Respiratory Failure in an Extremely Premature Neonate with COVID-19
Vasantha H. S. Kumar,
Arun Prasath,
Clariss Blanco,
Patrick O. Kenney,
Christina M. Ostwald,
Tracy S. Meyer,
Cara F. Clementi,
Richard Maciejewski,
Mark T. Wilby,
Anne Marie Reynolds,
N Ja Hpa,
Karl O. A. Yu
Affiliations
Vasantha H. S. Kumar
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
Arun Prasath
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
Clariss Blanco
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
Patrick O. Kenney
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
Christina M. Ostwald
Division of Infection Prevention, John R. Oishei Children’s Hospital, Buffalo, NY 14203, USA
Tracy S. Meyer
Division of Infection Prevention, John R. Oishei Children’s Hospital, Buffalo, NY 14203, USA
Cara F. Clementi
Department of Pathology and Laboratory Medicine, Kaleida Health, Buffalo, NY 14203, USA
Richard Maciejewski
Department of Pathology and Laboratory Medicine, Kaleida Health, Buffalo, NY 14203, USA
Mark T. Wilby
Department of Pathology and Laboratory Medicine, Kaleida Health, Buffalo, NY 14203, USA
Anne Marie Reynolds
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
N Ja Hpa
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
Karl O. A. Yu
Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA
Coronavirus disease 2019 (COVID-19), a condition associated with SARS-CoV-2, typically results in mild infection in infants and children. However, children with risk factors such as chronic lung disease and immunosuppression have higher risk of severe illness from COVID-19. We report a case of a 27-week-gestation extremely premature infant born to a mother with COVID-19 infection. The infant, initially treated for surfactant deficiency, developed worsening hypoxic respiratory failure on the fifth day of life requiring escalating ventilatory support, an elevated level of C-reactive protein, thrombocytopenia, and an elevated level of d-dimer. The infant was positive for SARS-CoV-2 by RT-PCR from Day 1 to Day 42 of his life. The infant responded to a seven-day course of dexamethasone with a gradually decreasing oxygen requirement and could be extubated to non-invasive ventilation by the end of the fifth week after birth. The infant is currently on home oxygen by nasal cannula. Prolonged shedding of the virus may be a unique feature of the disease in premature infants. Extreme prematurity, immature lungs, and an immunocompromised status may predispose these infants to severe respiratory failure and a prolonged clinical course. Instituting appropriate COVID-19 protocols to prevent the spread of the disease in the neonatal intensive care unit (NICU) is of utmost importance. Infection with SARS-CoV-2 may have implications in the management of extremely premature infants in the NICU.
