Newborn from a 25-year-old mother, gravida 3, para 2 (G3 P2); 34 weeks of gestation with no history of chronic conditions (diabetes, high blood pressure, obesity or asthma).The urogenital infections had not been documented but she had presented fever measured between 39 ° and 40 ° C.
Her husband was listed as a contact with a confirmed case of COVID-19 in the town of Bukavu in South Kivu. The nasopharyngeal swabs for SARS-CoV-2 RT-PCR taken from the mother were confirmed positive by the national laboratory (INRB-Kinshasa).
She was referred by the medical team from the COVID-19 isolation center where she had been staying for 7 days for the management of a threat of premature delivery in a background of coronavirus disease. Treatments received: antibiotic therapy, tocolysis and administration of dexamethasone for pulmonary maturation of the fetus.
The delivery took place by cesarean section in an operating room. There was a barrier between the mother and the medical team; she was wearing a surgical mask and the medical team wore personnel protective equipment ( sterile gowns,N95 mask, face shields and sterile gloves). The newborn was female, Agpar score 9 at 1 minute and 10 at 5 minutes; weighing 1760 g, measuring 44 cm in size and 30 cm in cranial perimeter. The mother did not hold the baby of delivery; usual care were performed for the newborn (wipe and drying the skin, stimulation, administration of vitamin K1, eyes and cord care).
Immediately after birth a blood sample was drown for SARS-COV-2 serological testing; The IgG and IgM returned negative. The nasopharyngeal swabs for the SARS-CoV-2 RT- PCR was sent to the laboratory of the INRB-Kinshasa. A gastric survey was carried out, the swabs (ear, umbilical cord) as well as blood cultures were taken. The newborn was isolated with her mother in a personal room according to the recommendations for the care of the newborn in the context of an epidemic coronavirus (10–13).
The mother hold the newborn, 48 hours after birth, only for breastfeeding and was wearing a surgical mask. The medical team wore personal protective equipment (disposable gowns, surgical mask, sterile gloves) before entering the room. The newborn had good temperature and blood sugar control. In terms of respiratory functions, the newborn was autonomous.
Probabilistic antibiotic prophylaxis combining Penicillin G to Amikacin was prescribed.
The initial kinetics of CRP (<3 mg / L at H0-H24) with procalcitonin (PCT 0.47 ng / ml); anemia (Hb 9.7 g / dL and HCT 25.8%) with normal platelet count. On the third day of follow-up the newborn developed jaundice (BT 30.29 mg /dl; BD 1.47mg/ dl); severe respiratory distress; axial hypotonia; bloating with abdominal tenderness; gastric residues (> 50%) consisting of undigested milk; thrombocytopenia(112.OOO/microliter); CRP 26.24 mg /L; Procalcitonin> 100 ng/mL. The diagnoses of neonatal jaundice and ulcerative enterocolitis were retained. Phototherapy was indicated for a period of 72 hours and the newborn was put on oxygen for an oxygen saturation> 92%.
The gastric fluid cultures have isolated Citrobacter sp and Enterobacter Cloacae. Antibiotic therapy combining Meropenem and Vancomycin was initiated to replace the initially prescribed Penicillin G and Amikacin as per the antibiogram. The nasopharyngeal swab for SARS-CoV-2 RT-PCR returned positive. The outcome was death after 5 days of follow-up.