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22 april 2020

Late-Onset Neonatal Sepsis in a Patient with Covid-19 - NEJM

Late-Onset Neonatal Sepsis in a Patient with Covid-19 - NEJM

22-4-2020; 10.1056/NEJMc2010614
By: A.C. Munoz, et al. 

Aim: describe a case of neonatal covid-19 sepsis

Keys:

  • Although children are less likely than adults to have severe Covid-19, this case illustrates that it can occur and can be successfully managed with standard PICU protocols. The one exception to the standard protocol was that noninvasive mechanical ventilation was not attempted, since Covid-19 was suspected.

Summary:

  • 3-week-old boy presents with 2-day history of nasal congestion, tachypnea and reduced intake. 

     

    • Previously treated for suspected neonatal sepsis with 48-hour antibiotics because of fever. Sepsis work-up negative and therefore discharged. 
  • Few days later new ED presentation with:

     

    • temp 36.1, pulse 166/min, RR 90/60, resp rate 40/min, sat 87%
    • Chest radiograph: bilateral linear opacities and consolidations.
  • Patient was transferred to the PICU. Treatment: empiric antibiotics, intubation, vasopressors and crystalloid solution. 
  • Patient was placed in isolation and negative pressure room
  • Elevated lymphocytes and inflammatory markers
  • Cultures turned out negative. AB stopped after 48 hours. Start of hydroxychloroquine and azitromycine for presumed covid-19
  • On day 2 hypotension resolved. Patient develloped a pneumothorax treated with tube thoracostomy. 
  • Extubation on day 5 and transfer to peadiatric unit. 
  • On day 7 PCR turned out possitive for covid-19. 
  • Discharge on day 9 without supplemental oxygen. One of his eight household contacts had fever but none had been tested.