Fellows Column: Unexpected Pneumomediastinum with Spontaneous Resolution in a Newborn

Spontaneous pneumomediastinum is uncommon in neonates. We report a case of unexpected pneumomediastinum with spontaneous resolution in a newborn supported by a literature review.

Antibody Testing of Infants Born to Asymptomatic COVID-19 Positive Mothers

Awareness of SARS-COV-2 IgG may contribute to the management of asymptomatic RT PCR COVID-19 positive pregnant women, their newborns, and future vaccination practices. Objective: Characterize COVID testing results of asymptomatic COVID-19 positive pregnant women and their infants. Our assumption/hypothesis maintained that all infants born to asymptomatic COVID-19 positive mothers would have detectable SARS-CoV-2 specific IgG. Study Design: Retrospective chart review. Clinical demographics/COVID-19 testing of maternal/infant dyads were reviewed/collected for reporting purposes. Setting: Center for Women and Infants (CWI), University of Louisville Hospital, Louisville, KY Participants: Asymptomatic COVID-19 positive pregnant women/infant dyads admitted to the CWI between June 2020 to February 2021. Results: 36 COVID-19 positive asymptomatic mother/37 infant dyads (one set of twins) reviewed. 38% of the mother/infant dyads were positive for SARS-CoV-2 IgG, while 27% of mother/infant dyads were negative for IgG. A COVID-19 positive mother of twins was IgG negative, but both twins were positive. Two mothers in this study group had developed significant COVID-19 disease at 28w4d gestation and 34w0d gestation. Both required intensive care but recovered, and their pregnancies were maintained until 37w4d and 39w3d gestation, respectively. By the time of delivery, both mothers had negative COVID-19 RT PCR testing, but both infants were positive for SARS-CoV-2 IgG antibodies. COVID-19 RT PCR testing on both of these infants at 24 and 48 hours of age was negative. Conclusion: SARS-CoV-2 IgG is passively transferred to the infant during pregnancy of asymptomatic positive COVID-19 mothers however appears variable and/or possibly based on the ability of IgG detection with current testing. Further investigation of the immune system’s response to the SARS-CoV-2 virus during pregnancy can direct future management/treatment during pregnancy, especially in the wake of vaccination for the virus during pregnancy and emerging variants.

Combining probability scores to optimize clinical use of the NICHD Neonatal BPD Outcome Estimator

Objective: Bronchopulmonary dysplasia (BPD) continues to prevail among very preterm infants. While NICHD BPD Outcome Estimator is easy to use, the clinical interpretation remains challenging. This study aims to optimize its use. Study Design: A retrospective study was conducted with 469 infants born between 2015 and 2020. Data were entered into the Estimator to obtain probability scores. Trajectories of the probability scores were modeled using generalized additive modeling. The optimal cutoff number for predicting severe BPD or death was identified by a grid search from a range established by the original population distribution and the ROC curve. Result: Combining probability scores from the severe and death categories and the no-BPD and mild categories may improve BPD outcome prediction. A cutoff of 21% combining outcome probabilities from severe and death categories is predictive of severe BPD or death. Conclusion: Combining probability scores of different categories improves BPD outcome prediction.