Necrotizing Enterocolitis as a Presenting Symptom of SARS-CoV-2 Infection in Premature Twins

Melissa Vos, Demi Jenna Timmermans, Janneke Hinke Kreijen-Meinesz, Jantien Wieringa, Luc Filippini

Abstract

Data on the signs and symptoms of severe acute respiratory syndrome coronavirus (SARS-CoV)-2 infection in preterm neonates are limited. We describe a case of premature twins with gastrointestinal (GI) symptoms, both testing positive for SARS-CoV-2 infection. After 7 days of birth, the first of the twins had classic clinical signs of necrotizing enterocolitis (NEC) Bell’s stage 1B. Both the nasopharyngeal and fecal reverse transcription polymerase chain reaction tests for SARS-CoV-2 were positive, and a few days later, she developed mild respiratory symptoms. Her twin sister also tested positive for SARS-CoV-2 on the same day (both nasopharyngeal and fecal). One day after the positive RT-PCR report, she had slight distension of the abdomen and started vomiting. Later, she developed mild respiratory symptoms.

GI symptoms are the common presenting symptoms of the SARS-CoV-2 infection, especially in children. To our knowledge, we are the first to report NEC as the presenting symptom of SARS-CoV-2 infection in premature twins. The link between SARS-CoV-2 infection and NEC seems plausible in this case. During the current pandemic, NEC should not automatically be attributed to prematurity alone, as it could also be triggered by a SARS-CoV-2 infection. This justifies lowering the threshold for testing preterm neonates for SARS-CoV-2.