At 32 weeks’ gestation, a 21-year-old multigravida underwent a Cesarean section to give birth to a boy child of Spanish descent.
After being brought to the intensive care unit (ICU) with pneumonia and multisystem disease, the mother was tested for SARS-CoV-2 at 27 weeks of pregnancy using a nasopharyngeal swab reverse transcription polymerase chain reaction (NP RT-PCR). Both the ultrasound evaluations and the fetal monitoring reports were continuously normal.
After giving prenatal corticosteroids to promote fetal lung development, a cesarean section was carried out for maternal reasons at 32 weeks of gestation.
At this point, the mother’s SARS-CoV-2 test results were negative. The newborn’s umbilical cord arterial blood gas has a pH of 7.22 and pCO2 and an Apgar score of four at one minute and seven at five minutes.
with a base excess of 11. of 97 mm Hg. The infant’s seizure-like behavior and breathing problems necessitated intubation and assisted ventilation.
Early hypotension and biventricular systolic depression identified by echocardiography were treated with vasopressors. Despite the early use of broad-spectrum antibiotics and surfactants, the lung disease persisted.
Upon respiratory recovery, the bilateral confluent densities seen on the first chest radiograph did not completely disappear. At 24 hours of age, the infant underwent NP RT-PCR and was found to be SARS-CoV-2 negative.
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The infant’s seizures were resolved, and antiepileptics were stopped. However, the infant had to be readmitted multiple times due to respiratory infections and failure to thrive.
The patient’s 12-month neurologic examination showed persistent abnormalities, including head lag, elevated appendicular tone, truncal hypotonia, delayed developmental features, and hyperreflexia. The child experienced an upper respiratory infection and visited the emergency department at 13 months old.
The infant was found unresponsive in bed by his mother three days later. Paramedics arrived and found the infant in asystolic cardiac arrest but could not revive him.
Case report 2: full-term infant
A Hispanic female infant with a gestational age of 39 weeks was born to a 20-year-old first-time mother. The mother had tested positive for asymptomatic SARS-CoV-2 in the second trimester but later tested negative.
The mother tested positive for COVID-19 during vaginal delivery, despite being asymptomatic. The newborn received Apgar scores of four at one minute and six at five minutes and revealed an umbilical cord arterial blood gas with a pH of 7.22, pCO2 of 47 torrs, and base deficit of 10.
The patient needed nasal continuous positive airway pressure to treatapnea and was treated with antibiotics for suspected sepsis. The physical examination showed mild hypotonia.
Clinical seizures were verified on continuous conventional electroencephalography when the infant was 16 hours old. The infant’s 24-hour SARS-CoV-2 RT-PCR tested negative. However, their SARS-CoV-2 immunoglobin G (IgG); combined IgA, IgG, and IgM reactivity against a SARS-CoV-2 spike recombinant derivative, cytokines, and inflammatory markers were significantly elevated.
