A Novel Case of Severe Respiratory Symptoms and Persistent Pulmonary Hypertension in a Saudi Neonate With SARS-CoV-2 Infection

Abstract

Coronavirus disease 2019 (COVID-19) is an emergent disease that has spread rapidly to infect more than 210 countries across the world. With the increasing number of infected pregnant women, many physicians hypothesized the perinatal transmission as a potential route of transmission. Some cases of perinatal transmission have been described, but it is unclear if these occurred via the transplacental or the transcervical routes or through environmental exposure. In this report, we described a case of a female infant who was delivered by caesarean section at 34 weeks' gestation to an infected mother. The neonate was transferred into the Neonatal Intensive Care Unit (NICU) Level 3, with the precaution of airborne and contact isolation. All required investigations were performed, including blood gases, nasopharyngeal swab, chest x-ray, and echocardiogram. On the fifth day of delivery, her investigations demonstrated a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite applying all recommended guidelines and following the treatment protocol, she developed severe respiratory symptoms with persistent pulmonary hypertension, which progressed significantly to her death.

How Do Inflammatory Mediators, Immune Response and Air Pollution Contribute to COVID-19 Disease Severity? A Lesson to Learn

“…In COVID-19, cytokine storm has been defined among the primary pathophysiologic features [32], and it appears to be related to the involvement of virus interaction with ACE2. The consequent loss of control over angiotensin II activity, in addition to manifesting its effects on the altered homeostasis of arterial and/or pulmonary pressure [55][56][57][58], culminating in a hypertension status, activates cells of the immune system in lung tissue [15]. When COVID-19 progresses to severe illness, an immune system overreaction that culminates in abnormally increased serum levels of CCL2, CCL3, and CXCL10, has been reported.…”

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

“…The low mortality rate and ICU admission reported from Iran and KSA are similar to the one observed in several studies worldwide conducted on pregnant women infected with SARS-CoV-2 ( Allotey et al, 2020 ; Elshafeey et al, 2020 ; Juan et al, 2020 ; Smith et al, 2020 ). In pregnant women with COVID-19 in this country, vaginal delivery was more prevalent than the cesarian one ( Algadeeb et al, 2020 ; Alhamoud et al, 2020 ; Al-Matary et al, 2021 ; AlQurashi et al, 2021 ). The most frequent adverse pregnancy outcomes were premature followed by fetal distress, and preeclampsia which occurred in pregnant women <37 weeks of gestational age ( Al-Matary et al, 2021 ).…”

“…No vertical transmission was reported ( Al-Matary et al, 2021 ; AlQurashi et al, 2021 ). This is except for one case where the female infant experienced severe respiratory symptoms together with persistent pulmonary hypertension that led consequently to her death ( Algadeeb et al, 2020 ).…”

From acute SARS-CoV-2 infection to pulmonary hypertension

“…On the fifth day of post delivery, the neonate’s investigations demonstrated a positive SARS-COV-2 infection, complicated with severe respiratory symptoms with persistent pulmonary hypertension that responded poorly to inhaled nitric oxide and respiratory support, which subsequently progressed to her death. Whether COVID-19 contributed directly to the development of pulmonary hypertension or whether the outcome was a sequela of lung pneumonia remains unclear and requires further investigation ( Algadeeb et al, 2020 ).…”