Severe Brain Damage in a Moderate Preterm Infant as Complication of Post-COVID-19 Response during Pregnancy

Abstract

Current evidence from the COVID-19 pandemic suggests that neonatal SARS-coronavirus-2 infections usually have a mild course. Data on how maternal infection during pregnancy affects fetal development are scarce. We present the unique case of a moderate preterm infant with intracranial bleeding and periventricular leukomalacia as a potential consequence of post-COVID-19 hyperinflammation during pregnancy.

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

“…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 7 . In a case series of 20 neonates, Pawar et al described one neonate with a cardiac thrombus 5 .…”

“…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 7 .…”

“…The authors hypothesized this to be secondary to maternal hyperinflammatory response following SARS-CoV2 infection during second trimester of pregnancy. 7 In a case series of 20 neonates, Pawar et al described one neonate with a cardiac thrombus. 5 Mamishi et al 17 studied the CT findings in 24 children with SARS-CoV2 infection, age ranging from 3.5 to 9.5 years.…”

“…Winant et al 3 observed segmental pulmonary emboli in patients of MIS‐C on thoracic imaging and recommended maintaining a high index of suspicion for embolism in these patients. There are now emerging reports of neonatal MIS (MIS‐N), mainly presenting with cardiac manifestations, ground‐glass opacities in the lungs and elevated inflammatory markers 5–9 . PTE is not common among the neonatal population and is a consequence of imbalance between procoagulant and anticoagulant systems 10 .…”

“…On follow-up at the age of 3 months, child is developmentally normal with adequate weight gain.2 | DISCUSSIONWhile vertical transmission of the SARS-CoV2 virus is rare due to low placental expression of the canonical receptors necessary for viral entry, placentas from infected mothers have shown thrombotic and vascular changes, which suggests that SARS-CoV2 is a highly procoagulant infection and even in the absence of fetal viral infection, it can trigger an inflammatory response, leading to multiorgan damage 12,13. There are multiple case reports of neonates presenting with cardiac manifestations of shock, arrythmias, thrombosis, persistent pulmonary hypertension, as well as respiratory failure, neurological abnormalities, and hematological manifestations [5][6][7][8][9]14. All these neonates had history of exposure to maternal COVID-19 infection during pregnancy, positive SARS-CoV2 antibodies, and elevated inflammatory and prothrombotic laboratory markers.…”