COVID-19 and ECMO support after neonatal congenital heart surgery: a case report

Çiçek, Murat; Önalan, Mehmet Akif; Yurtseven, Nurgül

doi:10.1017/s1047951121002511

Cited by 5 publications

(6 citation statements)

References 12 publications

(21 reference statements)

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“…Cardiac abnormalities may have an impact on disease progression. There have been documented cases of acute respiratory distress in COVID-19 positive neonates after congenital heart surgery or with medically-treated PDA (35)(36)(37). These findings indicate that the predisposition to severe COVID-19 seen in adult and pediatric patients may extend to neonatal patients as well (38).…”

Section: Discussionmentioning

confidence: 93%

Epidemiology of Neonatal COVID-19 in the United States

et al. 2022

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OBJECTIVE Data on COVID-19 infections in neonates are limited. We aimed to identify and describe the incidence, presentation, and clinical outcomes of neonatal COVID-19. METHODS Over 1 million neonatal encounters at 109 US health systems, from March 2020 to February 2021, were extracted from the Cerner® Real World Database. COVID-19 diagnosis was assessed using SARS-CoV-2 laboratory tests and diagnosis codes. Neonates were defined as patients aged ≤28 days on hospital admission. Incidence of COVID-19 per 100,000 encounters was estimated. RESULTS COVID-19 was diagnosed in 918 (0.1%) neonates (or 91.1/100,000 encounters [95% CI 85.3 – 97.2]). Of these, 71 (7.7%) had severe infection (7/100,000 [95% CI 5.5 – 8.9]). Median time to diagnosis was 14.5 days from birth (interquartile ratio 3.1 – 24.2). Common signs of infection were tachypnea and fever. Those with severe infection were more likely to receive respiratory support (50.7% vs 5.2%, p <0.001). Severely ill neonates received analgesia (38%), antibiotics (33.8%), anticoagulants (32.4%), corticosteroids (26.8%), remdesivir (2.8%) and COVID-19 convalescent plasma (1.4%). A total of 93.6% neonates were discharged home, 1.1% were transferred to another hospital, and discharge disposition was unknown for 5.2%. One neonate (0.1%) with presentation suggestive of Multisystem Inflammatory Syndrome in Children died after 11 days of hospitalization. CONCLUSION Most neonates infected with SARS-CoV-2 were asymptomatic or developed mild illness without need for respiratory support. Some neonates had severe illness requiring treatment for COVID-19 with remdesivir and CCP. Thus, SARS-CoV-2 infection in neonates, though rare, may result in severe disease.

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Section: Discussionmentioning

confidence: 93%

Epidemiology of Neonatal COVID-19 in the United States

et al. 2022

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“…We identified 312 articles through the initial database search and the subsequent manual search. After removing 207 items based on the title and abstract, we reviewed the full text of 105 articles and included 44 studies (total number of ECMO use = 110) in the systematic review (8, 9, 11–14, 19–56). In particular, three studies with relatively large sample sizes (number of ECMO use = 42, 31, and 69) were excluded because they did not provide clinical data of patients on ECMO separately (57–59).…”

Section: Resultsmentioning

confidence: 99%

“…In particular, three studies with relatively large sample sizes (number of ECMO use = 42, 31, and 69) were excluded because they did not provide clinical data of patients on ECMO separately (57–59). Of the 44 articles, 18 were retrospective observational studies (8, 9, 14, 19–33), four were case series (11–13, 34), and 22 were case reports (35–56). Among the total of 22 observational studies and case series, 10 studies included only one ECMO patient (12, 14, 27–34).…”

Section: Resultsmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Watanabe

Yasuhara

Karube

et al. 2022

Pediatric Critical Care Medicine

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OBJECTIVES: The indication, complications, and outcomes of extracorporeal membrane oxygenation (ECMO) in children with COVID-19–related illnesses remain unelucidated. Our study aimed to investigate the characteristics and outcomes of ECMO in children with COVID-19–related illnesses. DATA SOURCES: We searched PubMed and EMBASE databases in March 2022. STUDY SELECTION: We retrieved all studies involving children (age ≤ 18 yr) with COVID-19–related illnesses who received ECMO. DATA EXTRACTION: Two authors independently extracted data and assessed the risk of bias. Mortality, successful weaning rate, and complications while on ECMO were synthesized by a one-group meta-analysis using a random-effect model. Meta-regression was performed to explore the risk factors for mortality. DATA SYNTHESIS: We included 18 observational studies, four case series, and 22 case reports involving 110 children with COVID-19–related illnesses receiving ECMO. The median age was 8 years (range, 10 d to 18 yr), and the median body mass index was 21.4 kg/m 2 (range, 12.3–56.0 kg/m 2 ). The most common comorbidities were obesity (11% [7/63]) and congenital heart disease (11% [7/63]), whereas 48% (30/63) were previously healthy. The most common indications for ECMO were multisystem inflammatory syndrome in children (52% [47/90]) and severe acute respiratory distress syndrome (40% [36/90]). Seventy-one percent (56/79) received venoarterial-ECMO. The median ECMO runtime was 6 days (range, 3–51 d) for venoarterial ECMO and 11 days (range, 3–71 d) for venovenous ECMO. The mortality was 26.6% (95% CI, 15.9–40.9), and the successful weaning rate was 77.0% (95% CI, 55.4–90.1). Complications were seen in 37.0% (95% CI, 23.1–53.5) while on ECMO, including stroke, acute kidney injury, pulmonary edema, and thromboembolism. Corticosteroids and IV immunoglobulin therapies were associated with lower mortality. CONCLUSIONS: The mortality of children on ECMO for COVID-19 was relatively low. This invasive treatment can be considered as a treatment option for critically ill children with COVID-19.

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“…At the time of this report, there have only been a few cases reported of neonates who were supported on ECMO for COVID-19. Both reported cases involved neonates with congenital heart disease, one pre-and the other post-op with only one of those neonates surviving to discharge (16,17). Compared to other published case reports, our patient had a more rapid progression from diagnosis to intubation and need for ECMO support, and he also had a longer duration of ECMO (18).…”

Section: Discussionmentioning

confidence: 59%

Extracorporeal membrane oxygenation in the care of a preterm infant with COVID-19 infection: Case report

Patrick-Esteve

Mumphrey

et al. 2022

Front. Pediatr.

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Coronavirus disease 2019 (COVID-19) was first reported to the World Health Organization (WHO) in December 2019 and has since unleashed a global pandemic, with over 518 million cases as of May 10, 2022. Neonates represent a very small proportion of those patients. Among reported cases of neonates with symptomatic COVID-19 infection, the rates of hospitalization remain low. Most reported cases in infants and neonates are community acquired with mild symptoms, most commonly fever, rhinorrhea and cough. Very few require intensive care or invasive support for acute infection. We present a case of a 2-month-old former 26-week gestation infant with a birthweight of 915 grams and diagnoses of mild bronchopulmonary dysplasia and a small ventricular septal defect who developed acute respiratory decompensation due to COVID-19 infection. He required veno-arterial extracorporeal membrane oxygenation support for 23 days. Complications included liver and renal dysfunction and a head ultrasound notable for lentriculostriate vasculopathy, extra-axial space enlargement and patchy periventricular echogenicity. The patient was successfully decannulated to conventional mechanical ventilation with subsequent extubation to non-invasive respiratory support. He was discharged home at 6 months of age with supplemental oxygen via nasal cannula and gastrostomy tube feedings. He continues to receive outpatient developmental follow-up. To our knowledge, this is the first case report of a preterm infant during their initial hospitalization to survive ECMO for COVID-19.

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COVID-19 and ECMO support after neonatal congenital heart surgery: a case report

Cited by 5 publications

References 12 publications

Epidemiology of Neonatal COVID-19 in the United States

Epidemiology of Neonatal COVID-19 in the United States

Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

Extracorporeal membrane oxygenation in the care of a preterm infant with COVID-19 infection: Case report

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