Current Issues

2021 : Volume 1, Issue 1

Premature Baby of 32 Weeks Has Sars-Cov-2 Infection: Case Report

Author(s) : Camila Gemin R. Locatelli ¹ , Mariana Digiovanni ¹ , Tatyane Calegari ¹ and Wendel Paiva Vita ¹

¹ Pediatric Intensive Care Unit , Hospital Universitário Evangélico Mackenzie , Brazil

Open J Pediatr Neonatol

Article Type : Case Reports

DOI : https://doi.org/10.53996/2769-6200.ojpn.1000102

Abstract

In December 2019, a new coronavirus called “severe acute respiratory syndrome coronavirus-2” (SARS-CoV-2), children of all ages can be infected with SARS-CoV-2, appeared in China. The objective of this study to report the case of a premature baby of 32 weeks has Sars-Cov-2 infection, admitted to a Pediatric Intensive Care Unit. Case: Premature baby, 32 weeks, male, admitted to the Pediatric Intensive Care Unit of a University Hospital that after worsening of the clinical picture collected viral panel (PCR) its result: PCR positive for SARS-CoV-2. Conclusion: In critically ill patients using mechanical pulmonary ventilation, adopting a strategy with an emphasis on protective ventilation and effective weaning may guide the treatment of pediatric patients with SARS-CoV-2 infection.

Keywords: Pediatric Intensive Care Unit; Coronavirus Infections; Mechanical Ventilation

Introduction

Children of all ages can be infected with SARS-CoV-2. Preliminary studies suggest that SARS-CoV-2 infection in children is generally milder and may be less symptomatic when compared to adults [1-9]. Children are believed to have a less intense immune response than adults and relatively healthier blood vessels. The angiotensin II-converting enzyme (ACE2) is known as a SARS-CoV-2 receptor and the evidence indicates that these receptors in children have less maturity and function, making children less sensitive to the virus [3,10-18].

The majority of cases in children are the result of exposure to adults at home environment and the contagion associated with care in health units is also reported [19-21]. Caring for children with COVID-19 will require careful considerations in clinical care, staffing and isolation requirements, and all intensive care unit should be prepared for these possibilities [22]. The report followed the CARE recommendations and aims to report the case of a premature baby infected with SARS-CoV-2, admitted to a Pediatric Intensive Care Unit.

Case Report

Premature baby, 32 weeks, male, previously admitted to the Neonatal Intensive Care Unit of a University Hospital, has increased tracheal secretion and mechanical ventilation parameters 21 days after he was born, collected viral panel (Influenza A/B, Adenovirus, Respiratory Syncytial Virus, Meta pneumonic virus, Rhinovirus and Sars-Cov2). Due to PCR positive for SARS-CoV-2, he was transferred to the Pediatric Intensive Care Unit (PICU). Premature baby, admitted in PICU, intubated under invasive mechanical ventilation, controlled pressure mode, assisted/controlled mode, continuous infusion of analgesia, fasting. The anthropometric, clinical, laboratory and mechanical ventilation characteristics are described in Table 1.

Corrected age		35+4
Age (days)		25
Sex		Male
Weight (kg)	Weight (kg)	2.075
	Mechanical ventilation
	Inspiratory pressure (cmH₂O)	20,0
	Final expiratory pressure (cmH₂O)	7,0
	Respiratory rate (rpm)	30,0
	Inspiratory time (sec)	0,50
Inspired oxygen fraction (%)		0.6
Arterial blood gas analysis	Ph	7,31
	PcO₂(mmHg)	57,0
	PaO₂(mmHg)	52,0
	HCO₃(mmol/L)	28,7
	BE (mmol/L)	2,4
	SatO₂(%)	83,0%
PaO₂/FiO₂ ratio		86,6
Oxygenation index		2,07
Source: The authors (2020).
Note: kg = kilograms; cmH2O = centimeters of water, rpm = breaths per minute; % = percentage; sec = seconds; mmHg: millimeters of mercury; mmol / L: millimoles per liter;

Table 1: Anthropometric, clinical, laboratory and mechanical ventilation characteristics.

In the first 24 hours, preterm newborn evolves with several episodes of desaturation, hemodynamic instability, severe respiratory acidosis and inspired oxygen fraction (FiO2): 100%. The strategy was to optimize protective mechanical ventilation with Final expiratory pressure (PEEP) titration, prone maneuver, adjustment of sedation and vasoactive drug (Graph 1).

Graph 1: Evolution of the patient in 24 hours.
Source: The author (2021).

Figure 1 shows a chest x-ray with bilateral infiltrate and atelectasis in the right hemi thorax.

Figure 1: Image examination.

The protective strategy was adopted with a prone maneuver for 48 hours at intervals with the supine position for PICU care. The time of invasive mechanical ventilation after the diagnosis of COVID-19 was 4 days. The weaning mode adopted by the team was PSV (support pressure), with support pressure of 12, PEEP of 6, FiO2 40%. The planned estuation took place after the spontaneous breathing test. The modality adopted after estuation was non-invasive mechanical ventilation, with an nasal prong interface for 6 days and after an oxygen nasal catheter for 10 days. The gradual weaning from oxygen therapy was adopted due to the previous history of prematurity and pulmonary bronchodysplasia. During PICU stay, antibiotic therapy, neuromuscular blocker and corticosteroids were not used. The vasoactive drug was suspended after 2 days of institution with its hemodynamic stability. The discharge to the pediatric ward took place after 20 days of PICU with a full oral diet and hospital discharge after 2 days in the ward, without the need for home oxygen therapy and with full breast and complementary offer.

Discussion

A rare case of infection by SARS-CoV-2 in a newborn was described above, the initial symptoms presented included: worsening ventilation and food intolerance, factors that could be associated with prematurity. In a systematic review of 25 cases of SARS-CoV-2 infection in children younger than 3 months, the symptoms presented included: fever, cough, dyspnea and food intolerance [23]. Regarding the severity of the patients, a systematic review that included 1475 pediatric patients highlights that only 2% had severe conditions with dyspnea, hypoxemia and central cyanosis [23]. In a systematic review of 587 children with laboratory-confirmed COVID-19, 22 percent had an underlying condition [23]. Chronic pulmonary disease was the most commonly reported underlying condition in children from the United States and Europe with laboratory-confirmed COVID-19 [24-25].

The newborn's radiological findings corroborate the literature, in which changes are observed in 50% of patients [23]. An Italian study with 8 cases of children hospitalized for SARS-CoV-2 infection, described in its findings sub pleural consolidation in 7 of the 8 patients [25]. The implementation of a protective mechanical ventilation strategy is essential to achieve success in the treatment of patients infected with SARS-CoV-2. The need for PEEP titration individually is currently the best way to recruit and stabilize alveolar units, thus minimizing lung injury induced by mechanical ventilation [15,24,26]. The literature describes some guidelines with empirical antibiotic therapy guidelines, but recently it has been observed that co-infection with bacteria is infrequent, so in the newborn of the study it was decided to perform serial infectious screening and because there was no growth of bacteria in any culture. The patient did not receive antibiotic therapy. Also, treatment with glucocorticoids was not used, since its use in pediatric patients with SARS-CoV-2 infection is still uncertain, and clinical trials are in progress [27,28].

Data are insufficient to describe the effectiveness of different therapeutic interventions in children and currently there are no specific antiviruses for the treatment of infection. It is believed that in critically ill patients using mechanical pulmonary ventilation, adopting a multi-professional strategy with an emphasis on protective ventilation and effective weaning may guide the treatment of pediatric patients with SARS-CoV-2 infection.

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CORRESPONDENCE & COPYRIGHT

Corresponding Author: Camila Gemin R. Locatelli, Pediatric Intensive Care Unit, Hospital Universitário Evangélico Mackenzie, Brazil.

Copyright: © 2021 All copyrights are reserved by Camila Gemin R. Locatelli, published by Coalesce Research Group. This This work is licensed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.