Case report
We report a 37 weeks’ gestation newborn who was confirmed by
real-time-reverse-transcription polymerase chain reaction (rt-PCR) to be
positive after a nasopharyngeal swab was taken at 24 hours of age.
The mother of the index case is a 16-year-old pregnant woman who
presented to the maternal emergency department on June 13th, 2020, at
17:0 due to premature rupture of membrane (PROM). She was a
primigravida, and her previous medical history was unremarkable of any
medical or pregnancy-related illnesses. She was following up on her
pregnancy in a private hospital. There was no history of suspected or
confirmed individuals with COVID-19 among her family members.
Her initial assessment was body temperature 36.5 °C, blood pressure
112/66 mm Hg, respiratory rate 20 breaths per minute, heart rate 118
beats per minute, and oxygen saturation 95% in room air. She didn’t
have any upper respiratory symptoms (cough, sneezing, or sputum). Fetal
heart monitoring was reassuring between 130-140 beats per minute, with
no signs of abnormality.
The mother was admitted to the prenatal ward for observation and started
on intravenous ceftriaxone because of premature rupture of membrane and
amniotic fluid leakage.
Blood tests showed white blood cells count 10.8 x109 cells /L,
neutrophil 7.67x109 cells/L, hemoglobin level 10 g/dl, platelet count
194 x109 cells /L; coagulation profile (prothrombin time 11.8 sec,
partial thromboplastin time 28.7sec, international normalized ratio1.1;
erythrocyte sedimentation rate 6 mm/h, liver function tests: aspartate
aminotransferase 22.6 U/L, alanine transaminase 9.8 U/L and ferritin
level was 74.5 ng/ml.
At 00:20 on June 14th, 2020, the mother developed chills, felt feverish,
and was complaining of back pain. Her body temperature was 37.8 °C. She
was given oral paracetamol for fever. She was suspected of having
COVID-19; thus, a nasopharyngeal swab for COVID-19 was taken at 04:30
the same day as per hospital policy. At 6:00, she continued to have
fever 37.8 °C as well as mild dry cough and relative tachycardia. Her
chest x-ray was unremarkable. Fortunately, at 8:30, her body temperature
and tachycardia subsided, and fetal heart monitoring remained
reassuring. Since the mother was suspected of having COVID-19, universal
surgical masking and regular prevention measures for COVID-19 were
practiced by healthcare workers who attended the delivery room.
Following the local guidelines, the delivery took place in the isolation
room. A decision was made not to allow the skin to skin contact between
the baby and her mother, neither breastfeeding.
The baby girl was delivered on June 14th at 17:00 via vaginal delivery
without any complications. She was immediately shifted to a separate
room where initial steps of resuscitation were applied. Apgar scores
were 8, 9, and 9 at 1, 5, and 10 minutes respectively. Physical
examination revealed a well-appearing baby.
Birth weight was 3070 grams (50th to 90th percentile), length of 52 cm
(50th to 90th percentile), and her head circumference of 35 cm (50th
percentile).
The newborn was admitted to the level-II neonatal intensive care unit
(NICU) in an isolation room with a continuous cardiac monitor. She was
afebrile, not distressed, and maintained her saturation above 95% on
room air.
On June 14th, at 20.00 nasopharyngeal swab taken from mother came
positive for COVID -19.
Nasopharyngeal swab sampling for the baby was taken at the age of 24
hours and also came positive.
Her laboratory blood tests showed white blood cells 14.27 x109 cells /L,
neutrophil 9.39 x109 cells/L, hemoglobin 17.4 g/dl, platelet 231x109/L
and hematocrit 57%; C-reactive protein 3.11 (positive >10
mg/L); blood gas analysis pH 7.4 with base excess -5.5; liver function
tests: aspartate aminotransferase 16 U/L and alanine transaminase 2.9
U/L. Blood culture was negative. Chest radiography didn’t reveal any
abnormality.
The baby continued to be asymptomatic and maintained normal vital signs
in room air. She was tolerating regular formula feeding orally. Repeated
nasopharyngeal swab done at 48 hours of life was negative. Both baby and
mother were discharged home on day 5 with no complication. The baby was
monitored until day 28 of life, and she remained asymptomatic.