<b><i>Introduction:</i></b> The predominant coagulation abnormalities in patients with coronavirus disease 2019 (COVID-19) suggest a hypercoagulable state and are consistent with uncontrolled clinical observations of an increased risk of venous thromboembolism. <b><i>Aim and Objectives:</i></b> To compare the effect of prophylactic versus therapeutic doses of enoxaparin in the treatment of severe cases of COVID-19 infection. <b><i>Materials and Methods:</i></b> This was a retrospective observational study conducted at Latifa hospital, Dubai. Fifty-nine patients enrolled from March to June 2020 and divided into 2 groups: patients who received the prophylactic dose of enoxaparin (group 1) and patients who received the therapeutic dose of enoxaparin (group 2). <b><i>Results:</i></b> The mean age of all cases was 47.2 ± 10.4 years, while the mean weight was 76.4 ± 13.4 kg. Males represented 79.7% of cases. Blood group “O” was the most frequent blood group (40.9%). None of the cases were smokers or using alcohol. Bronchial asthma, lung diseases, diabetes mellitus, hypertension, CKD, cardiac disease, thyroid disease, and immunodeficiency were present in 1.7, 1.7, 39, 27.1, 5.1, 1.7, 5.1, and 1.7% respectively. There was no significant difference between both study groups regarding personal and medical characteristics, except for hypertension where 35.9% of group 2 (therapeutic) cases were hypertensive compared to 10% of group 1 cases (prophylactic). There was a significant difference between both study groups regarding inflammatory markers improvement duration, duration of MV and O₂ support duration, with longer duration among (therapeutic) group 2 cases compared to group 1 cases (prophylactic). There was a highly significant difference between both study groups regarding ICU admission, as 64% of group 1 cases were admitted compared to 25% of group 1 cases. Similarly, 38.5% of group 2 cases needed MV compared to only 10% of group 1 cases, which was statistically significant. There was no significant difference between both groups regarding bleeding tendency and mortality (<i>p</i> value 0.54). <b><i>Conclusion:</i></b> Our results showed that use of prophylactic dose of enoxaparin might have some benefits compared to the therapeutic dose in terms of less duration of ICU and hospital stay, duration of oxygen support, need and duration of MV, and normalization of inflammatory markers. However, there was no significant difference between the 2 regimens regarding the mortality.

IntroductionPleural effusion is defined as fluid accumulation in the pleural space. This potential space exists between the parietal pleura lining the chest wall and the visceral pleura around the lung. (1) The incidence ranging from 1/10,000 to 1/15,000. (2,3) There is a wide spectrum of aetiology ranging from idiopathic, chromosomal anomalies, inflammatory association, or structural malformations. (4) It is usually chylous. (5,6) Currently, there is no sufficient data regarding the incidence of isolated pleural effusion associated with inflammation or genetic syndromes. The aetiology can be classified in primary and secodary aetiologies. The primary causes could be hydrothorax or chylothorax. Secondary causes usually associated with hydrops fetalis either immune or non-immune. Non-immune causes usually associated with infection, bronchopulmonary sequestration, congenital heart disease, congenital lung lesion, chromosomal -genetic syndromes or congenital diaphragmatic hernia. (7) Case reportA term baby girl 40+1 weeks of gestational age, weighing 3 kg, appropriate for gestation, was born by Kiwi assisted vaginal delivery done for foetal distress to a 25-year-old booked mother G2P1 with "O" positive blood group. The antenatal scan at 12 weeks of gestational age showed the nuchal translucency thickness at the upper normal limit (2.5 mm). The Foetal anomaly scan at 20 weeks of gestational age was reported normal. The repeated antenatal ultrasound at 31 weeks was normal but the antenatal scan at 39+5 weeks showed pleural effusion. Baby required resuscitation and intubation at birth and the Apgar scores were 5 and 7 at 1 and 5 minutes, respectively. She was in severe respiratory distress after resuscitation in the form of tachypnoea, with subcostal and intercostal recessions and breath sounds were diminished over the left hemithorax with right sided apex heartbeats auscultated for which she was admitted to the neonatal intensive care unit. She was observed with dysmorphic features in the form of upward slanting eyes, short neck, sandal gap deformity sign [Figure 1], but there was no signs of hydrops fetalis. Rest of the systemic examination was normal. The blood gas analysis revealed severe mixed acidosis with pH 6.8, PaO2 90 mmHg, and PaCO2 113 mmHg, HCO3 and BE were unrecordable. The baby was connected to conventional mechanical ventilation; IV fluids and antibiotics were charted but there was progressive worsening with increasing Fio2 requirements up to 100%. An urgent bedside chest X-ray was done revealed left side pleural effusion with mediastinal shift of the airway and heart to the right side [Figure 2]. Echocardiography was done and showed large sized patent ductus arteriosus with severe persistent pulmonary hypertension. Chest tube was inserted which drained straw-coloured fluid around 100 ml.

Respiratory distress in a term newborn has a wide range of differential diagnoses. Lobar lung collapse as a cause of respiratory distress in a term newborn always raises the suspicion of congenital pneumonia but it is challenging to determine if (1) it presents since birth, (2) it has a migratory nature, and (3) infection was excluded as a cause. We report a case of lobar lung collapse in a full-term baby and present our management of the case until the underlying diagnosis was reached.

Although bicytopenia or pancytopenia is an uncommon presentation in the neonatal intensive care units setup, it still carries a wide range of differential diagnoses ranging from simple benign to complex malignant etiologies. We report an unusual etiology of a neonatal bicytopenia and discuss our approach of management.