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370 Cytokine storm in preterm newborns, born to covid 19 positive mothers, their presentations, management and outcomes in a tertiary care centre in Guwahati
  1. Geetanjali Sahariah Khound
  1. India


Background Novel corona virus disease is caused by SARS-COV-2 virus. The consequences of this disease is largely unknown in neonates, specifically in Preterm newborns. Though Cytokine storm is an extremely dangerous event, it is treatable if diagnosed in proper time.

Objectives Our aim of the study is to discuss the events that the two newborn babies born to covid 19 positive mothers, went through during their cytokine storm due to transplacentally transferred covid IgG ; their treatment and outcome.

Methods Two Preterm newborn babies- one of them was very low birth weight (VLBW) baby (birth weight 1.25 kg), delivered at 32 weeks in November 2020 to a covid 19 (RT-PCR) positive mother with preeclampsia and PROM; and another appropriate for gestational age (AGA) baby (birth weight 2.5 kg) born at 33 weeks in December 2020 to a mother who was covid RT-PCR positive at 2nd trimester of pregnancy with GDM and PROM more than 24 hrs are discussed here.

The 1st baby had severe birth asphyxia, MSL and respiratory distress soon after birth with SPO2 in room air was 70%-80%. She was treated with nasal prong CPAP with PEEP 5, iv antibiotics, caffeine citrate, iv fluid and supportives. All Blood reports were within normal limit and blood C/S showed no growth and covid RT-PCR was negative. At day 3 of life baby started having frequent episodes of apnoea, desaturation, tachycardia and shallow breathing. As the mother was covid 19 positive; inflammatory markers were checked which revealed IL6-4318 pg/ml, d Dimer -1450, Ferritin- 514.6 ng/ml, LDH-687, procalcitonin >100 ng/ml, Trop I-119.9 ng/L, NTproBNP-1008, platelet counts- 55 × 103/uL, PT-18.0 secs INR-1.341, APTT-48.9 secs and covid IgG- 3.48 with B/L opacity on CXRay. The mother also found to have covid IgG -3.48 at the same time. Accordingly iv steroids and IVIg was started along with SC LMWH. The child responded to treatment well and started tolerating feeds and gaining weight.

The 2nd baby had grunting, and respiratory distress soon after birth. She was admitted in NICU and started with iv fluid, iv antibiotics and O2 through nasal prong. Investigations revealed covid 19 RT-PCR negative but covid 19 IgG-7.89, IL6–184.0 pg/ml, D Dimer – 919, LDH-593, Trop-I- 155.1 ng/L, NTproBNP-567.1, procalcitonin- 0.866 ng/ml with B/L haziness on CXRay. The mother also had covid IgG -7.89. The baby was treated with IVIg, SC LMWH, and supportives. The baby responded to treatment well and discharged.

Results Both the babies responded well to IVIg, iv antibiotics and supportives. We have use iv dexona in 1st case.

On follow up all the laboratory parameters of the 1st baby was normal and she was gaining weight. The 2nd baby was on LMWH as her d Dimer, APTT and covid IgG were high. Clinically she is asymptomatic, feeding well and gaining weight.

Conclusions Though cytokine storm is dangerous consequence of covid 19 in Preterm newborns timely diagnosis and appropriate treatment can reduce the morbidity and mortality of the disease.

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