6. What is known about possible fetal COVID-19 transmission? Impact of postnatal testing and treatment especially in the setting of critical CHD?

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6. What is known about possible fetal COVID-19 transmission? Impact of postnatal testing and treatment especially in the setting of critical CHD?

Currently criteria for vertical transmission have not been developed. Based on limited data, viremia rates in patients with COVID-19 appear to be low and transient, suggesting placental seeding and vertical transmission are unlikely. [27] In a few recent review articles on pregnant women with COVID-19, no cases of vertical transmission have been registered. [28-30] A few newborn COVID-19 cases have been reported based on elevated IgM levels and/or pneumonia on days 1 or 2 of life with either negative or not performed COVID-19 testing on fetal blood, amniotic fluid, and placenta. [31-34] However, it is not reliable to diagnose congenital COVID-19 based only on IgM detection because IgM assays can be false positive and cross reactivity may occur. The most likely cause of positive IgM in many of those cases might be related to early infant infection due to postnatal contact with infected parents. [35]

Even though there is no reliable data to confirm vertical COVID-19 transmission, the CDC recommends that newborns born to mothers with known COVID-19 at the time of delivery should be considered to have suspected COVID-19 and should be tested and isolated from other healthy infants. [36] It is equally important to ensure that a critical CHD for a newborn of a mother with COVID-19 is managed timely and that testing for COVID-19 would not prolong or delay a transfer to tertiary center with neonatal CHD ICU unit where the highest quality and timely management of critical CHD’s is available.

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