Abstract Number: Esoc2026lb184 Prospective Cohort Study of Predictors of Infection-Associated Cerebrovascular Injury in Neonates

Abstract Background and aims TORCH infection has been the main trigger of early neurological disorders in children of early age causing many discussions between scientists for decades. However, since 2019 pandemics SARS-CoV-2 has become the center of debates upon the possibility of the vertical transmission of virus thus causing a perinatal brain damage the later outcome of which is still not yet fully understood. Methods We had a prospective cohort study of 129 mothers and their children born in Tashkent maternity hospitals #7 and #1. The umbilical cord blood samples were collected for qualitative express testing for TORCH and SARS-CoV-2 right after the delivery and the heel blood. Neurological severity was assessed by Sarnat staging. Neurosonography and Doppler were performed in the first month. Logistic regression with ROC analysis identified predictors of CNS injury. Results Only 16.5% of neonates showed no neurological abnormalities. Sarnat staging revealed Stage I in 51.2%, Stage II in 34.9%, and Stage III in 14.0%; mortality was 6.2% (8/129). Independent predictors of adverse outcome were positive SARS-CoV-2 rapid test (OR 4.6), pathological neurosonography (OR 5.1), low Apgar score (OR 2.9; p=0.017), and impaired cerebral blood flow (OR 3.2). The model showed an AUC of 0.992 with 83.5% accuracy. Conclusions Vertical transmission of SARS-CoV-2 was frequently detected and was associated with perinatal brain injury, particularly in preterm neonates with cerebral circulatory disturbances. Integration of early clinical assessment, rapid infection testing, neurosonography, and Doppler parameters enables early neurological risk stratification. External validation in independent cohorts is required before routine implementation. Conflict of interest