A Severe COVID-19 Infection in Neonates: A Case Report

Coronavirus disease (COVID-19) is a highly contagious infectious disease. First case was reported at the end of 2019 in China. Children and neonate population appears to be relatively free of the virus. We reported a severe and fatal neonate case of COVID-19 in a 22 days old neonate female due to the delta variant strain during the third wave outbreak. She presented with fever, cough, grunting and diarrhea started 5 days before admission. Physical exam’s revealed severe respiratory distress, hypoxia and bilateral pulmonary condensation. PCR test for COVID-19 was positive. Chest X-ray found bilateral infiltrates. Chest CT showed diffuse ground glass images with 75% of lung parenchymal involvement. She was treated with antibiotics, corticostoid, respiratory support (CPAP and oxygen). Death occurred after 15 days of hospitalization in the context of multiple organ failure and pulmonary hypertension.


Introduction
In December 2019, there was an outbreak of an infectious disease in Wuhan in the Hubei Province of China, called Coronavirus disease 2019 (COVID-19) [1]. COVID-19 is highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a positive-sense single-stranded RNA virus with a propensity for epithelial cells and the respiratory system [2].
Adults represent the population with the highest rate of infection. Neonate population has so far been relatively free of the virus based on the small number of cases reported in the literature [3].
We report a severe case of COVID-19 due to delta variant in a newborn aged 22 days during the third wave of COVID-19 outbreak in Senegal.

Observation
A 22-day-old female infant was admitted for severe respiratory distress. Pregnancy follow up was unremarkable. The mother was primigeste and primiparous. Delivery was normal after 40 weeks of amenorrhea without resuscitation.
APGAR score at the first minute was 9/10. Medical history noticed difficulty to breath cough and diarrhea with yellowish liquid stools 5 days before admission.

Discussion
Coronavirus disease (COVID-19) was firstly reported at the end of 2019. Epidemiological data reported that adults represent the population with the highest rate of infection. Neonates, children and elderly patients can also be infected with SARS-CoV-2 [4].
In the United States, 22% of the affected population are infants, children and adolescents under the age of 18 years [5]. Children represent a small proportion (<2%) of COVID-19 cases, including hospitalizations and deaths [6]. Neonatal population appears to be relatively free of the virus [3] [7]. Symptoms in infected neonates and particularly premature infants are less specific and less clear than in adults. Most children infected by SARS-CoV remained asymptomatic. According to the available data, COVID-19 in children appears to be usually mild. A minority of children with COVID-19 require hospitalization [8] Fever, cough and gastrointestinal symptoms are the most common reported symptoms in children [9]. Common symptoms such as respiratory distress syndrome, fever or hypothermia, gastrointestinal manifestations are common in severe children's COVID-19 cases [10]. Our patient presented with fever, cough, severe respiratory distress associated diarrheal.
SARS-CoV-2 is mainly transmitted via respiratory droplets. The virus is spread through the respiratory droplets of infected persons by sneezing, coughing or talking without covering the mouth and nose [2] [11]. Several studies have been conducted on the mode of transmission of COVID-19 in newborns. Vertical transmission cannot be completely excluded, but is very low [3] [7] [12]. In our patient, the most likely mode of transmission was horizontal transmission. Symptoms started in our patient at day 16 after birth. The mother COVID-19 PCR test was negative in the postpartum period. Although the clinical manifestations of COVID-19 in children are generally less severe than in adult patients, young children, especially infants, are vulnerable to COVID-19 infection [13]. Children are very sensitive to the delta variant strain. Our patient had severe distress with hypoxia, anaemia, thombocytopenia and elevated cardiac enzymes and pulmonary hypertension requiring mechanical ventilation. According to Zhu, these findings are very common in neonates infected with SARS-CoV-2 [14]. There are no clear recommendations about the management of children with COVID-19 [15]. Our patient had received curse antibiotic, combined with corticosteroids, rehydration, oxygenation and respiratory support.

Conclusion
COVID-19 is a highly infectious disease. The neonate population has been relatively spared to date. However, rare cases of severe forms have been reported in the literature due to the severity of delta variant strain particularly in the third wave of COVID-19 outbreak.

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.