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Objectives: * Initially, newborns seemed to be relatively spared from severe COVID-19. However, with the emergence of the B.1.617.2 (Delta) variant hospitalization rates among children aged 0-4 years increased by 10-fold by the middle of August 2021. We present a case of a 2-week-old previously healthy preterm, twin, male infant who developed severe COVID-19 pneumonia, subsequent acute respiratory distress syndrome (ARDS), and an inflammatory syndrome requiring VA – ECMO support for 22 days. Methods: * A retrospective chart review was performed after successful weaning from ECMO. Parental permission for a case report was obtained in compliance with institutional standards. Results: * Multiple challenges were encountered during this patient’s 22 days on ECMO. Rising markers of inflammation (LDH, Ferritin, D-dimer, CRP, ESR, troponin) made us concerned for multi-system inflammatory syndrome (MIS) in the setting of pneumonia. This complicated our treatment plan and led to a limited trial of immunomodulating agents in a baby with concurrent viral pneumonia. Dexamethasone, IVIg, and Anakinra were used. After treatment with these agents, clinical improvement began with a slowly clearing chest x-ray (Table 1 and 2) and weaning of ECMO flows. He developed seizures concerning for stroke in the setting of stable markers of coagulation, necessitating faster weaning and earlier ECMO decannulation than desired. Imaging studies showing extensive change to the lung architecture and ultimately required tracheostomy placement. Conclusions: * Severe COVID19 in infants remains a rare condition. Most infants have mild symptoms and recover completely. Unfortunately, some develop severe illness requiring extracorporeal life support. These infants can be successfully managed on ECMO during their acute crisis. The presents of a what appears to be a concurrent hyperinflammatory syndrome presents additional management challenges, but use of immunomodulating agents should be considered in infants.




Presented at the 10tth EuroELSO Congress 2022; London, England; May 4-6, 2022.

Concurrent COVID19 pneumonia and systemic inflammatory syndrome in a two-week-old requiring ECMO

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