Respiratory distress in SARS-CoV-2 exposed uninfected neonates followed in the COVID Outcomes in Mother-Infant Pairs (COMP) Study

Olivia M. Man (), Tamiris Azamor, Mary Catherine Cambou (), Trevon L. Fuller, Tara Kerin, Sophia G. Paiola, Jessica S. Cranston, Thalia Mok, Rashmi Rao, Weiqiang Chen, Jae U. Jung, Viviana Fajardo Martinez, Suan-Sin Foo and Karin Nielsen-Saines
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Olivia M. Man: University of California, Los Angeles
Tamiris Azamor: Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic
Mary Catherine Cambou: University of California, Los Angeles
Trevon L. Fuller: University of California, Los Angeles
Tara Kerin: University of California, Los Angeles
Sophia G. Paiola: University of California, Los Angeles
Jessica S. Cranston: University of California, Los Angeles
Thalia Mok: University of California, Los Angeles
Rashmi Rao: University of California, Los Angeles
Weiqiang Chen: Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic
Jae U. Jung: Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic
Viviana Fajardo Martinez: University of California, Los Angeles
Suan-Sin Foo: Global Center for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic
Karin Nielsen-Saines: University of California, Los Angeles

Nature Communications, 2024, vol. 15, issue 1, 1-11

Abstract: Abstract Respiratory distress (RD) has been reported in SARS-CoV-2 exposed uninfected (SEU) term neonates. Prior studies suggest that prenatal exposure to Coronavirus Disease 19 (COVID-19) may activate an inflammatory cascade in the newborn airway. In this study, we examine the relationship between maternal COVID-19 vaccination and neonatal RD using a longitudinal cohort of mother-infant pairs in Los Angeles, CA. Two-hundred and twenty-one mothers with laboratory confirmed SARS-CoV-2 during pregnancy and 227 exposed fetuses are enrolled in our study. Maternal disease severity and neonatal RD variables were defined based on current accepted clinical criteria. To explore the multifactorial associations between maternal COVID-19 parameters and infant RD, we utilize a multivariable logistic regression model and a proteomic sub-analysis to propose a pathway for the development of RD following in utero exposure to SARS-CoV-2. Unusually high rates of RD are observed in SEU infants (17%). The odds ratio of RD is 3.06 (95% CI:1.08-10.21) in term neonates born to unvaccinated individuals versus those born to individuals vaccinated prior to maternal infection. Proteomic analysis reveals a robust inflammatory response associated with ciliary dysregulation and enhanced IgE production among SEU neonates with RD. Maternal vaccination against COVID-19 reduces the frequency of neonatal RD.

Date: 2024
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DOI: 10.1038/s41467-023-44549-5

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