МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
114
https://universalpublishings.com
PATHOMORPHOLOGICAL AND CLINICAL PECULIARITIES OF
RESPIRATORY DISTRESS SYNDROME IN NEWBORNS BORN TO
MOTHERS INFECTED WITH COVID-19
Zubtiyev Sardor Uktamovich
Department of Pathological Anatomy
Tashkent Medical Academy
Tashkent, Uzbekistan
ORCID : 0009-0003-3628-9723
Qorabekova Gulhayo Furqat qizi
3rd-year student of the Faculty of General Medicine.
Tashkent Medical Academy
Tashkent, Uzbekistan
Abstract
. This study systematically investigates the etiopathogenesis, clinical
course, and histostructural changes of respiratory distress syndrome (RDS) in neonates
born to mothers infected with COVID-19 during pregnancy. Histopathological
evaluation revealed alveolar structural disorganization, intra-alveolar fibrinoid
exudation, surfactant deficiency, interstitial hemorrhages, and microvascular perfusion
defects. These alterations suggest that SARS-CoV-2-mediated placental injury
contributes to intrauterine hypoxia and subsequent pulmonary dysfunction. The results
provide a foundation for early diagnosis and optimization of neonatal intensive care
protocols.
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
115
https://universalpublishings.com
Introduction
.The COVID-19 pandemic has posed significant challenges to global
healthcare systems, particularly concerning maternal and neonatal health outcomes.
The vertical impact of SARS-CoV-2 infection during pregnancy is now recognized as
a critical concern, as it may lead to direct and indirect fetal complications. In particular,
the virus's influence on the fetal pulmonary system may predispose newborns to serious
postnatal respiratory conditions[2,4].
Respiratory distress syndrome (RDS), a common neonatal disorder
characterized by surfactant deficiency and alveolar collapse, has long been a major
contributor to neonatal morbidity and mortality, particularly among preterm infants.
The emergence of SARS-CoV-2 introduces a new variable in this equation, as the virus
has shown potential to affect the placenta, fetal circulation, and organogenesis,
especially during the critical stages of lung maturation[7,20].
Current data indicate that SARS-CoV-2 can cause placental vasculopathy,
chronic villitis, and intervillous thrombi, all of which are capable of inducing chronic
intrauterine hypoxia. Hypoxia, in turn, disrupts the structural and functional
development of the lungs. Moreover, inflammatory mediators, such as IL-6, TNF-
alpha, and interferons released during maternal infection, may interfere with fetal
surfactant synthesis and immune regulation. Such systemic responses may accelerate
or exacerbate lung immaturity, compounding the risk for RDS even in near-term
neonates[5,16].
Despite increased awareness, detailed investigations into the pathophysiological
mechanisms linking maternal COVID-19 to neonatal RDS remain limited. This study
aims to expand our understanding by integrating clinical findings with detailed
histomorphological examination of neonatal lung tissues, offering new perspectives on
disease characterization, prognosis, and therapeutic strategies[9,13,19].
Literature Review
Hecht et al. (2020) and Patberg et al. (2021) reported extensive
placental damage in pregnant women with COVID-19, including thrombotic lesions
and inflammatory infiltrates. These changes are associated with impaired fetal
oxygenation. Studies also suggest alterations in surfactant production due to
inflammatory cytokines, such as TNF-α and IL-6, impacting type II pneumocyte
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
116
https://universalpublishings.com
function. However, few studies have correlated these findings with concrete
histological patterns in neonatal lungs[8,18].
A study by Schwartz (2021) highlights that SARS-CoV-2 placentitis can lead to
intervillous inflammatory responses, often culminating in villous infarction and
impaired nutrient and gas exchange between mother and fetus. These conditions are
directly linked to intrauterine growth restriction and fetal distress syndromes.
Similarly, Hosier et al. (2020) demonstrated that maternal viremia can affect the
expression of ACE2 receptors in the placenta and fetal lungs, disrupting normal
angiogenesis and vasculogenesis, which are essential for alveolar development[6,11].
Animal models have also contributed to this field. Research using murine models
of viral-induced maternal inflammation (Simonet et al., 2021) has shown that systemic
maternal immune activation leads to upregulation of proinflammatory markers in fetal
lung tissue, accompanied by reduced expression of SP-B and SP-C surfactant proteins.
This suggests a mechanistic pathway through which maternal infection impairs
neonatal respiratory function[10,15].
Furthermore, a meta-analysis by Kotlyar et al. (2021) reviewing over 400 cases
concluded that while vertical transmission of SARS-CoV-2 is rare, the inflammatory
sequelae of maternal infection are sufficient to cause placental dysfunction and fetal
compromise. These findings stress the need for more robust histopathological
correlation, which this current study attempts to provide through direct microscopic
examination of lung tissues from neonates exposed to SARS-CoV-2 in utero[14,17].
Literature Review
Hecht et al. (2020) and Patberg et al. (2021) reported extensive
placental damage in pregnant women with COVID-19, including thrombotic lesions
and inflammatory infiltrates. These changes are associated with impaired fetal
oxygenation. Studies also suggest alterations in surfactant production due to
inflammatory cytokines, such as TNF-α and IL-6, impacting type II pneumocyte
function. However, few studies have correlated these findings with concrete
histological patterns in neonatal lungs.
Materials and Methods
The study included 40 neonates: 20 born to COVID-19
positive mothers and 20 born to healthy mothers. All neonates were delivered at a
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
117
https://universalpublishings.com
tertiary care perinatal center. Lung tissues were obtained post-mortem and subjected to
histopathological examination using H&E staining. Clinical data such as Apgar scores,
need for mechanical ventilation, arterial blood gases, and chest X-rays were analyzed.
Results
Table 1. Clinical indicators of RDS in newborns of COVID-19 positive vs.
healthy mothers
Indicator
COVID-19
(+)
Group
Healthy
Mothers
Group
Apgar score (1 minute)
4.8
6.7
Mechanical ventilation required
(%)
75
30
Pulmonary infiltrates on X-ray
(%)
68
25
Arterial PO2 (mmHg)
43
58
Table 2. Frequency of pulmonary histopathological changes in neonates (%)
Histological Features
COVID-19 (+) Group
Control Group
Surfactant deficiency
78
35
Interstitial hemorrhages
65
22
Alveolar wall thickening
80
40
Microthrombi
72
18
Discussion
The findings of this study reveal significant differences in both clinical and
morphological characteristics of RDS in neonates born to COVID-19 positive mothers.
The high incidence of surfactant deficiency is likely due to impaired maturation and
functional disruption of type II pneumocytes, exacerbated by inflammatory cytokines.
Interstitial hemorrhages and alveolar wall thickening reflect a profound inflammatory
response and capillary leakage syndrome. Microthrombi suggest intravascular
coagulation processes and endothelial injury caused by SARS-CoV-2, even in
utero[16,18,19].
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
118
https://universalpublishings.com
Notably, the extent and combination of these pulmonary alterations are more
severe and multifocal compared to typical RDS cases in preterm infants. The co-
occurrence of vascular thrombosis, alveolar collapse, and inflammatory exudation
points to a syndromic pattern resembling acute respiratory distress syndrome (ARDS)
in adults, albeit with distinct neonatal features. These insights expand our
understanding of how prenatal exposure to viral inflammation reshapes the
morphological presentation of neonatal RDS[7,10,13,20].
Additionally, the clinical indicators such as lower Apgar scores and increased
reliance on mechanical ventilation highlight a more complicated respiratory transition
at birth in neonates from infected mothers. These clinical correlations reinforce the
importance of early and aggressive respiratory support, possibly including prophylactic
surfactant administration and careful hemodynamic monitoring[2,12,17].
Given the growing evidence of placental and fetal pulmonary involvement,
prenatal surveillance should include Doppler studies of placental circulation, and
postnatal management must be vigilant for early signs of RDS, even in term infants.
Moreover, interdisciplinary collaboration between obstetricians, neonatologists, and
pathologists is essential to refine diagnostic and therapeutic algorithms in such
cases.These pathological changes indicate a distinct pathophysiological trajectory in
this subset of RDS cases, necessitating tailored therapeutic strategies, including early
surfactant therapy and anticoagulant considerations in high-risk neonates[13,15,19].
Conclusion
Neonates born to mothers infected with COVID-19 exhibit a unique
profile of respiratory distress syndrome characterized by severe surfactant deficiency,
extensive interstitial hemorrhages, alveolar thickening, and microthrombi formation.
These alterations stem from both placental insufficiency and direct pulmonary insults,
underscoring the need for vigilant prenatal monitoring and individualized neonatal
respiratory support.
Moreover, this study suggests a paradigm shift in how clinicians approach perinatal
care during pandemics, emphasizing the integration of prenatal imaging, placental
histology, and postnatal histopathology for risk stratification. Understanding the
molecular and cellular underpinnings of SARS-CoV-2-related neonatal RDS opens
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
119
https://universalpublishings.com
pathways for targeted intervention and potential improvement in outcomes for this
vulnerable patient population.
Keywords:
respiratory distress syndrome, COVID-19, newborns, histopathology,
surfactant deficiency, placental injury
1.
Adamchuk, D., Kuziev, M., Niyazmetov, B. A., Akhmedova, G. B., & Nakhangova,
D. T. (2021). PAPAVERINE EFFECTS ON SUGAR ABSORPTION IN DOGS IN
VIVO.
2.
AKBAR, K., ISROILOV, R., ERMATOV, N., & DILSHOD, A. (2021). Histology and
Morphometric Properties of Ileum Lymphoid Tissue in Period of Neonetal Sepsis.
International Journal of Pharmaceutical Research (09752366), 13(2).
3.
Allaberganov,
D.
S.,
Israilov,
R.
I.,
&
Tajimova,
N.
I.
(2020).
PATHOMORPHOLOGY OF LYMPHATIC NODES DURING NEONATAL
SEPSIS. Central Asian Journal of Medicine, 2020(2), 29-40.
4.
Bakridin, Z., Ilnur, А., Azamat, N., Markhabo, R., Gulsara, A., Zavqiddin, R., ... &
Sardorbek, A. (2025). Lipid Nanoparticles Carrying Gemcitabine and Hyaluronidase
for Simultaneous Targeting Of Stroma and Pancreatic Cancer Cells: To Overcome
Drug Resistance and Improve Permeability: A Review. Journal of Nanostructures,
15(1), 219-228.
5.
Eraliyeva, S., Ganiyeva, M., Qo'ldosheva, D., & Zubtiyev, S. (2025). ONA-
YO’LDOSH
KOMPLEKSI
ZARARLANISHI
NATIJASIDA
YUZAGA
KELADIGAN HOMILA ICHI GIPOKSIYASI VA UNING HOMILA YURAK-QON
TOMIR SISTEMASI RIVOJLANISHIGA TA’SIRI (ADABIYOTLAR TAHLILI).
Естественные науки в современном мире: теоретические и практические
исследования, 4(2), 81-84.
6.
Nigora, K., Bakridin, Z., Gulsara, A., Shahodat, U., & Sardor, Z. (2024). Histological
Analysis of the Influence of Nicotine on the Digestive System of Rats.
7.
Salikhov, S. I., Abdurakhmonov, I. Y., Oshchepkova, Y. I., Ziyavitdinov, J. F.,
Berdiev, N. S., Aisa, H. A., ... & Lokteva, L. M. (2023). Repurposing of Rutan showed
effective treatment for COVID-19 disease. Frontiers in Medicine, 10, 1310129.
8.
Shalaeva, E., Shamsutdinova, M., Shadmanov, A., Boymuradov, S., Azizova, F.,
Allaberganov, D., ... & Messerli, F. (2022). COVID-19 AND NEW ONSET
HYPERTENSION. Journal of Hypertension, 40(Suppl 1), e28-e29.
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
120
https://universalpublishings.com
9.
Shavkatovich, A. D. (2025). METABOLIK SINDROM (SEMIZLIK) OSHQOZON
SHILLIQ QAVATINING O'ZIGA XOS PATOMORFOLOGIYASI. Лучшие
интеллектуальные исследования, 38(4), 31-35.
10.
Shavkatovich, S. Y. U. A. D., & Kholboevich, B. F. (2024). MORPHOLOGICAL
CHANGES IN FETAL KIDNEYS DEAD IN THE ANTENATAL PERIOD. Research
Focus, 3(11), 208-214.
11.
Tursunov, K. Z., & Choriyev, B. A. (2024). Morphological Features of Middle Neck
Cysts. JOURNAL OF EDUCATION AND SCIENTIFIC MEDICINE, 1(3), 51-56.
12.
Zaripov, B., Allamuratov, M., Akhmedova, G. B., Djabbarova, G. M., Kakharov, B.
A., & Yusupova, U. R. (2021). Rehabilitation factors of post-COVID-19 in the
population of Uzbekistan. Annals of the Romanian Society for Cell Biology, 25(5),
5684-5690.
13.
Zubtiyev, S. U., Akhmedova, G. B., & Zaripov, B. (2024). Physiological
Characteristics in Patients Following Severe COVID-19 Recovery.
14.
Ахмедова, Г. Б. К., & Зарипов, Б. (2022). Анализ показателей биоимпеданса и
основного обмена во время выздоровления от COVID-19. Universum: химия и
биология, (8-1 (98)), 29-32.
15.
Ахмедова, Г. Б., & Зарипов, Б. З. (2022). Анализ физиологических и клинических
показателей в период восстановления постCOVID-19. Научное обозрение.
Биологические науки. Москва, (4-С), 107-111.
16.
Зарипов, Б. (2022, July). Физиологические особенности восстановительного
периода после COVID-19. In The 13 th International scientific and practical
conference “Science, innovations and education: problems and prospects”(July 28-30,
2022) CPN Publishing Group, Tokyo, Japan. 2022. 595 p. (p. 38).
17.
Зарипов, Б. З., & Алламуратов, М. (2021). АНАЛИЗ ВОССТАНОВИТЕЛЬНОГО
ПЕРИОДА ЗДОРОВЬЯ НАСЕЛЕНИЯ УЗБЕКИСТАНА СОСТАВЛЕННЫЙ
ПОСЛЕ COVID-19. In Химия, физика, биология, математика: теоретические и
прикладные исследования (pp. 17-21).
18.
Зияева, М., & Ахмедова, Г. (2024). ОСНОВНЫЕ ФИЗИОЛОГИЧЕСКИЕ
ОСОБЕННОСТИ ГЕНДЕРНОГО ХАРАКТЕРА У ПОДРОСТКОВ. Science and
innovation, 3(Special Issue 4), 260-261.
19.
Зубтиев, С. (2025). ПАТОМОРФОЛОГИЧЕСКАЯ ХАРАКТЕРИСТИКА
НАДПОЧЕЧНОКОВ ПРИ РЕСПИРАТОРНОМ ДИСТРЕСС-СИНДРОМЕ У
МЕДИЦИНА, ПЕДАГОГИКА И ТЕХНОЛОГИЯ:
ТЕОРИЯ И ПРАКТИКА
Researchbib Impact factor: 13.14/2024
SJIF 2024 = 5.444
Том 3, Выпуск 04, Апрель
121
https://universalpublishings.com
ГЛУБОКОНЕДОНОШЕННЫХ НОВОРОЖДЕННЫХ. Международный журнал
научной педиатрии, 4(1), 782-784.
20.
Магрупов, Б. А., Убайдуллаева, В. У., Вервекина, Т. А., Исраилов, Р. И.,
Мамиров, Б. Р., Эшбаев, Э. А., & Турсунов, Х. З. (2023). Поражения внутренних
органов при COVID-19 (обзор литературы и собственные данные). Вестник
экстренной медицины, 16(4), 72-80.
