV) in maternal body secretions, ex- creta, and/or peritoneal fluid. This case series is the first report to describe the clinical course of the first cohort of liveborn infants born to pregnant women with SARS. CASE REPORTS Case 1 A male infant was born to a 34-year-old mother at 28 weeks’ gestation and weighed 1035 g. Apgar scores were 5 and 9 at 1 and 5 minutes, respectively. The mother received intravenous ribavirin (400 mg, every 8 hours) and hydrocortisone (100 mg, every 6 hours) 4 days before delivery. Antenatal monitoring by cardioto- cograph revealed a decreased fetal heart rate variability. The infant developed respiratory distress syndrome (RDS) necessitat- ing positive pressure ventilation and surfactant replacement (Sur- venta; Abbott Laboratories, North Chicago, IL; 4 mL/kg for 2 doses, 12 hours apart), and systemic hypotension was treated with dopamine (8 g/kg/min for 3 days). Enteral feeding was com- menced on day 4. On day 8, he was treated with intravenous indomethacin (0.1 mg/kg daily for 2 doses) for a patent ductus arteriosus. The infant developed marked abdominal distension, pneumoperitoneum, and increased respiratory distress 48 hours after treatment. Intravenous ribavirin (20 mg/kg/d for 10 days) was started empirically. Laparotomy confirmed necrotizing en- terocolitis (NEC) with ileal perforation measuring 0.3 cm in diam- eter. There were also multiple areas of necrosis at the antimesen- teric border of the terminal ileum. Partial resection of the small bowel (3.5 cm) and ileostomy was performed. The infant slowly recovered from surgery but developed bronchopulmonary dys- plasia. Chest radiograph revealed nonspecific diffuse haziness and ill-defined streaky densities in both lung fields. There was, how- ever, no patchy consolidation appearance suggestive of SARS pneumonia. The infant was extubated successfully on day 25 after treatment with postnatal dexamethasone. He is now breathing in air without ventilatory support and is tolerating full enteral feed- ing administered via the orogastric tube. The mother died of SARS and secondary methicillin-resistant Staphylococcus aureus pneumo- nia 14 days after delivery of the infant. Reverse transcriptase- polymerase chain reaction (RT-PCR) of her nasopharyngeal aspi- rates was positive for SARS-CoV. Case 2 A female infant was born to a 32-year-old mother at 26 weeks’ gestation and weighed 975 g. Apgar scores were 5 and 7 at 1 and From the *Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Lai Chi Kok, New Territories, Hong Kong; ‡Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; §Department of Microbiology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territo- ries, Hong Kong; Department of Microbiology and Pathology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong; ¶Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong; and #Department of Obstetrics and Gynecology, Princess Margaret Hospital, Lai Chi Kok, New Territories, Hong Kong. Dr C. C. Shek and Professor P. C. Ng contributed equally to writing of this report and the supervision of the clinical management of these infants. Received for publication May 29, 2003; accepted Jun 23, 2003. Reprint requests to (T.F.F.) Department of Paediatrics, Level 6, Clinical Science Bldg, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. E-mail: taifaifok@cuhk.edu.hk PEDIATRICS (ISSN 0031 4005). Copyright © 2003 by the American Acad- emy of Pediatrics. e254 PEDIATRICS Vol. 112 No. 4 October 2003 http://www.pediatrics.org/cgi/content/full/112/4/e254 by guest on April 27, 2017 Downloaded from