Neonatal Coronavirus 2019 (COVID-19) Infection: A Case Report and Review of Literature

Abstract

Coronavirus disease 2019 , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic affecting 213 countries as of April 26, 2020. Although this disease is affecting all age groups, infants and children seem to be at a lower risk of severe infection, for reasons unknown at this time. We report a case of neonatal infection in New York, United States, and provide a review of the published cases. A 22-day-old, previously healthy, full-term neonate was hospitalized after presenting with a one-day history of fever and poor feeding. Routine neonatal sepsis evaluation was negative. SARS-CoV-2 polymerase chain reaction (PCR) testing was obtained, given rampant community transmission, which returned positive. There were no other laboratory or radiographic abnormalities. The infant recovered completely and was discharged home in two days once his feeding improved. The family was advised to self-quarantine to prevent the transmission of COVID-19. We believe that the mode of transmission was horizontal spread from his caregivers. This case highlights the milder presentation of COVID-19 in otherwise healthy, full-term neonates. COVID-19 must be considered in the evaluation of a febrile infant. Infants and children may play an important role in the transmission of COVID-19 in the community. Hence, with an understanding of the transmission patterns, parents and caregivers would be better equipped to limit the spread of the virus and protect the more vulnerable population.

Case report of a neonate with high viral SARSCoV-2 loads and long-term virus shedding

“…The mother had not previously been infected and was not infected by this neonate during the period of viral shedding despite the high viral load. As described in current literature, symptoms of COVID-19 in newborns were mild, or even none with complete recovery; which is consistent in our case report [ 7 , 10 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ]. In most cases, the mother was infected and probably transmitted horizontally to the neonate.…”

“…Eligible studies (including case reports, case series, cohort studies and retrospective studies) published in English-language journals that have described neonates diagnosed with COVID-19 were included for analysis. We summarized the studies involving neonates in Table 2A , Table 2B [ 10 , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ]. Most of these neonates had an infected mother and were asymptomatic (n = 7) or became symptomatic after 16 hours until 17 days after birth (n = 20).…”

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

“…Inflammatory markers were often elevated and described as a multisystemic manifestation, sometimes leading to multiorgan dysfunction complications. 13 , 23 , 31 Hematologic and lymphatic manifestations were also reported, with variations in leukocytes, 18 , 24 , 37 lymphocytes, 17 , 19 , 24 neutrophil count, 17 , 18 , 40 and erythrocyte sedimentation rate. 31 Twelve cases of lymphadenopathy were described.…”

“…Acute kidney injury was identified in 38 patients, 16 , 20 representing a frequent complication. Cardiac manifestations were often described as alterations in myocardial enzymes, 18 , 24 , 34 tachycardia, 26 , 27 , 34 , 36 , 37 , 38 and shock, 16 with eight and 25 presentations, respectively. Vascular manifestations included aneurysms 26 and ischaemic infarctions 15 were identified and associated with obesity.…”

“… 12 However, due to the outrageous number of infected children, some fatal cases are being reported, associated with extrapulmonary complications, pointing to a need of medical and scientific attention. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 …”