There is no consensus on the vertical transmission of Covid19. Some studies have founded mother-to-child transmission of covid19 impossible. Furthermore, some studies claim that vertical transmission is possible(2). In our case, mother had no signs and symptoms of infection and his nasopharyngeal swab test was negative. Although there is some report of possible vertical transmission of coivd19 infection from mother that they had history of disease in 6 weeks before delivery (3). Also with epidemic condition of covid19, we could not exclude the transmission of covid19 from asymptomatic carrier mother to fetus.
There was several studies that reported diagnosis and management of covid19 early sepsis in neonates. Zeng et al in China reported that covid19 presented clinically in 9 percent of neonate as early-onset sepsis(4).Zhu et al. suggested that SARS-COV-2 in neonate can cause respiratory distress, thrombocytopenia or abnormalities in liver function tests or maybe death on neonates (2) in our study, newborn had respiratory distress, lymphopenia, elevated LDH, hypocalcaemia, hypokalemia, thrombocytopenia and elevated INR at 5th day of life. CRP level did not rise. Saeedi et al showed in infants, unlike adults, elevated inflammatory markers are less common, CRP does not increase in neonates, and leukopenia and lymphopenia are less common(5).Serology test (IgM and IgG against SARS-COV-2) was negative. It has been reported that a significant proportion of neonates with positive RT-PCR results had negative antibody tests, maybe due to host factors that effect on the immune response to SARS-CoV-2 (6)
In our case, radiographic findings were nonspecific, also due to instability of the patient, we were not able to get chest CT scan (computed tomography). Some studies showed that radiographic findings in neonates could be normal and may be show thickened lung texture, mild pulmonary infection, ground glass opacity, and patchy shadow under pleura, and in the chest CT scan, we may see subpleural lesions with localized inflammatory infiltration.(4, 5)
During this pandemic, there are few reports of neonatal early-onset infection of SARS-COV-2. Premature neonates maybe at risk of more severe signs and symptoms. Up to now, no valid guideline for the treatment of Covid19 disease in neonates has yet been published. Therefore, the management of Covid19 disease in neonates is usually different in each hospital(7) and in each country, medical groups have been developed guidelines for the neonatal COVID-19 disease (guideline models in Italy(8), United Kingdom(9), United State(10), Islamic Republic of Iran(11) addressed at reference). Undoubtedly, these are urgent steps against the pandemic, but due to constant updates and some controversial data, health systems have difficulty in determining the best guidelines. In addition, it is clear that our knowledge about early onset infection of SARS-COV-2 is incomplete in many ways.
In this paper, we report our experience about use of corticosteroid and IVIg in covid19 pneumonia in one neonate. There is no specific drug for COVID-19. The principle of care is supportive (including oxygen therapy, electrolyte maintenance, acid-base balance, nutritional support). Most of studies for newborns with severe acute respiratory distress syndrome implemented surfactant, nitric oxide, mechanical ventilation. According to some studies, recommended ventilation in neonates with COVID-19 is high-frequency oscillating ventilation(5). In our study, at first we used intratracheal surfactant and Assist Control (A/C) mode ventilation then Synchronized intermittent mandatory ventilation (SIMV) mode ventilation until extubation.
some studies had different experience. Sagheb reported good outcome of using Hydroxychloroquine in treatment of covid19 pneumonia in two cases(12). Kamali used Oseltamivir in a 15 day old neonate and baby discharged with good condition(13) however, there is insufficient data to suggest any benefit of these medication.(14)
Coronado et al used Hydroxychloroquine and azithromycin for a 3-week-old patient(14). Moolasart treated a 47-day-old male newborn with Favipiravir, Hydroxychloroquine, and Lopinavir/Ritonavir. He claimed that a Favipiravir-based regimen may be the drug of choice for coronavirus disease 2019 pneumonia in the newborn(15). Hopwood used Remdesivir and corticosteroid and plasma in a 4 day old neonate that had good outcome(16) in our case, we used corticosteroid and IVIG for treatment of 5 day old neonate. IVIG has been used in some pediatric with Covid19 in special conditions(17). We achieved good results after 2 week treatment of Dexametasone 0.3 mg/kg/day and 2 gr/kg IVIG (in three divided doses). It seems that this treatments, along with adjuvant ventilation and the use of intratracheal surfactants, was able to improve the patient's lung and pleural involvement.