A 30-year-old pregnant woman at 35.4 week-gestation who was exposed to COVID–19 positive patients developed a dry cough, nasal congestion, headache, and sore throat with no documented fever for few days. On March 23, a RT-PCR assay on a nasopharyngeal swab for COVID–19 done by national epidemiological survey came positive. On March 24, the patient was admitted to King Abdullah University Hospital (KAUH) with the same symptoms, her physical examination was reassuring with no signs of respiratory distress. She received Hydroxychloroquine 400 mg every 12 hours for one day then commenced on 200 mg twice daily for additional 9 days. Her condition continued to be stable and didn’t need antiviral or oxygen therapy.
On March 27, the mother developed spontaneous labor and a 2500-gram female infant was delivered by cesarean section at a gestational age of 36 weeks plus 3 days. Cesarean section was performed due to two previous uterine scars. APGAR scores were 8 at 1 minute and 9 at 5 minutes. At birth, the baby looked appropriate for gestational age. Her physical examination was benign apart from mild tachypnea with a respiratory rate of 70/ min. The neonate required supportive oxygen via nasal cannula at 2 liter per minute for less than an hour for a possible transient tachypnea, then weaned off oxygen and remained stable with no respiratory distress. Infant was then quarantined in an isolation room. RT- PCR test for COVID 19 was performed on amniotic fluid sample at the time of delivery, as well as on the baby’s nasopharyngeal swab taken immediately after delivery and on a sample of expressed breast milk obtained right after delivery. All three tests were reported negative. Also, another RT-PCR test on the baby’s nasopharyngeal swab was taken at the age of 4 days and was reported negative. Complete blood count, C-reactive protein, and liver function tests were done at the age of 48 hours and all were within normal limits. To avoid possible spread by direct contact, the infant continued to be isolated from her mother and was not offered direct breastfeeding. Her mother had two negative PCR tests for COVID–19 four days apart. The baby remained clinically stable, tolerated oral feeding of standard infant formula, had no concerning symptoms throughout the 7-day hospital stay and was discharged home in good general condition. The mother was given extensive counseling about contact precautions at home and an appointment with the health care providers was scheduled for follow up.