Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature

Abstract

ObjectivesTo describe challenges in diagnosis and treatment of congenital neonatal gangrene lesions associated with history of maternal coronavirus disease 2019 (COVID-19) infection.Case presentationA preterm neonate was born with upper extremity necrotic lesions and a history of active maternal COVID-19 infection. The etiology of his injury was challenging to deduce, despite extensive hypercoagulability work-up and biopsy of the lesion. Management, including partial forearm salvage and hand amputation is described.ConclusionsNeonatal gangrene has various etiologies, including compartment syndrome and intrauterine thromboembolic phenomena. Maternal COVID-19 can cause intrauterine thrombotic events and need to be considered in a differential diagnosis.

Cavitary lung lesions in a neonate: Potential manifestation of COVID‐19 related multisystem inflammatory syndrome

“…Although, COVID antibodies were found in the newborn, the coagulation workup was normal. The thromboembolic event was thought to be a vascular effect of the COVID infection 16 . In another case reported by Engert et al 7 a moderate preterm (33 5/7 weeks) infant had petechial bleeds, intracranial hemorrhage, and periventricular leukomalacia with elevated d ‐dimer levels and low platelet counts.…”

“…The thromboembolic event was thought to be a vascular effect of the COVID infection. 16 In another case reported by Engert et al 7 a moderate preterm (33 5/7 weeks) infant had petechial bleeds, intracranial hemorrhage, and periventricular leukomalacia with elevated D-dimer levels and low platelet counts. The authors hypothesized this to be secondary to maternal hyperinflammatory response following SARS-CoV2 infection during second trimester of pregnancy.…”

“…The neonate was initiated on broad-spectrum antibiotics and oxygen via nasal canula. Perveen et al 16 reported a neonate born with an ischemic limb to a COVID-19 positive mother. Although, COVID antibodies were found in the newborn, the coagulation workup was normal.…”

Covid-19 and Upper Limb Anomalies in Newborns: A Reason for Concern?

“…Forearm amputation at level of 4 cm distal to the olecranon tip was performed at 19 days of age. 33 The summary of the limb anomalies observed in congenital virus infection can be seen in Table 1.…”

Consequences of Transplacental Transmission of the SARS-CoV-2 Virus: A Single-Center Experience

“…The SARS-CoV-2 infection has been associated with hypercoagulability and the development of ischemic changes, D-dimer elevation, and, in some patients, disseminated intravascular coagulopathy [ 16 , 17 ]. In one study, a few patients showed fetal vascular malperfusion, which was potentially related to aberrant cord insertion [ 18 ]. However, in most cases, there was no gross umbilical cord abnormality known to be associated with fetal vascular malperfusion.…”