Case 3
A 36 weeks preterm boy was delivered by cesarean section due to fetal decelerations. Pregnancy was complicated by SARS-CoV-2 infection during the second trimester, type 2 diabetes mellitus, hypertension, oligohydramnios, and chorioamniotic separation. At 24 hours of life, he was found to have elevated total bilirubin of 13.6 mg/dL requiring phototherapy and close to the threshold needing exchange transfusion. Additional investigations were consistent with intravascular hemolysis with elevated reticulocyte count, elevated immature reticulocyte fraction, elevated free plasma hemoglobin (120 mg/dL), elevated LDH (1853 U/L), low haptoglobin (<8 mg/dL). SARS-CoV-2 antibodies were reactive (Table 2). Hyperbilirubinemia responded to intensive phototherapy. Glucose-6 phosphate dehydrogenase (G6PD) level was low at 5.4 units/g Hb.