Extremely Preterm Infant Born to a Mother With Severe COVID-19 Pneumonia

Abstract

Little is known about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnant women, fetuses, and neonates, especially when the virus is contracted early in pregnancy. The literature is especially lacking on the effects of SARS-CoV-2 on extremely preterm (<28 weeks gestation) infants who have underdeveloped immune systems. We report the case of an extremely preterm, 25-week 5-days old infant, born to a mother with severe COVID-19 (coronavirus disease-2019) pneumonia. In this case, there is no evidence of vertical transmission of SARS-CoV-2 based on reverse transcription-polymerase chain reaction testing, despite extreme prematurity. However, it appears that severe maternal COVID-19 may have been associated with extremely preterm delivery, based on observed histologic chorioamnionitis. This is the first reported case of an extremely preterm infant born to a mother with severe COVID-19 pneumonia who required intubation, and was treated with hydroxychloroquine, azithromycin, remdesivir, tocilizumab, convalescent plasma, inhaled nitric oxide, and prone positioning for severe hypoxemic respiratory failure prior to and after delivery of this infant. The infant remains critically ill with severe respiratory failure on high-frequency ventilation, inotropic support, hydrocortisone for pressor-resistant hypotension, and inhaled nitric oxide for severe persistent pulmonary hypertension with a right to left shunt across the patent ductus arteriosus and foramen ovale. Pregnant women or women planning to get pregnant should take all precautions to minimize exposure to SARS-CoV-2 to decrease adverse perinatal outcomes.

Convalescent Plasma for Pregnant Women with COVID-19: A Systematic Literature Review

“…At that point, 13 articles were assessed for eligibility [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. After reading the full texts, one article was removed: Chong et al [ 15 ] reported the case of a 41-year-old woman, 32 weeks pregnant, who developed severe acute respiratory distress syndrome (ARDS) from SARS-CoV-2 infection, necessitating emergency Cesarean section in the intensive care room.…”

“…At the end of the assessment phase, 12 records were included in this review; all were case reports involving a total of 12 pregnancies [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. Table 1 presents the characteristics of the studies included in the final review.…”

“…According to this assessment, the overall quality of the studies included in this systematic review was low. The reports originated from the USA ( n = 5) [ 19 , 20 , 24 , 26 , 27 ], Italy ( n = 2) [ 17 , 22 ], Iran ( n = 2) [ 16 , 18 ], Mexico [ 23 ], Qatar [ 21 ] and China [ 25 ]. The age of the women ranged between 22 [ 20 ] and 42 years [ 27 ].…”

“…No comorbidity was declared in five cases [ 18 , 22 , 23 , 25 , 27 ]. Two women had one comorbid condition (obesity) [ 16 , 17 ] and five had multiple comorbid conditions [ 19 , 20 , 21 , 24 , 26 ]. The gestational age at CP treatment ranged between 21 + 2 [ 16 ] and 36 + 2 [ 24 ] weeks.…”

“…All patients received other medications during their stay in hospital: antivirals of the nucleotide analogue class (remdesivir, n = 5), protease inhibitors (lopinavir/ritonavir; n = 4), steroids ( n = 8), heparin ( n = 7), hydroxychloroquine ( n = 5) and humanized monoclonal antibodies (tocilizumab, n = 2). Additional maternal interventions were described in nine patients, of whom six were given invasive mechanical ventilation, three received extracorporeal membrane oxygenation [ 21 , 25 , 27 ] and three required tracheostomy [ 20 , 22 , 27 ].…”