Page 25 - Delaware Medical Journal - May/June 2020

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A Unique Presentation of a Critically Ill
Infant Secondary to COVID-19
Meghan Meghpara, DO; Brenda Bender, MD; Magdy W. Attia, MD
ABSTRACT
Recent reports of COVID-19 have demonstrated there are fewer severe
cases in children than adults, which
limits the data available on critically
ill pediatric presentations. The authors present a case of a critically ill infant due to COVID-19 who presents with primarily gastrointestinal symptoms.
INTRODUCTION
Initial reports of pediatric cases of Novel Coronavirus 2019 that originated from China suggest that clinical presentation compared to adults is less severe.1 However, infants less than 1 year of age have the greatest proportion of severe and critical cases.2 We have limited data on clinical presentation for younger infants. In a retrospective review, Wei
et al describe nine hospitalized infants
in Wuhan, of which seven had available information about clinical presentations, including asymptomatic, fever, and
mild respiratory symptoms.3 Our case report describes the presentation of an infant with vomiting, diarrhea leading to severe dehydration, and severe metabolic acidosis secondary to COVID-19.
CASE PRESENTATION
We present a case of a 5-week-old, previously healthy, full-term male, who was referred from an outside hospital (OSH) on 4/30/2020 due to severe dehydration. He had presented to the OSH two days prior for vomiting and diarrhea and was well-appearing without signs
of dehydration, thus determined to be
safe for discharge home with supportive care. He continued to have vomiting
and diarrhea and returned to the ER on 4/30/2020. Of note, though, there were no symptomatic family members at home. His father worked at a chicken farm;
a known area with high incidence of COVID-19 in southern Delaware. Prior to arrival to the hospital, the patient had remained afebrile.
On initial assessment at OSH, patient was noted to have severe dehydration, delayed capillary refill, and mottled skin. A right intraosseous (IO) line was placed and the patient received a total of 40cc/kg bolus of normal saline. He was noted to be tachypneic and placed on 4L nasal cannula of oxygen; afterwards, he was transported to our hospital for further management.
Upon initial assessment in our Emergency Department, patient was noted to be pale and ill-appearing,
Del Med J | May/June 2020 | Vol. 92
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No. 3
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