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Lessons learned in caring for newborns from one viral outbreak to the next

Pediatric Research volume 95, pages 416–417 (2024)Cite this article

Over the past decade we have experienced several major viral outbreaks that have had significant impacts on populations, pregnant patients, and their offspring.1 First, was the Zika virus epidemic in 2015 which began in Brazil and quickly spread throughout Central and South America and the Caribbean. This virus was a newly recognized human teratogen, adding to what we previously recognized as congenital infections (i.e., TORCH infections). The severe phenotype of antenatal Zika virus infection was termed congenital Zika syndrome, which included microcephaly, severe thinning of the cortical mantle and other malformations of cortical development, ocular abnormalities, arthrogryposis, and significant neurodevelopmental disabilities among surviving infants. The Zika virus was also responsible for causing stillbirths and miscarriages for fetuses with severe infection. However, children without Zika-related birth defects have also since been recognized to have differences in neurodevelopment necessitating longitudinal neurodevelopmental multispecialty evaluations. During this time, a lot has been learned by the medical community, researchers, and public health officials regarding maternal-infant surveillance and effects of the virus on pregnancies and infants.2

SARS-CoV-2 (COVID-19 illness) was the next major viral outbreak which rapidly spread to pandemic levels throughout the world in early 2020. Did the experience of the preceding Zika virus epidemic help prepare or inform the medical community and public health officials for how to care for and evaluate pregnant patients and offspring from the COVID-19 pandemic? Would SARS-CoV-2 be a teratogen and cause a spectrum of neurodevelopmental disabilities in offspring like the Zika virus? Could the virus be vertically transmitted or spread through breast milk? What special care may be needed in newborns? The answers to these important questions were unknown at the beginning of the COVID-19 pandemic. At the outset, the pregnant patient and offspring were considered an important patient group and special attention was placed to try and limit the spread of infection to potential vulnerable newborns and find answers to these important questions.3 It is likely that the recent Zika virus epidemic played a role in enhancing the healthcare system’s concern for potential effects of SARS-CoV-2 on pregnant people, the fetus, and infants. Population and cohort studies and surveillance data collection was rapidly initiated to inform risk to infants and clinical obstetric and neonatal protocols were adjusted as information was learned on the risks to newborns at delivery, safety of breastfeeding, rooming-in practices, and general care of the mother-infant dyad.3,4 In the review article by Istemi Han Celik and colleagues in the 2024 Pediatric Research Annual Reviews Issue, they review the management of neonates with antenatal exposure to SARS-CoV-2 and describe how neonatal care has changed over the course of the COVID-19 pandemic as data emerged and informed improved practice.3

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Funding

Dr. Mulkey receives research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (grant number R01HD102445 [PI: SBM] and R01HD107140 [Co-I: SBM]) for studies on Zika virus and SARS-CoV-2, respectively. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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  1. Prenatal Pediatrics Institute, Children’s National Hospital, Washington, D.C, USA

    Sarah B. Mulkey

  2. Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Sarah B. Mulkey

  3. Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Sarah B. Mulkey

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Correspondence to Sarah B. Mulkey.

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Dr. Sarah Mulkey receives grant funding from the National Institutes of Health as described in funding. Dr. Mulkey does not have conflicts of interest to disclose.

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Mulkey, S.B. Lessons learned in caring for newborns from one viral outbreak to the next. Pediatr Res 95, 416–417 (2024). https://doi.org/10.1038/s41390-023-02937-z

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