key: cord-0908504-d051cptp
authors: Armanpoor, Parisa; Armanpoor, Parvaneh
title: Neonatal pleural effusion due to COVID-19 pneumonia
date: 2022-02-04
journal: Pediatr Neonatol
DOI: 10.1016/j.pedneo.2021.12.006
sha: 49ad60891ba0068c6c2fd4584f8acffafa5eab94
doc_id: 908504
cord_uid: d051cptp

nan

To the Editor:

To date, studies have shown that COVID-19 in neonates is often asymptomatic although patients with severe respiratory diseases have been reported (1) (2) . This letter presents the case of a newborn with pleural effusion due to COVID-19.

A twenty-five-year-old primigravida mother gave birth to a girl at 31 weeks of gestation (birth weight: 1530 g) through vaginal delivery because of preterm labor. The neonate required resuscitation and had an Apgar score of 5 and 6 at 1 and 5 min, respectively. Her antenatal sonographies were normal. The first chest X-ray showed bilateral white lungs, so the first dose of poractant alfa (2 cc/kg) was administered intratracheally. Because of severe respiratory distress, we administered the second dose (2 cc/kg) after 8 hours. After injection, oxygen saturation and vital signs were improved.

In the first lab data, we observed coagulopathy. Therefore, fresh frozen plasma was infused to correct the hemostatic profile.

On the third day, the neonate weaned from mechanical ventilation, and nasal continuous positive airway pressure (NCPAP) was started.

On the fifth day of hospitalization, the patient's respiratory condition worsened, and she needed a higher fraction of inspired oxygen, so she was reconnected to NCPAP. The chest X-ray ( Due to concerns about a superinfection, we added vancomycin to the previous antibiotics (ampicillin and cefotaxime) and stopped it when the pleural fluid was negative.

To rule out hypoalbuminemia, we tested albumin, total protein, cholesterol levels, and thyroid function, which were normal. Neonatal C-reactive protein and blood culture were negative.

Complete blood count showed lymphopenia (WBC: 10000/mm3; lymphocyte: 25%).

Echocardiography showed normal cardiac anatomy and function. Associated effusions in other cavities, namely, ascites and subcutaneous edema, were negative. Due to the COVID-19 pandemic, on the fifth day of hospitalization, we performed the COVID-19 polymerase chain reaction test using nasopharyngeal swabs of the neonate and her asymptomatic mother, which returned positive. We monitored the neonatal condition (respiratory rate, oxygen saturation, and measurement of blood gases) to detect any deterioration in the cardiorespiratory status, which would warrant intervention.

After 2 days, the general condition of the patient got better. We performed serial chest X-rays and sonographies, which showed that the pleural effusion absorbed slowly and the atelectasis resolved. The neonate gradually gained weight and was sent home in good condition after 20 days.

A review of the literature reveals that pleural effusions were rarely reported in adult patients with SARS-COVID-19 (3) (4). In a review article (5), fetal hydrops was reported to be the most frequent cause of congenital effusions. The differential diagnosis included congenital chylothorax, congenital heart disease, infection, pneumonia, and transient tachypnea of the newborn.

To the best of our knowledge, this is the first case of COVID-19-related pleural effusion in neonates. 

COVID-19) on maternal, perinatal and neonatal outcome: systematic review

The clinical course of SARS-CoV-2 positive neonates

Pleural effusion as an isolated finding in COVID-19 infection

COVID-19 with pleural effusion as the initial symptom: a case study analysis. Annals of Palliative Medicine

Neonatal pleural effusions in a level III neonatal intensive care unit