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

Abstract

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.

Global Coinfections with Bacteria, Fungi, and Respiratory Viruses in Children with SARS-CoV-2: A Systematic Review and Meta-Analysis

“…COVID-19 children coinfected with bacteria, fungi, and/or respiratory viruses were reported to have received antibiotics in 77 studies [5,8,9,[12][13][14][15][16][19][20][21][22][23]36,[38][39][40]42,45,46,[50][51][52]55,56,59,60,[63][64][65][66][67][68][69][70]72,[74][75][76][77]80,[86][87][88]90,92,93,[96][97][98]100,…”

Early-Onset Neonatal Sepsis in a COVID-19 Infected Neonate

“…As data on neonatal covid-19 infection are scarce, not many therapeutic options have been tried in this population. There are case reports of using remdesivir, 8 intravenous immunoglobulin 9 (IVIG), and steroids 10 for severe neonatal COVID-19 infection. Marsico et al 10 also used enoxaparin on their patient for a progressive rise in d-dimer.…”

“…There are case reports of using remdesivir, 8 intravenous immunoglobulin 9 (IVIG), and steroids 10 for severe neonatal COVID-19 infection. Marsico et al 10 also used enoxaparin on their patient for a progressive rise in d-dimer. Due to paucity of data and constantly changing landscape of COVID-19, decision to use these therapeutic options should be made on case-by-case basis in consultation with the experts.…”

COVID-19 among infants: key clinical features and remaining controversies

“…In addition to the above, studies have published unique presentations such as bronchiolitis, parotitis, croup, bradycardia, arrhythmias, cardiomyopathy, acute kidney injury, necrotizing enterocolitis, late-onset sepsis, and coagulopathy/thrombosis [ 27 , 55 , 61 , 67 - 72 ]. The need for ventilator support is rare [ 61 , 73 , 74 ]. Many reports are complicated by occasional bacterial coinfection early or late in the COVID-19 disease course, and underlying comorbidities may also present with associated overlapping symptoms and signs.…”