Severe Neonatal Coronavirus Disease 2019 Presenting as Acute Respiratory Distress Syndrome

Trieu, Connie; Poole, Claudette; Cron, Randy Q; Hallman, Madhura; Rutledge, Chrystal; Bliton, Kyle; Phillips, A. James; Lawrence, Maggie; Boppana, Suresh B.; Pinninti, Swetha

doi:10.1097/inf.0000000000002864

Cited by 17 publications

(15 citation statements)

References 8 publications

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Section: Discussionmentioning

confidence: 99%

“…Data on the use of corticosteroids in neonatal COVID‐19 are limited, 6,8,10 but these drugs have been used for a long time in neonatal medicine for purposes other than infections. While in two cases of neonatal COVID‐19 steroids were used late during the disease course and in combination with antiviral therapy without complications directly related to steroid treatment, 6,10 in another case a significant clinical, radiological, and laboratory worsening was described following two doses of dexamethasone 8 . In the present newborn the beneficial effect of weaning the neonate from mechanical ventilation was counterbalanced by the onset of bacterial sepsis and a significant worsening of the CXR, in which a contribution of both steroid‐related immunosuppression and SARS‐CoV‐2 induced immunosuppression and uncontrolled replication could have had a role.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, early reports on neonatal SARS‐CoV‐2 infections were reassuring, with most cases showing an asymptomatic course or rarely symptomatic uncomplicated diseases 3,4 . As the pandemic evolved, however, reports of neonatal acute respiratory distress syndrome have been increasingly published, 5–10 raising concerns about the most appropriate diagnostic and therapeutic management of infected neonates.…”

Section: Introductionmentioning

confidence: 99%

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Severe neonatal COVID‐19: Challenges in management and therapeutic approach

Marsico

Capretti

Aceti

et al. 2021

Journal of Medical Virology

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Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the etiological agent of coronavirus disease 2019 (COVID‐19), may manifest as a life‐threatening respiratory infection with systemic complications. Clinical manifestations among children are generally less severe than those seen in adults, but critical cases have increasingly been reported in infants less than 1 year of age. We report a severe case of neonatal COVID‐19 requiring intensive care and mechanical ventilation, further complicated by a multidrug‐resistant Enterobacter asburiae super‐infection. Chest X‐rays, lung ultrasound, and chest computed tomography revealed extensive interstitial pneumonia with multiple consolidations, associated with persistent increased work of breathing and feeding difficulties. SARS‐CoV‐2 RNA was detected in respiratory specimens and stools, but not in other biological samples, with a rapid clearance in stools. Serological tests demonstrated a specific SARS‐CoV‐2 antibody response mounted by the neonate and sustained over time. The therapeutic approach included the use of enoxaparin and steroids which may have contributed to the bacterial complication, underlying the challenges in managing neonatal COVID‐19, where the balance between viral replication and immunomodulation maybe even more challenging than in older ages.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Severe neonatal COVID‐19: Challenges in management and therapeutic approach

Marsico

Capretti

Aceti

et al. 2021

Journal of Medical Virology

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“…One newborn had a positive assay on postnatal day two but was not ill thereafter [83]. Some infants developed symptomatic respiratory infection by days 4-15 [76,260,[262][263][264][265][266][267]. Four other newborn infections appeared to have occurred despite maternal Caesarean section and physical separation [261,268].…”

Section: Neonatal Infectionsmentioning

confidence: 99%

A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19

Cimolai

2021

SN Compr. Clin. Med.

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The maternal-fetal/newborn unit is established at risk for COVID-19 infection. This narrative review summarizes the contemporary and cumulative publications which detail maternal infection, antenatal and newborn infections, and maternal/fetal/newborn management and prevention. There is a wide spectrum of maternal disease, but the potential for severe disease albeit in a minority is confirmed. COVID-19 carries risk for preterm delivery. Pregnant females can suffer multisystem disease, and co-morbidities play a significant role in risk. Congenital infection has been supported by several anecdotal reports, but strong confirmatory data are few. No typical congenital dysmorphisms are evident. Nevertheless, placental vascular compromise must be considered a risk for the fetus during advanced maternal infections. Clinical manifestations of newborn infection have been mild to moderate and relatively uncommon. Proven antiviral therapy is of yet lacking. The mode of delivery is a medical decision that must include patient risk assessment and patient directives. Both presymptomatic and asymptomatic mothers and offspring can complicate infection control management with the potential for spread to others in several regards. In the interim, infections of the maternal-fetal-newborn unit must be taken seriously both for the disease so caused and the potential for further dissemination of disease.

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“…In neonates, COVID-19 most often presents with fever and mild respiratory symptoms, though it may present with gastrointestinal symptoms and abdominal distension in a subset of neonates (Golden and Simmons, 2020;Karabay et al, 2020;Marin Gabriel et al, 2020;Ng et al, 2020;Smith et al, 2020). However, there have been case reports of COVID-19 presenting with severe ARDS in the neonatal population (Frauenfelder et al, 2020;Kalyanaraman et al, 2020;Trieu et al, 2020;Wardell et al, 2020).…”

Section: Prematurity Cigarette Smoke Exposure and Covid-19mentioning

confidence: 99%

Cigarette Smoke Exposure, Pediatric Lung Disease, and COVID-19

et al. 2021

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The detrimental effects of tobacco exposure on children’s health are well known. Nonetheless, the prevalence of secondhand or direct cigarette smoke exposure (CSE) in the pediatric population has not significantly decreased over time. On the contrary, the rapid incline in use of e-cigarettes among adolescents has evoked public health concerns since increasing cases of vaping-induced acute lung injury have highlighted the potential harm of these new “smoking” devices. Two pediatric populations are especially vulnerable to the detrimental effects of cigarette smoke. The first group is former premature infants whose risk is elevated both due to their prematurity as well as other risk factors such as oxygen and mechanical ventilation to which they are disproportionately exposed. The second group is children and adolescents with chronic respiratory diseases, in particular asthma and other wheezing disorders. Coronavirus disease 2019 (COVID-19) is a spectrum of diseases caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has spread worldwide over the last year. Here, respiratory symptoms ranging from mild to acute respiratory distress syndrome (ARDS) are at the forefront of COVID-19 cases among adults, and cigarette smoking is associated with worse outcomes in this population, and cigarette smoking is associated with worse outcomes in this population. Interestingly, SARS-CoV-2 infection affects children differently in regard to infection susceptibility, disease manifestations, and complications. Although children carry and transmit the virus, the likelihood of symptomatic infection is low, and the rates of hospitalization and death are even lower when compared to the adult population. However, multisystem inflammatory syndrome is recognized as a serious consequence of SARS-CoV-2 infection in the pediatric population. In addition, recent data demonstrate specific clinical patterns in children infected with SARS-CoV-2 who develop multisystem inflammatory syndrome vs. severe COVID-19. In this review, we highlight the pulmonary effects of CSE in vulnerable pediatric populations in the context of the ongoing SARS-CoV-2 pandemic.

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Severe Neonatal Coronavirus Disease 2019 Presenting as Acute Respiratory Distress Syndrome

Cited by 17 publications

References 8 publications

Severe neonatal COVID‐19: Challenges in management and therapeutic approach

Severe neonatal COVID‐19: Challenges in management and therapeutic approach

A Comprehensive Analysis of Maternal and Newborn Disease and Related Control for COVID-19

Cigarette Smoke Exposure, Pediatric Lung Disease, and COVID-19

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