COVID Encephalopathy in a Newborn

Neonatal COVID-19 infection is often not associated with neurological symptoms, but emerging evidence suggests that neurological considerations in neonates with COVID-19 might be misunderstood. 

A term neonate was born healthy to a mother with an unremarkable antenatal history but presented on day 18 with poor feeding, lethargy, and abnormal movements starting from day 10 of life. 

On examination, the baby showed signs of low oxygen levels, central and peripheral hypotonia, and poor reflexes. Blood work revealed elevated C-reactive protein (13.3 mg/L), low platelet count (80,000), and persistent lymphocytic counts. 

The baby developed respiratory distress with lung abnormalities seen on chest X-ray. The nasal swab tested positive for COVID-19, but the cerebrospinal fluid was negative. Other metabolic parameters were unremarkable. MRI brain with spectroscopy showed no restricted areas and was reported as normal, while the electroencephalogram showed a dysmature background with diffuse slowing without seizure activity. The baby responded well to supportive treatment with continuous positive airway pressure (CPAP) and nebulized steroids. 

The diagnosis was COVID-19 induced encephalopathy, which was made after ruling out other potential causes.

Although the baby's condition improved slowly with time, follow-up at three months of age in the high-risk clinic showed evidence of neurodevelopmental delay and persistent hypotonia, indicating potential long-term neural dysfunction. 

Source: Rustogi D, Bhardwaj R, Chopra SS. Indian Journal of Pediatrics. 2023 Apr 25:1-.