Perinatally Acquired COVID-19 Requiring ECMO with Severe Hematologic Complications

ABSTRACT

Case Report Perinatal acquisition of COVID-19 in neonates is uncommon and development of severe pulmonary disease remains extremely rare. Thus far, there have been no reports of otherwise healthy neonates requiring extracorporeal life support (ECLS) for ARDS secondary to COVID-19. Further, little is known about the hematologic implications of COVID-19 in the neonatal population. We report the first perinatally acquired case of COVID-19 requiring ECLS and describe associated hematologic complications. The patient was a 35-week gestational age twin infant, born to an asymptomatic COVID-19 positive mother. The infant was COVID-19 PCR positive just after birth, though asymptomatic. She presented on day of life 9 with respiratory distress and hypoxia. She had progressive respiratory failure and at 2 weeks of life was placed on veno-venous (VV) extracorporeal life support (ECLS). On post-operative day 1 there was development of a bi-atrial clot requiring open thrombectomy and conversion to veno-arterial (VA) ECLS with an open chest. Three days post-thrombectomy, despite therapeutic anticoagulation with heparin, the circuit oxygenator developed significant clot burden leading to oxygenator failure and requiring circuit change. Five days post-thrombectomy, patient developed severe, persistent hemorrhage after chest closure despite discontinuation of heparin anti-coagulation therapy and was transitioned to comfort care per parental request. Whole exome sequencing was negative with no evidence of innate hematologic disease. Conclusion: This case highlights the rare, though significant, risk COVID-19 infection can potentially impose on pulmonary and hematologic systems of an infected neonate.