Criteria for predicting early neonatal adaptation of newborns in women who had COVID-19 infection during pregnancy

Abstract

Objective of the study: to investigate the possibility of predicting the early neonatal adaptation of newborns based on clinical and instrumental data that assesses the status of pregnant woman with COVID-19 infection and the fetus.
Materials and methods. The participants of the study were 58 pregnant women with a diagnosis of COVID-19 (group A) and 40 women with a physiological course of pregnancy (group B), as well as their newborns. In addition to the analysis of standard examinations results, perinatal consequences for the mother and the fetus/newborn, the association between the saturation level (SрO2) in the pregnant woman, the short-term heart rate variability (STV) according to cardiotocography data of the fetus and the assessment of the newborn according to the Apgar scale was studied.
Results. The SрO2 level was 95% or more in 87.9% of infected pregnant women, in 12.06% it was 90–94% (critical for pregnant women). 10.3% of pregnant women needed intensive therapy and respiratory support, 69% of women had inflammatory changes in the chest organs (pneumonia, etc.). Cardiotocography showed a significant difference in the type of basal heart rate between the groups (χ2 = 14.9055, p = 0,00058) and STV (7.78 ± 2.56 vs 8.39 ± 2.03 ms) in groups A and B, respectively
(U = 687, p = 0.00022).
The Apgar scale index in groups A and B was 6.48 ± 2.39 and 8.05 ± 0.54 points, respectively (χ2 = 21.933, df = 4). 20% of newborns in group B had 7 points in the first minute, 80% had 8 points or more. 51.85% of newborns in group A had scored 7 points or less (F = 0.00246, p < 0.05, odds ratio 4.308, 95% CI 1.681 – 11.037). 10.34% of newborns required intensive care, 5.17% – administration of surfactant, 1.72% – artificial lung ventilation. Regression analysis showed that the Apgar scale indicator at the first minute of life in newborns in group A depends on the SрO2 level of the pregnant woman (Y = 0.89X1 – 79.19), as well as on the STV (Y = 0.89X1 + 0.028X2 – 79.53), where Y is the score on the Apgar scale, X1 is the SрO2 in a pregnant woman, X2 is the STV.
Conclusions. Assessment of the hypoxemia degree in pregnant women with COVID-19 infection and the cardiotocographic assessment of the fetus state require special attention: there is a direct association between these indicators and the assessment of the newborn according to the Apgar scale, which allows predicting the course of the period of early neonatal adaptation. It is recommended that these newborns be classified as a risk group with a violation of the adaptation period and possible long-term consequences.