Severe form of COVID-19 in a neonate with resuscitated cardio-respiratory arrest - Case presentation
Authors:   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Jugulete Gheorghita ,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Panciu Andreea Madalina ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Safta Mihaela ,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Borcos Bianca ,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Marin Luminita ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Gheorghe Elena ,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Zah Luciana ,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Negrea Delia ,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania, Merisescu Madalina Maria ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,   “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest, Romania
Published: July 2023

SARS-CoV-2 infection is usually a self-limiting viral infection in healthy children. Still, it’s effects on the neonatal population remain largely unknown. There has been evidence of adverse events on neonates, mostly consisting in case reports of patients with severe forms of COVID-19 and also recent cohort studied of the pediatric population including the neonatal subgroup. The clinical presentation appears different in the neonatal patients in contrast with older children, and may manifest also as a life-threatening respiratory infection with systemic complications. In this paper we present a clinical case of a premature boy with a corrected age of 40 weeks at admission to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on suggestive clinical picture (fever, dry couch, rhinorrhea, loose stools and inappetence) and confirmed by SARS-CoV-2 rapid antigen test. Laboratory investigations at admission showed only moderate to severe anemia, mild inflammatory syndrome and a mild neonatal hyperbilirubinemia, with normal leukocyte count, normal glycaemia, ionograme and blood gases. Chest x-ray showed moderate interstitial pneumonia. In the second day of admission, after 24h of favorable evolution, with no fever and present appetite, he suddenly presented during defecation a presumptive vasovagal syndrome, with general hypotonia and a short period of desaturation. Laboratory investigations made during the episode showed normal glycaemia, normal ionograme, normal blood gases, moderate-severe anemia and important metabolic acidosis. A new chest x-ray showed evolution of the interstitial pneumonia. We did a blood transfusion and continued antiviral treatment, antibiotic treatment and perfusions. He maintained normal pulmonary and cardiac function for another 6 hours, after which he presented a tonic-clonic seizure and after administration of intrarectal benzodiazepines he presented cardio-pulmonary arrest. He was resuscitated, intubated and sedated and transfer to a children ICU. 2 weeks later after admission in the ICU he was discharged with favorable outcome. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, COVID-19 in neonates can have an unpredicted course. Rapid evolution to sever forms can be a possible disease outcome. Preterm birth with associated complications like bronchodysplasia or anemia, can predispose to sever evolution of the disease, and this child must be kept safe. There is also a neurotropic potential of the SARS-CoV-2 virus that has to be followed.