Management Process of a neonate with severe meconium aspiration syndrome and PPHN delivered by a mother with COVID-19

Abstract

Abstract A full-term newborn was delivered by emergency cesarean section due to intrauterine distress with a mother infected with coronavirus disease (COVID-19) in another hospital. Grade III meconium-stained amniotic fluid was observed at delivery. The neonate developed respiratory distress soon after birth and was transferred to our neonatal intensive care unit 3.5 h after birth. After admission, the neonate had progressively worsening dyspnea and was diagnosed with severe meconium aspiration syndrome and acute respiratory distress syndrome. Despite respiratory and circulatory support, as well as treatment with pulmonary surfactants, the neonate developed severe respiratory distress, severe pulmonary hypertension, cardiac failure, and acute renal injury during the first 24 h of birth, with a maximum oxygenation index of 27. After initiating invasive high-frequency assisted ventilation with inhaled nitric oxide (iNO) therapy, the neonate’s condition gradually stabilized. But after a brief improvement, the infant's condition worsened again on the 11th day after birth, likely due to pulmonary infection, alveolar collapse, and cardiac failure. The treatment plan was adjusted, and prone positioning ventilation was applied to improve oxygenation. Invasive ventilation was eventually successfully withdrawn after 19 days, and the neonate was successfully weaned off oxygen 33 days after birth without significant persistent neurological complications. This case occurred during the peak of the COVID-19 pandemic. By using iNO with multiple pulmonary vasodilators and cardiopulmonary circulatory support, prone ventilation, and point-of-care ultrasonography, the neonate was successfully treated without ECMO.