Our case represents a probable case of congenital COVID-19 infection in a live-born preterm neonate. Congenital infection is supported by the following findings: The mother was not in labor, the amniotic membranes were intact before birth, and a strict isolation protocol was maintained throughout neonatal care. The RT-PCR results tested within 24 and 96 hours of life were positive for SARS-CoV-2. Other investigations of raised inflammatory markers and findings of ground glass opacities with pneumonia on CT scan chest support the diagnosis of SARS-CoV-2 infection [4]. We have determined this case to be a probable case of congenital SARS-CoV-2 infection as opposed to a confirmed case because of lack of testing for the COVID-19 gene targets in placenta, cord blood or in NP swab taken at birth of the neonate.
Prematurity, MAS, asphyxia and early onset sepsis are the closest differentials to the mentioned clinical and laboratory findings. However, the absence of a clinical response to surfactant administration, the absence of typical radiological findings of MAS on CXR, raised IL-6 levels at 48 hours, and the chest CT scan showed ground glass opacities consistent with SARS CoV-2 pneumonia in the absence of any other infection and ET secretions positive for RT-PCR twice points towards COVID-19 infection [5,6].
Congenital SARS-CoV-2 infection may occur with a frequency not yet defined. All health care workers (HCWs) attending a suspected or confirmed COVID-19 mother’s delivery or the neonate should recognize this risk and use appropriate personal protective equipment (PPE). Neonates should be tested as soon as possible for SARS-CoV-2 RNA in cord blood, placental specimens and nasopharyngeal swabs, without waiting the 24 hours indicated in the guidelines. (5). This would establish the prevalence of SARS-CoV-2 in neonates of infected women and allow classification of those infected based on the process (in utero, intrapartum or postpartum).