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

Abstract

A 3-week-old boy presented with a 2-day history of nasal congestion, tachypnea, and reduced feeding. He was born at 36 weeks of gestation to a 21-year-old woman (gravida 3, para 1) who had received antenatal treatment for carriage of group B streptococci. He had previously received a 48-hour course of antibiotics for suspected neona-tal sepsis because of a fever (temperature, 38.5°C), but the workup for sepsis was negative, and he was discharged home. On admission of the patient to the emergency department, the temperature was 36.1°C, the pulse 166 beats per minute, the blood pressure 89/63 mm Hg, the respiratory rate 40 breaths per minute, and the oxygen saturation 87% while the patient was breathing ambient air. Chest radiography showed bilateral linear opacities and consolidation in the right upper lobe (Fig. 1A). Oxygen and empirical antibiotics (ampicillin and gentamicin) were administered, and the patient was transferred to a pediatric hospital. On transfer, the patient had hypotension, tachycardia, hypothermia, and tachypnea. Droplet and contact precautions were initiated, and he was transferred to a negative-pressure room in the pediatric intensive care unit (PICU), where he was intubated and received crystalloid solution at a dose of 60 ml per kilogram of body weight, followed by vasopressors. Nasal swabs were obtained for severe acute respiratory syndrome coronavi-A B C Figure 1. Chest Radiographs. On admission, a radiograph showed bilateral linear opacities and consolidation in the right upper lobe (Panel A). After intubation, a radiograph showed bilateral infiltrates and partial collapse of the right upper lobe (Panel B). On day 2 after admission, a radiograph showed pneumothorax on the right side (Panel C).