A Case Report of a Neonate with Severe Covid Pneumonitis

ABSTRACT

Aims Literature describes that most neonates with SARS-CoV-2 infection are asymptomatic or present with mild symptoWe describe an ex-preterm twin infant, born at 31+5 with birthweight 1600g, who deteriorated with COVID pneumonitis at 34 weeks corrected gestational age. They were an inpatient in a level 3 neonatal centre, with an uncomplicated stay prior to becoming unwell and had never been ventilated in their early neonatal course. Methods They acquired postnatal covid on day 24 of life, and deteriorated over the next 72 hours, escalating from high flow to CPAP then BiPAP, and finally requiring intubation. They were empirically commenced on antibiotics and required sedation and muscle relaxation to manage their worsening respiratory failure. Given their acute respiratory decompensation in the context of COVID, and with negative extended virology and bacterial testing otherwise, they were managed on a presumptive diagnosis of COVID pneumonitis. CXRs were consistent with this diagnosis. Despite further escalation in their ventilation strategies, including high frequency oscillatory ventilation and inhaled nitric oxide, they continued to deteriorate with severe hypoxic respiratory failure. Inotropic support was required to maintain cardiac stability. There was extensive MDT discussion between NICU, PICU and the Infectious Diseases teaDue to the severity of their condition, Remdesivir was commenced and the parents were fully informed of the trial nature of the drug and the guarded prognosis. Hydrocortisone was also commenced. Results Due to ongoing deterioration, the patient was transferred to PICU for ongoing care and consideration of ECMO. However, the infant stabilised and the hydrocortisone that had been commenced was switched to methylprednisolone. The Remdesivir was discontinued after 2 doses due to a worsening in LFTs. The situation was further complicated by COVID isolation guidelines while keeping family centred care at the heart of our approach, working within infection control policies and managing a relatively unfamiliar pathology in the neonatal population. Conclusion The infant progressed well and was extubated onto nasal cannula oxygen on day 40 of life and repatriated to our neonatal unit on day 41 at 37+4 corrected gestational age. They had an uneventful stay in our SCBU, establishing feeding, until discharge with home oxygen at 41+1 weeks corrected gestational age.