The 21-year-old pregnant woman, gravida 1, underwent cesarean section due to eclampsia at week 33 of gestational age. She experienced fever since three days prior to operation, and complained of headache, dry cough, and shortness of breath, which made her a COVID-19 suspected case. Clinical tests confirmed the diagnosis of COVID-19 and she received its treatment in an isolated room.
The pre-term male neonate born by cesarean section on March 14, 2020 was transferred to NICU, and isolated due to maternal suspicion of COVID-19. Contact and respiratory isolation was prescribed for the neonate in negative pressure room and all visits to the patient were prohibited.in day 1, Laboratory examination included RBC = 4.2 million/mm3, WBC = 10.2 x 109/L, a platelet count 146 x 109/L, absolute neutrophil count of 7.752 x 109/L, a lymphocyte cell count of 2.04 x 109/L, and a hemoglobin concentration of 14.1 g/dl. The patient's serum C-reactive protein was negative. Blood culture test results were negative; hemoglobin O2 saturation was 87.8%; chest x-ray was normal [Figure 1]. Repeated real-time RT-PCR tests for SARS-CoV-2 from oropharynx swabs were negative on March 14 and March 17.
The patient was monitored, but not intubated, in NICU, received O2 via oxyhood, and O2 saturation was between 93% and 95%. The patient's vital signs were normal, had no fever and was slightly hypothermic (T = 36.8), heartbeat 110 per min, with the respiration rate of 33 per minute. The baby did not breastfeed and only got infant formula.
The patient underwent phototherapy due to physiologic jaundice. O2 saturation drop (up to 92%) was occasionally observed. He was calm but sleepy, and responded to stimulations, tolerated infant formula and had no abdominal distension. Phototherapy was discontinued on March 23rd, 2020. Medical order NCPAP was prescribed if required but was not performed due to normal O2 saturation (90-95%). Fluid and electrolytes, and acid-base balance were investigated. Pulmonary surfactant was not applied. No problem was observed with the baby's O2 saturation drop and cyanosis; the patient continued with oxyhood. On March 25, 2020, another oropharynx sample was sent to laboratory under sterile conditions to determine the covid-19 test result, which was negative. This test was conducted by real-time reverse transcriptase polymerase chain reaction (RT-PCR) tests for COVID-19 On the same date, chest X-ray showed bilateral perihilar shadowing indicated of bronchopneumonia; and no sign of coronavirus was evident [Figure 2]. Blood tests also showed no sign of lymphopenia; the results are as follows: RBC = 5 million/mm3, WBC = 5.6 x 109/L, absolute neutrophil count of 3.92 x 109/L, a lymphocyte cell count of 1.512 x 109/L, a platelet count 156 x 109/L, and a hemoglobin concentration of 16 g/dl. The patient's serum C-reactive protein was negative. Liver function tests were also normal: SGOT = 36 units per liter of serum, SGPT = 18 U/L, LDH = 888 U/L, total bilirubin = 5.5 mg/dL, direct bilirubin = 0.2 mg/dL. The result did not confirm vertical transmission of (COVID-19).