Arterial Thrombosis and Gangrene in a Neonate with COVID-19: A Case Report

Abstract

Background: Coronavirus disease 2019 (COVID-19) in neonates is an emerging challenge to pediatricians. The majority of the neonates with COVID-19 reported so far are suspected to be infected due to postnatal transmission. Vertical transmission has already been reported in two case-cohort studies. Case report: A 32-week preemie with a birth weight of 2 kg was admitted to the neonatal intensive care unit due to respiratory distress. The case was born to a primigravida mother with a history of preterm premature rupture of membranes. The neonate developed arterial thrombosis on the first day of life and subsequent gangrene of the right foot and tested positive for serology and reverse transcription polymerase chain reaction (RT-PCR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with elevated inflammatory markers (C-reactive protein, D-dimer, serum ferritin, lactate dehydrogenase). Since the mother was asymptomatic, she was not tested for SARS-CoV-2 antenatally. After the confirmation in the neonate, the mother was also tested for SARS-CoV-2 and tested positive by RT-PCR as well as serology. Conclusion: This rare presentation calls for further research in transmission patterns either antenatally or vertical transmission. This report emphasized the possibility of vertical transmission of COVID-19 in neonates from asymptomatic mothers, with significant, early-onset neonatal infection in the form of thrombosis.