COVID-19 in Neonates: A Case Series

Petya Angelova Radulova, Violeta Ivanova Dimitrova, Boriana Petrova Slancheva

Abstract

Background: The WHO named the novel coronavirus infection as COVID-19 on January 7, 2020; it is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The incidence, signs, and symptoms of COVID-19 infection in children are different than those observed in adults. In children, the severity of the infection is mostly mild, but diagnosis and treatment become challenging due to unusual medical presentations and different modes of transmission (eg, vertical transmission).

Case Presentation: We analyzed the symptoms, diagnostic procedures, and challenges faced during the treatment of 3 neonates born to their respective asymptomatic mothers who tested positive in real-time polymerase chain reaction (RT-PCR) for SARS-CoV-2. Of the 3 neonates, 1 was a late preterm neonate and 2 were full-term neonates. All the 3 neonates were retained in the quarantine ward.

One of the neonates developed respiratory distress syndrome within the first 24 hours of birth and was on mechanical ventilation for 3 days. Radiography and lung ultrasound showed inflammation in the lungs. Another neonate had elevated C-reactive protein levels and hence was treated with antibiotics. In all the 3 neonates, platelet count and leukocyte count were normal, but lactate dehydrogenase levels were elevated. The throat and nasopharyngeal swab samples and tracheal aspirate were tested using RT-PCR between the first and seventh day after their birth, and all 3 tested negative for SARS-CoV-2. The 3 neonates were discharged after treatment, according to specific discharge criteria.

Conclusion: Perinatal COVID-19 infection may result in adverse effects such as fetal distress, premature labor, and respiratory distress syndrome. The infection also leads to abnormal laboratory findings.