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.